Heparin is the anticoagulation of choice for cardiac surgery requiring cardiopulmonary bypass. Heparin resistance (HR) is inability to achieve ACT > 400s inspite of administering high dose of heparin. Causes for HR include antithrombin deficiency, increased heparin binding proteins, prior heparin exposure, platelet activation, medications like Nitroglycerin, increased heparin clearance, high levels of factor VIII and factitious heparin resistance. It can be managed with FFP or antithrombin concentrates to increase the levels of AT. Alternate anticoagulants like direct thrombin inhibitors and factor Xa inhibitors were also successfully used for anticoagulation during CPB, but the risk of thrombosis remains high. We hereby report a case of a 40 year female who developed heparin resistance during CPB for mitral valve replacement which was successfully managed with transfusion of FFP.

Large retrosternal goitre (RSG) usually poses a challenge to both anaesthesiologist as well as surgeon, as airway management in such case requires multidisciplinary discussion so as to formulate safe plan to secure the airway. Induction of anaesthesia and positioning may cause cardiorespiratory collapse and in severe cases cardiopulmonary bypass or veno-venous extracorporeal membrane oxygenation may be needed. Post-surgery extubating these patient constitutes another challenge due to risk of underlying tracheomalacia and may require prolonged ventilatory support or tracheal stenting. Authors describe successful management of a patient with long standing goitre for more than 20 years having retrosternal extension with tracheal narrowing and severe compression posted for left hemi thyroidectomy SOS total thyroidectomy. We secured the airway with intravenous induction by video laryngoscopy, after failed awake fiberoptic intubation.

Introduction: TIVA has many advantages over inhalational anaesthesia to name a few like its role in Day care surgeries, faster recovery rate, Lesser hospital stay and so on. Various drugs have been tried in TIVA, but no single drug have the ideal characteristics, hence various combinations of drugs are being used. One such drug combination is Ketofol (ketamine and propofol). Objective: To investigate ketofol as a suitable anaesthetic agent alternative to propofol, ketamine alone in short surgical procedures for onset, duration of anaesthesia, quality of analgesia, Haemodynamic and respiratory stability, adverse effects and recovery characteristics. Materials and methods: In this prospective comparative study, 3 group i.e, ketamine(k) group, propofol (p) group, ketofol (kp) group consisting 50 patients in each group undergoing short surgical procedures were studied. Each assigned group were premedicated and induced with ketamine 2mg/kg bodyweight in k group, propofol 2mg/kg bodyweight in p group and ketofol (ketamine 1mg/kg body wt+ propofol 1mg/kg body wt). The parameters like onset of action, duration, quality of analgesia, cardiorespiratory stability, adverse effects and recovery characters were studied. Results: We found significant difference p value <0.05 among k, p and kp groups. Kp (ketofol) group had better induction qualities, haemodynamic stability and lesser adverse effects. Conclusion: We concluded that ketofol (ketamine+propofol) combination is a better intravenous anaesthetic agent than propofol or ketamine alone in TIVA procedures.

Authors report an interesting case report of Prothrombin Complex Concentrate (PCC) administration in a pregnant patient admitted in emergency with pregnancy induced hypertension (PIH)and acute liver failure with intrauterine foetal death (IUFD).PCC treatment was effective to control bleeding and its associated complications in our patient with severe liver function derangement by INR reduction and promoted early recovery and discharge from the hospital.Use of PCCs to prevent bleeding in patients with liver coagulopathy , obstetric haemorrhage and it’s superiority to FFPs have not been reported very well in literature.Our case report is a small contribution in highlighting the benefits of PCCs as life saviour in prevention of bleeding in emergency.

