Introduction: In this study, two cases that demonstrate the importance of bedside echocardiography and hands-off telemedicine technology for diagnosis and intervention in patients with coronavirus disease 2019 (COVID-19) are discussed. Case Presentation: We report two cases of cardiac emergency associated with COVID-19. Case 1 is a 50-year-old female patient with chronic hypertension and chronic renal failure. Case 2 is a 64-year-old female with atrial fibrillation and recent stroke. Both were admitted to an isolation intensive care unit that was designated specifically to patients with COVID-19. Conclusions: During admission, both patients had sudden deterioration characterized by oxygen desaturation and hypotension necessitating inotropic support. As a result, for both patients, bedside echocardiography was performed by the attending intensivist. Echocardiographic findings showed cardiac tamponade and acute pulmonary embolism, respectively, which were confirmed by a cardiologist through telemedicine technology. Proper emergency management was initiated, and both patients recovered well. Limited bedside transthoracic echocardiography had a front-line impact on the treatment and outcome of the two patients with COVID-19. By implementing telemedicine technology, the lives of two patients were saved, demonstrating the significance of telemedicine in isolation intensive care units in the developing countries during the COVID-19 pandemic.

Background: This study aimed to assess the effect of intravenous lidocaine infusion affected on early postoperative pain control after complex spin surgeries. Ninety patients who were scheduled for complex spine surgery were included in this prospective double-blinded controlled trial. They were randomly assigned to one of two groups: L and P. Patients in group L received a loading dose of lidocaine 1 mg/kg then followed by 1.5 mg/kg/h infusion till the end of the surgery, while in group P, lidocaine was replaced with normal saline. Results: The pain score assessed by VAS at rest showed statistically significant lower values in group L at 30 min, 8, 12, and 24 h postoperatively. VAS during movement was significantly higher in group P only after 24 h postoperatively. The entire dose of intraoperative fentanyl consumed was significantly lower in group L. The time elapsed to ask for the first dose of rescue analgesia was significantly longer in group L. The first rescue dose of nalbuphine was significantly lower in group L. In group P, the overall dose of narcotics consumed in the first postsurgical day was significantly higher. Conclusions: When compared to placebo, lidocaine infusion significantly reduced the postoperative pain scores, as well as the entire dose of intraoperative and postoperative narcotics used.

Background: The ideal method for anaesthetic management during endoscopic retrograde cholangiopancreatography (ERCP) varies between deep sedation and general anesthesia with preference for general anesthesia over sedation. Objective: This study compares the effects of propofol-dexmedetomidine and propofol-ketamine combinations for anesthesia in patients having ERCP with respect to hemodynamic and respiratory parameters alterations as well as propofol requirements, recovery phase, and post-operative pain. Patients and methods: Patients, aged 20-50 years old, American Society of Anesthesiologists (ASA) І-II-III, were randomly allocated over a period of six months in 2 groups, each was 25. Group-I were administered dexmedetomidine loading 1 µg/kg slow IV over 15 minutes then infused at a rate of 0.5 µg/kg/h by syringe pump. Group II were administered Ketamine 1 mg/kg slow IV over 15 minutes then infused at a rate of 0.5 mg/kg/h by syringe pump. Results: The 2 groups had no significant differences as regards demographic data, ASA classification, time of the procedure, and baseline of hemodynamic data; heart rate (HR) and mean arterial blood pressure (MAP). Intra- and post-procedural dexmedetomidine-propofol group showed lower statistically significant differences as regards both heart rate and MAP. Post-procedural nausea, and cognitive disorders, were statistically significantly lower in dexmedetomidine-propofol group as well as recovery time was shorter. Conclusion: Dexmedetomidine-propofol combination was better compared with ketamine-propofol combination in terms of hemodynamic parameters (intra- and post-procedural), PONV, cognitive function and recovery time.

Background: Arthroscopic knee surgery encompasses a wide range of surgical operations involving the knee, and several analgesic regimens have been studied to determine the ideal analgesic combinations. The kind and duration of surgical intervention influence post-operative pain response, and it is sometimes difficult to determine which analgesic regimen would be optimal for each patient until post-operatively. Objective: The aim of the current study was to assess the effects of perineurally dexamethasone (DXM) addition to bupivacaine (BVC) in adductor canal block (ACB) for post-operative analgesia after knee arthroscopy under spinal anesthesia regarding. Patients and methods: This a randomized controlled double-blinded controlled clinical trial performed at Ain Shams University Hospitals, Cairo, Egypt. Study Period: Six months. Adults undergoing Knee Arthroscopy under Spinal Anaesthesia employing computer-generated codes and opaque sealed envelopes, were randomly divided into 2 groups: Group A (study group): These patients administered ACB with 20ml plain BVC (0.25%) + 8 mg DXM (2ml), Group B (control group): The patients received ACB with 20ml plain BVC (0.25%) + 2 ml of 0.9% saline. Results: A high statistical significant difference (p < 0.001) was found between both groups as regards analgesic duration (time of first call for analgesics) (min). The highest value was reported in group A(study) and group B(control) (241.02±36.15 and 188.49±28.27) respectively, this indicates that that the needs of analgesic in the group B were earlier than in group A. Also, a high statistical significant difference (p < 0.001) was reported in terms of cumulative morphine consumption “mg”. The highest value was reported in Group B and Group A 4 (3-4) and 2 (1-2) respectively, this indicates much higher needs of analgesic in the Group B than group A. Conclusion:ACB is an effective post-operative analgesic for knee arthroscopy performed under spinal anesthesia. Nonetheless, combining (8 mg) DXM with (0.25%) BVC in ACB resulted in superior post-operative analgesia and less analgesic usage compared with BVC alone.