A purposive sample (non-probability) consisting of (93) nurses were selected from nurses who work in the Coronavirus isolation center. Results: Findings indicate that nurses aged Less than 24 or equal to 34.4%, (54.8%) females, (35.5%), the secondary nursing school graduated, (54.8%) have 1-5 years of experience and no participated in training sessions. Findings demonstrated that evaluating the effect of leg exercise as nurses practices was poorly related to pulmonary embolism and preventive measures of pulmonary embolism. Overall Mean 1.62 respectively. There was a significant relationship between nurses' practices and their demographic data at a p-value <0. 05 . Nurses working in Coronavirus isolation center expressed poor effect leg exercise as nurse practice toward preventive measures of a pulmonary embolism due to low level of education and lack of training Recommendations:The study recommended the necessity of allocating special training courses for all nurses who work in the coronavirus isolation center to improve the practices of nurses toward preventive measure of pulmonary embolism, in addition to increasing the number of professional nurses graduating from the colleges of nursing the, enrolled in a coronavirus isolation center

Background: Cardiac output can be decreased by many factors whose effects may be exaggerated during induction of anesthesia (which is already insulted to have negative effect on cardiac output) till the point of cardiac stand still. Aims: This study aims to answer the questions that “Is there any effect of general anesthesia induction agents on cardiac output? If there is any, which patient is affected more?”. The Study Design: It is a cross sectional study with convenient sampling procedure. According to the inclusion criteria,  it includes patients planning to perform surgical procedure under general anesthesia while it excludes patients who refused to participate in the study or their surgical procedures had been canceled for certain reasons. Method and Patients: The study targeted a population from Duhok province and its territories; 207 patients, were admitted to Cardiac Center Operation theatres from 12/9/2021 to 30/10/2021 and Azadi Teaching Hospital operation theatres from 2/11/2021 to 15/1/2022. The data were collected pre operatively after taking a verbal consent as age, sex, weight, chronic diseases and duration of chronic diseases. Foreword by using echocardiography machine pre and post general anesthesia induction ejection fraction would be obtained. All this information would put in previously designed excel form. This data had been analyzed by Microsoft Excel Worksheet and transferred to SPSS V. 23(IBM). Descriptive statistics (central tendency) and proportions of uni-variant variables were calculated. Paired t test for sample mean difference and ANOVA test for more than two group means were applied to test the mean differences. A P value of < 0.05 considered statistically significant. Results: For the age of patients the mean was 40 years with range 77 years, minimum 1 year, maximum 78 year and standard deviation 15.731 years, for weight the mean was 71kg with range 130 kg, minimum 7kg, maximum 137kg, and standard deviation17.210 kg, for pre general anesthesia induction anesthesia the mean was 0.6055 %with range 0.45%, minimum 0.35%, maximum 0.80%, and standard deviation 0.06587%, for post general anesthesia induction the mean was 0.5531% with range 0.54%, minimum 0.24%, maximum 0.78% and standard deviation 0.087485, for duration of chronic diseases out of 41 patients the mean was 1.47 years with range 26 years, maximum 26 years, and standard deviation 3.802 years fortunately 166(80%) of patients were without any chronic diseases.  The post induction ejection fraction significantly differs with the pre operation ejection fraction for (207) patients received anesthesia in Duhok hospitals during 2021. The average means difference was of 0.04499 (95% confidence interval, 0.04499, 0.05984.69). This difference is statistically significant at a ≤ .05 by the paired τ test (two-tailed).  In this study, patients underwent induction of anesthesia had an average of .05242 (standard deviation, .00377) change in ejection fraction.

Background:There are several theories to explain the action of local anesthetic in combined spinal-epidural anesthesia (CSE), this study is to examine a technique of (CSE) that depends on the theory of leakage of epidural drugs to the subarachnoid cerebrospinal fluid (CSF). Patients and Methods:After approval of local medical ethics committee and obtaining informed consent, 60 patients (18-80 years, ASA physical status I to IV) who listed for orthopedic lower limb surgery under CSE were included in this study. The study design was prospective Cross-Section comparative one. It was done in Gulan General Hospital and Gian Private Hospital in Duhok Governorate in Kurdistan Region of Iraq in the period from 01/01/2017 to 28/2/2018. Results:the volume needed to get maximum sensory block (MSB) and the frequency of topup doses are greater in group A than B.The onset time of group A is longer than group B. The mean arterial pressure was much stable in group A with less nausea and vomiting in the same group. Addition, more patients in group A than group B were able to move against gravity. Conclusions:the effect of this technique in combined spinal-epidural anesthesia can be compared to that of separate needle with more stable vital signs and less complications but with more allover doses of local anesthetics. Duhok Med J 2019; 13 (1):9-21.

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Background and Aims: Regional anesthesia gained popularity over the last three decades due to the technical advances across subdisciplines, better understanding of the physiology, the advances in the field of anesthetic drugs, and the better approach in training for such techniques. The technique is currently used in many anatomical levels and most surgical procedures can be performed using the combined spinal epidural type. The aim of this study is to evaluate the feasibility of the combined spinal-epidural anesthesia in patients with respiratory and cardiovascular diseases who underwent open cholecystectomy. Patients and methods: This prospective cross sectional study which was done on patients undergoing elective open cholecystectomy (n=119) for whom the general anesthesia was contraindicated due to major cardiovascular and pulmonary diseases, under lumber combined spinal-epidural anesthesia. Results: The mean age of our patients was 64.33(SD: 12.085) years; females constituted 73 of them (61.3%) and males 46 (38.7%). Most patients (73) were complaining from the cardiovascular diseases (61.34%). In most patients the onset of the action of the anesthesia was between 10-12 minutes. In 55 patients (46.2%) no extra-drugs were required, and in the rest of patients intravenous mediations were given to relieve anxiety, pain, or both. In 81 patients (68.1%) no intraoperative complications were reported, the most common intraoperative complication was hypotension in 31 patients (26.1%), post-operatively no complications were reported in 86 patients (72%), and hypotension was reported in 12 patients (10.1%), nausea & vomiting in 11 patients (9.2%). The surgeon's satisfaction was excellent in 73.11% of the surgeries, as was good in 23.53%. Most patients gained the lower limb movement within 2 hours. There was a significant correlation between the need for extra drugs and both comorbid diseases and the development of intraoperative complications (P values 0.022 & 0.000) respectively and no significant correlations with other parameters such as the gender, postoperative complications and the surgeon's satisfaction (P values 0.707, 0.522, and 0.056) respectively. Conclusion:The technique of the combined spinal epidural anesthesia is safe and very effective when used for American Society of Anesthesiologist (ASA) patient classification class III and IV patients who need open cholecystectomy. This technique should be used by expert anesthetists who are well trained and gained skill in this technique, and it may be used in fields other than surgery such as trauma victims and for cancer patients.