Introduction: TIVA has many advantages over inhalational anaesthesia to name a few like its role in Day care surgeries, faster recovery rate, lesser hospital stay and so on. Various drugs have been tried in TIVA but no single drug have the ideal characteristics, hence various combinations of drugs are being used. One such drug combination is Ketofol (ketamine and propofol). Objective: To investigate ketofol as a suitable anaesthetic agent alternative to propofol, ketamine alone in short surgical procedures for onset, duration of anaesthesia, quality of analgesia, Haemodynamic and respiratory stability, adverse effects and recovery characteristics. Materials and methods: In this prospective comparative study, 3 group i.e, ketamine (k) group, propofol (p) group, ketofol (kp) group consisting 50 patients in each group undergoing short surgical procedures were studied. Each assigned group were premedicated and induced with ketamine 2mg/kg bodyweight in k group, propofol 2mg/kg bodyweight in p group and ketofol (ketamine 1mg/kg body wt+ propofol 1mg/kg body wt). The parameters like onset of action, duration, quality of analgesia, cardiorespiratory stability, adverse effects and recovery characters were studied. Results: We found significant difference p value <0.05 among k, p and kp groups. Kp (ketofol) group had better induction qualities, haemodynamic stability and lesser adverse effects. Conclusion: We concluded that ketofol (ketamine+propofol) combination is a better intravenous anaesthetic agent than propofol or ketamine alone in TIVA procedures.

Introduction: Difficult intubation carries almost one third of deaths due to failure to intubate or ventilate. We performed current study to compare tracheal intubation using Awake Fiberoptic intubation and using Intubating laryngeal mask airway in patients with difficult airway. Method-Two groups of 40 ASA I&II with MPC I,II,III were randomized for intubating trachea with awake Fiberoptic and Intubating laryngeal mask airway. Changes in hemodynamics monitored through all procedure till 10 min after intubation. Assessment done for ease of intubation,no.of attempts,complications like sore throat,arrythmias.Result-No significant difference found in demographic data as well in SBP,DBP,MAP,SPO2 in both groups. At 5 min after intubation mean heart rate changes were significant between both the groups. Maximum HR changes seen at 5 minutes as increase in HR of 18.57 from baseline in group F whereas in group I it was just 13.42.Conclusion-Intubation with Fiberoptic & Intubating laryngeal mask airway is equally successful and suitable with low complication rate in difficult airway.

Aim:  The aim of this study was to compare area under the curve (AUC), frequency, and odds of return of spontaneous circulation (ROSC) when epinephrine was administered in hypovolemic and normovolemic cardiac arrest models. Methods: 28 adult swine were randomly assigned to 4 groups: HIO Normovolemia Group (HIONG); HIO Hypovolemia Group (HIOHG); IV Normovolemia (IVNG); and IV Hypovolemia Group (IVHG). Swine were anesthetized. The HIOH and IVH subjects were exsanguinated 35% of their blood volume. Each was placed into arrest. After 2 minutes, cardiopulmonary resuscitation was initiated.  After another 2 minutes, 1 mg of epinephrine was given by IV or HIO routes; blood samples were collected over 5 minutes and analyzed by high-performance liquid chromatography.  Subjects were defibrillated every 2 minutes. Results: The AUC in the HIOHG was significantly less than both the HIONG (p = 0.047) and IVHG (p = 0.021). There were no other significant differences in the groups relative to AUC (p>0.05). HIONG had a significantly higher occurrence of ROSC compared to HIOHG (p = 0.018) and IVH (p = 0.018) but no other significant differences (p>0.05) the odds of ROSC were 19.2 times greater for HIONG compared to the HIOHG. Conclusion: The study strongly supports the effectiveness of HIO administration of epinephrine and should be considered as a first-line intervention for patients in cardiac arrest related to normovolemic causes.  However, our findings do not support using HIO access for epinephrine administration for patients in cardiac arrest related to hypovolemic reasons.

Introduction: Medical products are mostly manufactured for single use, including peripheral nerve block needles [1]. Under these conditions, the reuse of disposable peripheral nerve block needles has been thought to be a saving tool. Materials and Method: The Nerve stimulator and multimeter were connected to the peripheral block needles and the control needle, which had been sterilized with the technique described below and used 20 times on the artificial model tissue beforehand, and the stimulator was given current with the stimulator. Results: When the control needle and 1, 2, 3, 4, 6, 7, 10 needles were compared, in the independent sample t test analysis, the p value was 0.14, and no statistical significance was found. When the control needle and the 5,8,9 needles were compared, the p value was found to be <0.05 and was statistically significant.

