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Background Severe acute pain occurs in more than 10% of patients within the first 36 h after a cesarean section and can significantly impact women's satisfaction. The aim of this study was to compare the transversus abdominis plane (TAP) block for postoperative pain relief following cesarean section operations with the most famous analgesia (intrathecal morphine) used for a cesarean section regarding its efficacy and complications. Patients and methods This interventional double-blinded randomized controlled study was carried out on 60 cases, who underwent an elective cesarean delivery. They were randomized into two groups; patients were divided into two equal groups. Group M received intrathecal 150 μg morphine in a 0.5 ml volume, mixed with 10 mg of hyperbaric bupivacaine 0.5% in a 2 ml volume (total volume 2.5 ml). Group B received intrathecal 10 mg hyperbaric bupivacaine 0.5% 2 ml volume+0.5 saline (total volume 3 ml) and at the end of surgery the patient received bilateral TAP block with a 20 ml volume of 0.25% bupivacaine on each side. Results Postoperative heart rate, respiratory rate, oxygen saturation, mean arterial blood pressure, and intraoperative Bromage score were insignificantly different at all-time measurements between both groups. Visual analog score and postoperative Bromage score at 2, 3, and 4 h were higher in group B than group M (P<0.001). Time of rescue analgesia was significantly prolonged in group M than group B (P<0.001). Total paracetamol and morphine doses were significantly lower in group M than group B (P<0.001). Conclusions TAP block is a good alternative technique to intrathecal morphine in reducing postcesarean section pain, with less postoperative nausea and vomiting and pruritus compared with intrathecal morphine (ITM). [ABSTRACT FROM AUTHOR]

Background: Mechanical ventilation (MV) is required for most cases introduced the intensive care unit (ICU) as a portion of their process of care. However, either MV or the chronic illness can result in diaphragm dysfunction, an incident that may contribute to the incapability of MV separation to be done. Prolonged use of the ventilator significantly increases health-care expenses and subject morbidity and mortality. However, muscle disease symptoms and manifestations are frequently difficult to evaluate in a bedridden state ICU case due to complicating variables. A typical evaluation of diaphragm function lacks, non-invasive, time preservative, easy-to-perform bedside equipment or needs subject involvement. Lately, the utilization of ultrasound (US) has elevated a lot of interest as a simple, non-invasive approach for the assessment of diaphragmatic contractile activity. Objective: This narrative review aimed to briefly describe the common methods of diaphragmatic function assessment using ultrasound techniques. Methods: These databases were searched for articles published in English in 4 databases [PubMed - Egyptian Knowledge Bank - Google scholar-Science direct] and Boolean operators (AND, OR, NOT) had been used such as [Diaphragmatic AND Ultrasound OR Diaphragm function] and in peer-reviewed articles between 1985 and 2021. Conclusion: Diaphragmatic ultrasonography has been widely investigated and is still being explored as a predictor of effective mechanical ventilation weaning. Due to the substantial heterogeneity in research design and population, it remains difficult to draw general generalizations from individual studies. Even worse, terminology such as a failed breathing trial or unsuccessful extubation has not been defined across research, making comparisons of outcome measures unfeasible. [ABSTRACT FROM AUTHOR]

Background: Weaning from mechanical ventilation can be defined as the process of abruptly or gradually withdrawing ventilatory support. Recommendations for weaning practice would be based on the findings of multiple well-designed randomized trials conducted over the past decade. In comparison to more progressive removal of ventilatory aid, quick extubation following successful spontaneous breathing trials expedites weaning and minimizes the time of mechanical ventilation (MV). More recently, pressure support ventilation and bi-level positive airway pressure modes have become available. Modern ventilators are increasingly sensitive, allowing easy patient triggering of supported breaths, modes such as tube compensation, and measurement of numerous respiratory parameters. Developments in weaning techniques have paralleled these improvements in ventilator functionality. Objective: In this review article, the initially required criteria to start and the weaning methods from mechanical ventilation. Methods: These databases were searched for articles published in English in 3 databases [PubMed - Google scholar-science direct] and Boolean operators (AND, OR, NOT) had been used such as [Weaning AND Mechanical Ventilation OR Intensive Care Unit] and in peer-reviewed articles between 1992 and 2021. Documents in a language apart from English have been excluded as sources for interpretation were not found. Papers apart from main scientific studies had been excluded: documents unavailable as total written text, conversation, conference abstract papers, and dissertations. Conclusion: All cases that received ventilatory assistance should be evaluated daily for weaning suitability. This may include satisfying several preconditions and then undergoing an SBT. If weaning is ineffective, either PSV or daily spontaneous breathing spells of increasing length should be tried. [ABSTRACT FROM AUTHOR]