Skip to main content Skip to main navigation menu Skip to site footer

Laporan kasus teknik One Lung Ventilation (OLV) pada anak usia 4 tahun yang menjalani Video Assisted Thoracoscopy Surgery (VATS) bullectomy

  • I Putu Fajar Narakusuma ,
  • Putu Kurniyanta ,
  • Wangsa Aditya ,
  • Aldy ,

Abstract

Introduction: The One Lung Ventilation (OLV) technique in infants and children is a practice that is only used in certain cases and has continued to develop in the last 20 years. Video Assisted Thoracoscopic Surgery (VATS) is a minimally invasive surgical approach used to diagnose and treat problems in the chest cavity. To be able to use this technique, anesthesia must be carried out by isolating one lung. The OLV technique is the method of choice for VATS because it provides better visibility of the surgical site and can protect the healthy lung.

Case Report: A four-year-old child weighing 35 kg came to the emergency room complaining of shortness of breath and pain in the right chest. These symptoms appeared 24 hours after landing on a national flight. After repeated chest tube placement due to tightness, a thoracic CT scan was performed, and multiple bullae were found in the right lung. The surgeons decided to conduct a bullectomy using the VATS technique. Modified OLV in pediatrics uses a Fogarty embolectomy catheter as a replacement bronchial blocker without a Fiber Optic Bronchoscopy (FOB) device as a video-visual and the use of a single lumen Endotracheal Tube (ETT). Ballooning-based bronchial blockers are an alternative technique for performing OLV in pediatric patients.

Conclusion: Combining anatomical knowledge, size, and modification of available equipment based on radiological results can provide a safe approach to OLV technique in pediatric patients undergoing thoracoscopic procedures.

 

Pendahuluan: Teknik One Lung Ventilation (OLV) pada bayi dan anak merupakan praktik yang hanya digunakan dalam kasus tertentu dan terus berkembang sejak 20 tahun terakhir. Video Assisted Thoracoscopic Surgery (VATS) merupakan pendekatan pembedahan minimal invasif yang digunakan untuk melakukan diagnosis dan mengobati masalah di rongga dada. Untuk dapat menggunakan teknik ini harus dilakukan pembiusan dengan mengisolasi salah satu paru. Teknik OLV adalah metode yang dipilih pada VATS karena memberikan visibilitas yang lebih baik pada lokasi pembedahan dan dapat melindungi paru yang sehat.

Laporan Kasus: Seorang anak berusia empat tahun dengan berat badan 35 kg datang ke instalasi gawat darurat dengan keluhan sesak napas disertai nyeri pada dada kanan, gejala ini muncul 24 jam setelah mendarat dari penerbangan nasional. Setelah pemasangan chest tube berulang akibat sesak, dilakukan CT-Scan toraks dan didapatkan multiple bullae pada paru kanan. Ahli bedah memutuskan untuk melakukan bullectomy dengan teknik VATS. OLV modifikasi pada pediatri dilakukan dengan menggunakan kateter embolektomi Fogarty sebagai bronchial blocker pengganti tanpa perangkat Fiber Optic Bronchoscopy (FOB) sebagai video-visual dan penggunaan single lumen Endotracheal Tube (ETT). Bronchial blocker berbasis balloning merupakan salah satu teknik alternatif untuk melakukan OLV pada pasien pediatri.

Kesimpulan: Menggabungkan pengetahuan anatomi, ukuran, dan modifikasi peralatan yang tersedia berdasarkan hasil radiologi dapat memberikan pendekatan yang aman dalam teknik OLV pada pasien pediatri yang menjalani prosedur torakoskopi.

References

  1. Purohit A, Bhargava S, Mangal V, Parashar VK. Lung isolation, one-lung ventilation and hypoxaemia during lung isolation. Indian J Anaesth. 2015;59(9):606–17. Available from: 10.4103/0019-5049.165855
  2. Morgan RW, Karlsson M, Sutton RM, Kilbaugh TJ. An Update on Cardiopulmonary Resuscitation in Children [Internet]. Vol. 7, Current Anesthesiology Reports. 2017. p. 191–200. Available from: 10.1007/s40140-017-0216-7
  3. Mohtar S, Hui TWC, Irwin MG. Anesthetic management of thoracoscopic resection of lung lesions in small children. Paediatr Anaesth. 2018;28(11):1035–42. Available from: 10.1111/pan.13502
  4. Sihoe A. Video‐assisted thoracoscopic surgery as the gold standard for lung cancer surgery. Respirology. 2020;25:49–60. Available from: https://doi.org/10.1111/resp.13920
  5. Cortese G, Tognon C, Servillo G, Gamba P. Anesthesia in pediatric minimally invasive surgery [Internet]. ESPES Manual of Pediatric Minimally Invasive Surgery. Springer; 2019. 97–110 p. Available from: https://link.springer.com/chapter/10.1007/978-3-030-00964-9_12
  6. Giwangkancana G, Andriyanto L, Zulfariansyah A, Lestari AN. One lung ventilation techniques in infants and small children. J Pediatr Surg Case Reports. 2022;82:102314. Available from: 10.1016/j.epsc.2022.102314
  7. Lebao AA, Subanada IB, Suarta IK, Semadi N. Congenital pulmonary airway malformation type 4 on a 2 month old boy. Medicina (B Aires). 2018;49(1):53–8. Available from: 10.15562/medi.v49i1.265
  8. Prabawa IMY, Silakarma D, Manuaba IBAP, Widnyana M, Jeviana A. Chest therapy and breathing exercise in covid-19 patient: A case report. Bali Med J. 2021;10(2):495–8. Available from: 10.15562/bmj.v10i2.2403
  9. Manso MA, Guittet C, Vandenhende F, Granier L. Efficacy of oral midazolam for minimal and moderate sedation in pediatric patients: A systematic review. Pediatr Anesth. 2019;29(11):1094–106. Available from: https://doi.org/10.1111/pan.13747
  10. Wong TH, Weber G, Abramowicz AE. Smooth Extubation and Smooth Emergence Techniques: A Narrative Review. Pearl RG, editor. Anesthesiol Res Pract. 2021;2021:8883257. Available from: https://doi.org/10.1155/2021/8883257
  11. Murray-Torres T, Winch P, Naguib A, Tobias J. Anesthesia for thoracic surgery in infants and children. Saudi J Anaesth. 2021;15(3):283–99. Available from: 10.4103/sja.SJA_350_20
  12. Adidharma NC, Dharma BDI, Negara KNDP, Sudewa IGA. Breathing exercise and chest physiotherapy in post-acute COVID-19 patient: a case report. Intisari Sains Medis. 2022;13(1):293–6. Available from: 10.15562/ism.v13i1.1300
  13. Marraro GA. Selective bronchial intubation for one-lung ventilation and independent-lung ventilation in pediatric age: State of the art. Chinese J Contemp Pediatr. 2020;22(6):543–54. Available from: 10.7499/j.issn.1008-8830.1912121

How to Cite

Narakusuma, I. P. F., Kurniyanta, P., Aditya, W., & Aldy. (2023). Laporan kasus teknik One Lung Ventilation (OLV) pada anak usia 4 tahun yang menjalani Video Assisted Thoracoscopy Surgery (VATS) bullectomy. Medicina, 54(1), 1–4. https://doi.org/10.15562/medicina.v54i1.1226

HTML
283

Total
151

Share