Background: Muscle relaxants are used during surgery to ensure good skeletal muscle relaxation. Succinyl choline revolutionized anesthetic practice by providing intense neuro muscular blockade of very rapid onset and ultra-short acting duration favoring ease of endotracheal intubation. Rocuronium is the first non-depolarizing muscle relaxant considered to be an acceptable substitute for succinyl choline in facilitating rapid intubation of trachea due to its rapid onset of action. Aim: The main aim of our study was to evaluate and compare the onset time, intubation conditions and duration of action of various doses of Rocuronium. Materials and methodology: 60 adult patients of age group between 20 – 60 years belonging to ASA 1 and 2 of either sex posted for laparoscopic surgery were included in the study and were divided into three groups of 20 each as  Group I received 0.6mg/kg Rocuronium, Group II received 0.75mg/kg Rocuronium and Group III received 0.9mg/kg Rocuronium. Observation and results: The following parameters like time and dose of giving Rocuronium, time at which intubation was done, time at which all four twitches of TOF disappeared and recovered were noted in our study. The onset time was shown to reduce significantly with increasing the dosage from 0.6mg/kg to 0.75mg/kg and from 0.75mg/kg to 0.9mg/kg (p<0.002) in Mann Whitney test and p<0.009 in Kruskal Wallis test and in duration of action, there is significant increase in duration by increasing the dose 0.6mg/kg and 0.9mg/kg, 0.75mg/kg and 0.9mg/kg and 0.6mg/kg and 0.9mg/kg. Conclusion: Increasing the dosage from 0.6mg/kg to 0.75mg/kg and to 0.9mg/kg reduces the onset time, prolongs the clinical duration and gives excellent intubation conditions at 60 seconds.

Background and Aim: Sub arachnoid block is most commonly used technique for lower limb surgeries. Various adjuvants are being used with local anesthesia for prolongation of intra operative and post-operative analgesia. Most of the clinical studies about intrathecal alpha-2 agonists are related to clonidine. In view of few evidences of Dexmedetomidine, efficacy as adjuvant to Ropivacaine in Spinal Anesthesia. This study was conducted to explore its usefulness and also to compare this new alpha-2 adrenergic agonist with the previously established and widely used adjuvants like Clonidine on spinal block characteristics and post-operative analgesia. This study meant to compare the effects of Dexmedetomidine 5 mcg versus Clonidine 15 mcg on blockade characteristics and postop analgesia when given as adjuvants to 0.75 % Ropivacaine. The objectives were to compare the onset and duration of sensory and the motor blockade, duration of analgesia, hemodynamic parameters and side effect profile in among two groups. Materials and Methods: 60 adult patients posted for lower limb surgeries were randomly allocated into two groups. Group D received 3 mL 0.75% ropivacaine with 5 mcg of Dexmedetomidine and group C received 3ml of Ropivacaine with 15 mcg of Clonidine. Patients were preloaded with 10mL/kg of Ringer’s lactate. Onset and duration of sensory and motor blockade, peak sensory level, 2 segment regression duration of analgesia and rescue analgesia requirement were noted and compared. Results: Patients in group D had earlier onset of sensory and motor block compared to group C. Mean time of onset of sensory block group D was 3.467±0.507 min and group C was 3.900±0.759 min with a p value of 0.012. Mean time for onset of motor block group D 9.033±1.098 min was group C 10.00±1.66 min with a p value of 0.010. Mean time for two segments regression in group D was 135.5±7.925 min and in group C was 125.567±5.27 min with a p value of 0.000. Duration of motor and sensory block were also significantly prolonged in group D compared to group C. Mean duration of motor block in group D was 339.367±27.031 min and in group C was 306.600±23.940 min with p value of 0.000. Mean duration of sensory block in group D was 421.133±21.968 min and in group C was 360.600±23.940 min with a p value of 0.000. Group D showed a significantly less requirement of analgesia than group C with a p value of 0.000.  Hemodynamic were stable and comparable among both groups. Conclusion: We conclude that dexmedetomidine is a better adjuvant than clonidine in Spinal Anesthesia as far as patient comfort, stable cardio-respiratory parameters, intra-operative and post-operative analgesia is concerned. Overall the experience with Dexmedetomidine was quite satisfactory as compared to clonidine.

