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Introduction: Wound healing is influenced by various factors, one of which is nutritional status. Nutritional status itself is often detected by one of the important signs of serum albumin. Albumin is a protein in human plasma that is soluble in water and high in concentration in blood plasma. Low albumin levels as an estimate of the causes of malnutrition and also associated with increased complications and postoperative death. Serum albumin less than 3.5g / dL is recognized by the patient as hypoalbuminemia. Methods: This research was conducted with the aim of analyzing the relationship between albumin levels and wound healing in postoperative patients. This study used a cross sectional observational analytic method by taking secondary data from medical records of postoperative patients (disgestif surgery, neurosurgery, orthopedic surgery, oncology surgery) at Sanglah General Hospital. Result: Of the 60 patients involved in this study, patients with abnormal albumin levels were 36.7% and patients with normal albumin levels were 63.3%. The chi-square test results showed that postoperative patients who had the last abnormal albumin level before surgery 5.1 times more with unrecover wound compared to patients with normal albumin levels (PR = 5.182; 95% CI = 2.181-12.310, p = 0.00001). Conclusion: There is a significant relationship between albumin levels and wound healing.

Laparoscopic surgery has several advantages compared to a regular surgical procedures. This technique can reduce the stress of surgery, reduce the need for postoperative analgesia, decreased respiratory and wound complications, lowering long hospitalization, including in the intensive therapy, and the patient can go back to eat quickly. The magnitude of changes in vital signs that occur will be influenced by the patient's age, cardiovascular function, and anesthetic agents are used.Physiological changes in pediatric laparoscopic surgery were similar to adults. Children have a higher vagal tone and sometimes a stimulus to the peritoneum by gas insufflation or laparoscopic penetration and trocar can lead to bradycardia and asystole. Intra-abdominal pressure is an important determinant for maintaining cardiovascular stability during laparoscopy. Adequate relaxation needed during the duration of the surgery.

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3-day-old neonate, given a diagnosis of esophageal atresia (EA) with tracheoesophageal fistula (TEF), which is large and just above the carina, was scheduled for TEF repair. Routine anesthetic management focuses on adequate ventilation and avoidance of gastric distension during positive pressure ventilation. Using a balloon-tipped embolectomy catheter or a Fogarty catheter to block the fistula under the guidance of fiberoptic scope has been described. In most of the medical centers, however, the pediatric fiberoptic scope may not be available. We present a case of a neonate undergoing type C EA/TEF repair and describe a simple intraoperative technique that could temporarily occlude the gastroesophageal junction, which allowing stable vital signs of the patient and definitive repair of the tracheoesophageal fistula.

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Background The first wave of COVID-19 in 2020 created massive challenges in providing safe surgery for pediatric patients with COVID-19. Inevitably, emergency surgery and the unknown nature of the disease place a burden on the heavily challenged surgical services for pediatrics in a developing country. Lessons from the pandemic are important for future disaster planning. Aim To describe the characteristics of pediatric surgical patients with COVID-19 undergoing emergency surgery during the first wave and its perioperative narrative in a developing country. Methods The study was a multicenter retrospective descriptive study in eight Indonesian government-owned referral and teaching hospitals. The authors reviewed confirmed COVID-19 pediatric patients (≤18 years old) who underwent surgery. Institutional review board clearances were acquired, and data were evaluated in proportion and percentages. The writing of this paper follows the STROBE guidelines. Results About 7791 pediatric surgical cases were collected, 73 matched the study criteria and 24 confirmed cases were found. Cases were more common in females (58.3%), who were above 12 years old (37.5%) and who were asymptomatic (62.5%). Laparotomy (33.3%), general anesthesia (90.4%) and intubation (80.8%) were common, while use of video laryngoscopy (40%) and rapid sequence intubation (28.8%) were rare. The mean length of stay was 12 ±13.3 days, and in-hospital mortality was 8.3%. Discussions Lockdown and school closure were successful in protecting children, hence the low incidence of pediatric surgical cases with COVID-19 during the first wave. Many hospitals were unprepared to perform surgery for a droplet or airborne infectious disease, and COVID-19 testing was not available nationally in the early pandemic, hence the use of protective protection equipment  during these early pandemic times are often not efficient. Conclusion The incidence of COVID-19 in pediatric surgical patients is low. The rapidity and availability of preoperative testing for a new emerging disease are essential in a pandemic.

The Quadratus Lumborum Block (QLB) technique is a peripheral nerve block technique that aims to block pain in the abdominal area. This technique can be useful in surgeries with abdominal-pelvic incisions. In clinical studies, QLB have also been shown to provide less opioid consumption and longer postoperative analgesia than most of conventional procedures such as TAP (Transversus Abdominis Plane) blocks. Our case series study included five patients undergoing abdominal procedure with QLB approach. Mean age of patients included in this study was 2,8 years old; mean weight of 15,2 kg; mean height of 98,8 cm and mean BMI of 71 kg/m2. All patients were classified as ASA physical status I-II. Mean duration of operation was 94 minutes, and mean total opioid used was 6,6 mg. The pain severity score in FLACC was 0 in all patients at 0, 1st and 2nd hours post-operatively. However, the FLACC score at 4th hours were variable with a maximum score of 3. All patients had the FLACC score of 0 after the 4th hours. This study concludes that QLB is an effective analgesic option for patients undergoing abdominal procedure reflected by lower pain intensity using FLACC scoring system and reduced post-operative analgesic consumption. Keywords: Quadratus Lumborum Block, Post-Operative Analgesia, Opioid.