Background Muscle relaxants used in general anesthesia during the insertion of an endotracheal tube (ETT) to relax the muscles of the neck and throat, which reduces the risk of injury. They also are used to relax the chest muscles when an endotracheal tube is used to aid mechanical ventilation. Objective The aim of this study has been to evaluate the effect of calcium chloride coadministered with neostigmine and atropine on neuromuscular blockade recovery time at the end of general anesthesia. And compare it’s effect against usual neuromuscular reverse of neostigmine and atropine. Patients and Methods In this present study we use Double blind prospective randomized Clinical trial study, 30 patients were enrolled. They were divided in two groups each of which contains 15 patients: Group (A): received 5 mg/kg of calcium chloride coadministered with 25 μg/kg of neostigmine and 15 μg/kg of atropine at the end of surgery. Group (B): received the same volume of normal saline coadministered with 25 μg kg of neostigmine and 15 μg / kg of atropine at the end of surgery. Results Comparison between calcium and neostigmine groups according TOF at 5 minutes and 10 minutes using Independent t-test, P- value was less than 0.01 which means that there is high significant difference between 2 groups. On the other hand, TOF at 20 minutes in calcium and neostigmine groups shows no difference at all. Conclusion So Calcium chloride elevate serum calcium level, calcium has antineuromuscular blockade effect, therefore calcium chloride increase TOF and enhance neuromuscular recovery and decrease the PORC after neostigmine administration.

Background Septic shock remains the leading cause of death in the intensive care unit (ICU), with an increasing incidence and a current mortality rate of approximately 30 %. Sepsis was defined by the presence of at least two criteria of systemic inflammatory response syndrome associated with a clinically or microbiologically documented, or a highly suspected infection. Severe sepsis was defined as a sepsis associated with at least one organ failure different from that responsible for the infection. Septic shock was defined as a severe sepsis associated with low blood pressure despite adequate vascular filling which required a vasopressor support. Cardiac dysfunction in sepsis is driven primarily by release of cytokines, mitochondrial dysfunction, and tissue hypoxia that leads to cardiac myocyte injury and death. Aim of the Work The aim of this study was to evaluate the effect of diastolic function on prognosis of septic shock in patients admitted to an intensive care unit (ICU). Patient and Methods This study was conducted on (50) patients with septic shock admitted to an intensive care unit (ICU) from November 2017 to November 2018. Results These patients was divided according to cardiac echocardiography findings into two groups:-Group 1:- 25 patients with preserved diastolic function and diastolic dysfunction grade I; 12 Male and 13 Female were included in the study, the average age was 43.44±13.69.Group 2:- Another 25 patients with diastolic dysfunction grade II and grade III; 11 Males and 14 Females were included in the study, the average age was 47.28±15.7. Conclusion We recommend assessment of patients admitted to the ICU with septic shock via echocardiography to determine the grade of diastolic dysfunction and using diastolic dysfunction as a predictive risk factor in various score assessment of ICU patients. Our study was limited by decreased sample size and we recommend further studies with increased sample size..

Introduction Fundamental of regional anesthesia is pharmacologically interrupting transmission of sensation in the specific nerve fiber. The sensory signals generated by tissue damage triggers a state of increased excitability, leading to prolonged post-operative pain or sensitization to such pain. The optimal pain treatment pre-empts the establishment of pain hypersensitivity during and after surgery by minimizing the patient discomfort while leaving physiologic nociceptive mechanisms intact so as to function as an early warning symptom. Aim To measure the effect of intravenous magnesium infusion during spinal anesthesia on post operative analgesia in patients undergoing total hip replacement. Patients and Methods Patients were randomly assigned to two groups using closed envelopes chosen by patients before the study. Patients in the magnesium group (Group M, n = 15) received magnesium sulphate 50 mg per Kg over 15 min after spinal anesthesia and then 15 mg per Kg per hr by continuous i.v. infusion until the end of surgery. Patients in the saline group (Group S, n = 15) received the same volume of isotonic saline over the same period. Infusions were prepared in pharmacy and they were administered using the infusion machines. Study data were recorded by an observer unaware of group assignments. Results the study showed that intravenous magnesium infusion during spinal anesthesia decreased VAS results in magnesium group specifically in the first 24 hours and hence decreasing need for post operative rescue analgesic consumption .Also post operative nausea,vomiting and shivering were lower in magnesium group. Conclusion We concluded that intravenous magnesium infusion during spinal anesthesia improves post operative analgesia and reduces incidence of nausea, vomiting and shivering in patients undergoing total hip replacement.