Diaphragm is a musculoaponeurotic barrier dividing thoracic cavity from that of abdominal. Traumatic diaphragmatic rupture is a rare clinic pathological entity and a missed diagnosis. Diaphragmatic injury may result in the development of delayed herniation and strangulation of abdominal organs into the thoracic cavity. Spontaneous (effort or delayed) rupture of diaphragm is rarely seen with the incidence of approx. 1% without obvious blunt trauma of abdomen. This poses a great difficulty to the surgeons and radiologists to diagnose. Very easily the diagnosis is missed or confused with pneumothorax or hydro pneumothorax. The Spontaneous rupture of Right sided diaphragm is very rare in comparison to left sided rupture. Diaphragmatic hernia without trauma in adults is a very rare entity. The reported cases of Right sided diaphragmatic hernia in literature so far is only less than 20. We report 2 cases of Right sided spontaneous delayed diaphragmatic hernia, who presented in our out patients clinic with the chief complaint of breathlessness on exertion. In both the cases, the defect was repaired with primary closure and reinforced with marlex mesh.

During epidemics, health services must respond quickly to a massive patient admission. Protection of health workers becomes a priority to ensure the adequate level of care but recent outbreaks of SARS-CoV-2 showed a worldwide difficult to manage this emergency based on supply of personal protective devices and equipment. A simple-to-assemble device consisting of a face mask and a breathing filter system is effective in preventing risk of biological contamination by healthcare workers. We are against its routine use in normal condition, but we suggest that this device can be used in limited-resource settings or even in the case of acute shortage of personal protective devices and equipment.

Objectıves: Family physicians working in primary health care services are more alone when compared to other branches in matters requiring this type of urgency. In this study, we aimed to evaluate the knowledge, awareness, concerns, and gains of the participants as a result of the clinical training given to the family physicians by the anesthesiologists. Methods: This cross-sectional study was conducted in the Department of Anesthesiology and Reanimation, Konya Training and Research Hospital, Health Sciences University. A total of 32 individuals consisting of Family physician Assistants, were included in the study voluntarily. Clinical training was conducted in live patients in groups of 4 people in the operating room.The duration of the training was one week for each group. To evaluate the airway management, 10 questions were asked to the participants. Results: When we asked that ‘’ Do you believe you can intubate patients with respiratory arrest? ’’ For this question, before and after the clinical training, the meaningful relationship was in favor of the answer ‘Yes, I believe I can definitely do it’ (OR = 0.7, p = 0.004).  Conclusıons: According to the main resuscitation guidelines, significant improvements in self-confidence have been detected in live patients after airway management training.We believe that our study will contribute airway management training programmes planned for the future.

Introduction: Cardiopulmonary resuscitation is an intervention that every physician should apply when needed. But, some departments may be deficient in emergency intervention due to the low probability of encountering emergencies in working life. Methods: This survey study was conducted with the approval of the Ethics Committee of the Education and Research Hospital of Health Sciences University, Konya, 48929119/774, on physicians who were different departments between 1 April 2019 and 1 November 2019. Results: We analyzed 343 surveys. There were statistically significant differences between the participants in their ages, gender, and experiences (p<0.001, p<0.001and p<0.001). The overall survey results are detailed demographic data, experiences, and the current position was presented in Table. Conclusions: As a result, new studies are needed by expanding our working group. In our study, we think that especially anesthesiologists may be critical in determining where they are in this evaluation. We believe that this kind of work will open the way for a consultation with our colleagues on the issues they are experienced.

