Background: Chest wall surgeries are accompanied by severe postoperative pain. Inadequate relief of this pain may lead to both pulmonary complications as lung atelectasis and infection and chronic post thoracotomy pain syndrome. Regional analgesic modalities are important portion of the multimodal therapeutic approach suggested for the management of post thoracotomy pain. Objective: To evaluate serratus anterior plane block as a regional analgesia technique for post thoracotomy and thoracoscopy pain. Recent Findings: Serratus anterior plane block (SAPB), a regional analgesic modality developed by Blanco et al. in 2013, has shown good analgesic effect after thoracotomy and thoracoscopy in many case reports and clinical trials. In such block, a local anesthetic is injected in the fascial plane deep or superficial to the serratus anterior muscle leading to block of lateral cutaneous branches of the intercostal nerves. This provides a sensory block of T2-T9 dermatomes. Conclusion: Serratus anterior plane block as a fascial plane block can be a preferred regional analgesia technique for both post-operative pain management with procedures involving anterolateral chest wall as thoracotomy, thoracoscopy and breast surgery and in cases of multiple rib fractures. This is owing to its easy technique, effective pain relief and potentially better side effects profile compared to other regional modalities and systemic opioids.

Background: First described paravertebral block (PVB) to provide abdominal analgesia in 1905. This technique has been modified for rib fracturing, flail chest, hepatic-biliary operations, open cholecystectomy, inguinal hernia repair, breast tumors operations and thoracotomies. PVB was shown to be as successful as thoracic epidural analgesia with less minimal complications in recent systematic reviews and meta-analyses. Objective: To evaluate the effect of paravertebral block and Thoracotomy to the other technique in issues analgesia, complications. Conclusion:Paravertebral block is a very useful regional anaesthetic technique for surgeries, Paravertebral block was shown to be as successful as thoracic epidural analgesia with less minimal complications.

No abstract

Background: COVID-19 infection, which appeared for the first time in December 2019 in China as a combination of severe respiratory symptoms among which is pneumonia. A very common and severe complication of COVID-19 severe illness is the respiratory failure or acute hypoxemic respiratory insufficiency. This complication requires ventilation therapies to supply adequate oxygen for the patient. The World health organization (WHO) recommends the performing of endotracheal intubation in hypoxemic respiratory failure patients with acute respiratory distress syndrome who continue to have breathing problems however they received standard therapy of oxygen.Objective: This study aimed to assess the challenges related to intubation and ventilation, when to start intubation and how to deal with different outcomes and problems related to them. Methods: These databases were searched for studies published between December 2015 and April 2022 that had been peer-reviewed and had been published in English in the two databases: PubMed and Google Scholar. More synonymous key words had been used for searching such as intubation and ventilation challenges, ICU, ARDS and COVID-19 patients. Documents written in a language other than English have been disregarded since no sources for interpretation were discovered. Dissertations, conversations, conference abstract papers, and anything other than the primary scientific investigations had been disqualified. Conclusion:Early intubation is recommended over late intubation. The intensivist, ICU nurse, and respiratory therapist (RT) are crucial team members to manage intubation and ventilation. Prone positioning is an important aspect to be applied. Lung injury occurs often in serious COVID-19 patients due to the severe and protracted respiratory failure that occurs in these patients. Majority of PE patients experience some degree of hypoxia as a result of ventilation-perfusion mismatch and intrapulmonary shunting.

Background: Covid19 infection became one of the most widespread respiratory tract infections worldwide. The pandemic lastly spreading in Egypt made a great challenge for the health workers of different specialties. Anesthetists had to solve difficult problems related to the infected patients requiring surgical interventions and to make the balance between patient safety and medical team protection during the procedure. Objective: This study aimed to check for clear guideline protocol for anesthetic management of Covid-19 cases undergoing cesarean section, here is a case presentation for a twins pregnant patient. Case presentation: Female patient 32 years old diagnosed as covid-19 positive prepared for cesarean section for delivery of preterm twins with CT finding corads 5, clinically presented by acute respiratory distress syndrome (ARDS). The patient received spinal anesthesia associated with tap block, oxygenation was done by closed circuit system of the anesthesia machine with partial closure of adjustable pressure limiting (APL) valve and hypotension was managed by noradrenaline infusion during the procedure. Conclusion: Combined spinal anesthesia with tap block was the most successful modality for anesthesia for cesarean section (CS) in severe cases of covid-19 infected patients.