Background: Limited mouth opening almost always poses many difficulties not only for laryngoscopy but also for tracheal intubation. Many patients coming for oral and maxillofacial reconstructive surgeries with limited mouth opening due to pain, scars, burns or contractures involving head and neck, distorted anatomy of head, neck and oral cavity or due to previous surgeries on the oral cavity have challenging airway. In such cases the gold standard fiber optic intubation is the choice. But other alternative techniques like blind nasal intubation or awake retrograde intubation can be a very good choices at times when fiber optic bronchoscope is not available. We chose awake retrograde intubation to secure airway in our patients. We tested two different guide wires, CVC and Zebra guide wires for railroading ET tube through nasal route in these patients having limited mouth opening of less than 2cms to evaluate the ease of intubation by comparing different parameters recorded during or after intubation. Material and methods: Intubation was performed with little modifications using two different guide wires in similar scenarios. A 0.035"F central venous catheter guide wire and a 0.032"F Zebra urological guide wire were used to guide endotracheal tube nasotrachealy. 40 patients requiring oral and maxillofacial reconstructive surgeries of various types with limited mouth opening of less than 2cms with anticipated difficult laryngoscopy and intubation were chosen. Indications for the procedure included oral submucosal fibrosis, various fractures of mandible, malignancies of gingivobuccal sulcus involving retromolar trigone, temporomandibular joint ankylosis, reconstructive surgeries of face post hemimandiblectomy, internal derangement of temporomandibular joint, submandibular abscess etc. Results: Mean time taken for successful nasotracheal intubation with Zebra guide wire Mean±SD of 3.48±0.62 minutes was significantly lesser than with CVC guide wire Mean±SD of 6.58±1.21 minutes with p<0.001. Number of attempts and patient comfort were also significantly better with Zebra guide wire, p = 0.031 and p<0.001 compared to CVC guide wire respectively. Conclusion: 0.032"F Zebra guide wire is a better, safer, inexpensive alternative to 0.035"F Cvc guide for introducing or rail roading endotracheal tube through nasotracheal route during awake retrograde intubation. Our technique of awake retrograde intubation is an effective, inexpensive, safer alternative compared to other modified techniques of awake retrograde intubation without any major complications.

Introduction: Today, the Internet is widely used to obtain information about surgery and anesthesia. In this sense, it is seen that pregnant women from private patient groups use the Internet and social media to get information about the cesarean section and anesthesia [1]. Methods: The questionnaire, which was prepared within the scope of the study, was performed between September 1, 2019, and November 31, 2019, in pregnant patients who were scheduled for elective cesarean operation in Konya Training and Research Hospital. Results: There were 98 patients completed the survey for this study. Of those who completed the survey. The average age was 28.73±5.09 years (range 18-45). When we looked at the education levels.

Introduction: Rheumatoid arthritis is a chronic immune-inflammatory disease that affects synovial joints with possibility of extra articular manifestations. Prevalence of rheumatoid arthritis is about is 0.5–1 % [1-2] of population worldwide. Indian data suggest the prevalence to be around 0.65% to 0.75% [3]. Results: A total of 75 RA patients satisfying ACR criteria were enrolled in this study, which include 57 females (76%) and 18 males (24%). Male: female ratio was 1:3.2; Average age was 52.76 years. Conclusion: 1. Prevalence of peripheral neuropathy in RA was 35% 2. Male: female ratio of patients with peripheral neuropathy in RA is 1:2.7. 3. Most common pattern of peripheral neuropathy was pure sensory neuropathy (54%) followed by carpel tunnel syndrome (23 %), then Sensorimotor and Pure motor neuropathy 4. Peripheral Neuropathy is correlated to age, duration, Rheumatoid Factor, anti CCP antibody and ESR5.Peripheral Neuropathy is not correlated to gender, DAS 28 score, drugs, extra articular manifestation.

Background: Modern anesthesia is very safe and can be tailored to your individual needs and to suit type of surgery the individual having. Anesthesia is the use of medicine to keep you safe, comfortable and to stop you from feeling pain during surgical procedure either for therapy or diagnosis. Objectives: The present review highlights the roles of anesthesiologist, types, risks, side effects, and medications of anesthesia, perioperative care, anesthetic preparation, and anesthetic check-up. Anesthesiologists are doctors who have had specialist training in anesthesia and also in the treatment of pain, intensive care and emergency care. The main roles of the anesthesiologists are to avoid happen anesthesia risks, side effects and complications, and planning in advance to overcome any of previous mentioned consideration. There are several different types of anesthesia, which include general, regional, and local anesthesia. General anesthesia is suppressing the activity of the central nervous system and leads to loss of consciousness and total absence of sensation. Regional anesthesia is used for certain procedures of the chest, abdomen, pelvis, arms or legs. Local anesthesia only affects the nerves in the surgical area and not your brain, you may be awake during the procedure. Regional and local anesthetic agents prevent the transmission of nerve impulses without causing unconsciousness. Some of the risks of undergoing anesthesia are allergic reaction to the medicine, aspiration pneumonia, infection, bleeding, heart attack, stroke, nerve damage, hyperthermia, visual disturbances or loss of sight, cognitive dysfunction, and the worst Scenario among risks is death. Common side effects of anesthesia include headache, sleepiness, nausea, vomiting, thirst, and shivering can occur to a greateror lesser degree with all types of anesthesia. The more common side effects associated with the different types of anesthesia are muscle weakness, numbness, tingling, nausea, backache or headache. General anesthetics medications can be classified according to the ways of given into inhaled anesthetics agents and intravenous anesthetics agents. The perioperative care period begins when the patient is informed of the necessity for surgery and continued with surgical procedure and recovery, which end when the patient resumes his/her usual activities. The goal of perioperative care is to assist patient and their family in making decision and to meet and support the needs of patient undergoing surgical or other invasive procedure and achieve a level of wellness greater than the level prior to surgery. The anesthetic preparation involves procedures which are implemented based on the nature of the expected operation, anesthesia as well as the findings of the diagnostic workup and the pre anesthetic checkup. The patient who takes more than one or two medications, he/she must bring the list of medication with him/her, including any herbal or "natural" medications. The main goal for anesthetic preparation is to prepare patient physiologically, psychologically socially as well as planning of perioperative care through minimize, the predisposing factors and causes of perioperative morbidity and mortality. Pre-anesthesia checkup is a medical checkup, physical examination and laboratory investigations done by the anesthesiologist before an operation, to assess the patient's physical condition and any other medical problems or diseases. The aim of the assessment is to identify factors that significantly increase the risk of complications, and modify the procedure appropriately. Conclusion: It can be concluded that there are several different types of anesthesia. The risks of undergoing anesthesia are allergic reaction to the medicine, aspiration pneumonia, infection, bleeding, heart attack, stroke, nerve damage, hyperthermia, visual disturbances or loss of sight, cognitive dysfunction, and the worst Scenario among risks is death. Common side effects of anesthesia include headache, sleepiness, nausea, vomiting, thirst, and shivering. The main goal for anesthetic preparation is to prepare patient physiologically, psychologically and socially. Briefly, the most excellent anesthetic check-up leads to prepare the best perioperative care and the finest anesthetic preparation as result avoid or minimize risks, side effects, and complications of Anesthesia.

Klippel-Feil syndrome (KFS) is a rare syndrome characterized by a classic triad comprising a short neck, a low posterior hairline, and limited neck mobility due to fused cervical vertebrae. We hereby report anesthetic management for pyeloplasty of KFS patient with micrognathia and restricted mouth opening. A careful preoperative evaluation to exclude other anomalies associated with   KFS was done. The patient had restricted mouth opening, retrognathia, and limited cervical mobility due to cervical vertebral fusion, with sprengels deformity, aortic arch abnormality, sensory neuronal hearing loss and urologically pelviuretric obstruction on both sides. As difficult intubation was predicted, video laryngoscopy was our first choice for gaining control of the patient’s airway. In the operating room, tracheotomy equipment was kept ready if a perioperative surgical airway control was required. Surgery was uneventful. Careful preoperative examination and preparation for difficult airway management are important for KFS patients with micrognathia.

Objective: Intravenous analgosedative agents are used widely in the critical care units to achieve the target Richmond agitation sedative scale in mechanically ventilated patients. Although commonly used analgosedatives are effective, many cause unwanted adverse effects, including delirium, constipation, and negative hemodynamic effects. However, there are limited comparison data on the safety and efficacy of morphine in both septic and non-septic mechanically ventillated critically ill patients. The purpose of this study is to determine whether continuous morphine infusion in septic mechanically ventilated critically ill patients will affect the total norepinephrine vasopressor rate and overall requirement, the hemodynamic parameters, the risk of opioid induced constipation, the ICU overall hospital length of stay (LOS), and the overall 28-day ICU mortality compared to the comparative cohort of non-septic patients. Method: A retrospective analysis was conducted in our adult ICU at King Hussein Medical Hospital (KHMH) for patients who were admitted via the emergency department (ED) or via other hospital wards between April 2018 and  April 2020. Patients will be excluded if they discharged or died before completed at least 1 week of ICU admission and if the patient is not ventilated. A chi square test will be conducted to evaluate the proportion of studied patients in both tested analgosedative based critically ill cohorts. An independent T-test will be conducted to compare the Mean±SD of the tested aforementioned outcomes. Result: The mean age of our studied critically ill patients was 58.94±10.37. 56 patients of the eligible sample were male while 22 were female (30.3%). The incidence of convulsive seizure and rate of prokinetic consumption were significantly lower in Group II vs Group I with number (%) of 14 (35.9%) vs19 (48.7%) and 37 (94.9%) vs 39 (100.0%). Critically ill patients on Morphine require higher Norepinephrine infusion rate in Sepsis status (11.22±1.70 mcg/min) vs Non-Sepsis status (6.17±0.76 mcg/min). Conclusion: Morphine infusion as analgosedative in septic mechanically ventilated critically ill patients has a higher risk of gastric residual volume elevation, convulsive seizure frequency, and require higher rate vasopressor to maintain a comparable hemodynamic target level. However, it did not appear to affect overall ICU length of stay or mortality.

Emerging evidence has demonstrated that the initial lung involvement COVID-19 can be characterised more by a “pneumonia pattern” rather than a typical “ARDS pattern”. It therefore makes sense that the ventilation strategies applied should be different from the routine ARDS protocol. We developed a three-step evidence guided, experience based and ptient compatible protocol. The aim of the 3-step protocol was to ensure that maximum benefit of alveolar recruitment was provided in the first two days of ICU admission. The turning point for the successful expansion of NIV is its ability to achieve the same physiological effects as invasive mechanical ventilation with the avoidance of the life-threatening risks correlated with the use of an artificial airway [1].

Introduction: The number of caesarean sections has increased over, especially in the developed countries. Hence, it has increasingly become a greater challenge to provide care for the pregnant, but this has given obstetric anesthetists’ a greater opportunity to contribute to obstetric services. Aims: to identify the characteristics of participants during cesarean section by using the general and spinal anesthesia during the period of study. Methods: A cross-sectional study was conducted in the operation unit in Elweya Maternity Teaching Hospital in Baghdad. Semi-structured questionnaire was used to collect the information from the records. The sample size was 1987 cases. Data was described by using the descriptive statistics such as frequency, percentage, Chi-square, and p. value. STATA version 14 statistical package was used to analyze the data. Results: Our finding, 44.3% (841/1897) were between 31 - 40 years old, followed by 34.1% (646/1897) were between 21 to 30 years old. Majority of pregnant women 69.9% (1326/1897) were housewives; 57.4% were uneducated; 48.7% (924/1897) of them had overweight, followed by 30 %( 569/1897) had normal weight. The totals of CS were higher during October 36 %, followed by September 34.8% and the percentage was lower 29.2% in November 2020. Conclusion: We concluded that the most of them had general anesthesia during CS. The respiratory tract infections and overweight are one of reasons for spinal anesthesia indication. There are significant association had been found between the age, occupation and BMI by the types of anesthesia at the p. value less than 0.5. Recommendation:  we recommended to see the future development of new medications and newer techniques with a greater understanding and further research, obstetric anesthetists’ would play an even greater role to optimize the care of the parturient during caesarean delivery.