Neostigmine/atropine was effective in treating PDPH after only 2 doses. Neostigmine can pass the choroid plexus but not the blood-brain barrier. The central effects of both drugs influence both cerebrospinal fluid secretion and cerebral vascular tone, which are the primary pathophysiological changes in PDPH. The results are consistent with previous studies and clinical reports of neostigmine activity.

Aim of the work: there is an increased interest in the role of magnesium ions in clinical medicine, nutrition and physiology. Magnesium affects many cellular functions, including transport of potassium and calcium ions and modulates signal transduction, energy metabolism and cell proliferation. Magnesium deficiency is not uncommon among the general population: its intake has decreased over the years. Magnesium derangement results in various symptoms and signs; magnesium supplementation or intravenous infusion may be beneficial in various diseased states; so this review aimed to highlight the physiology of magnesium in humans, the derangement of magnesium in the form of hyper and hypomagnesemia , their clinical picture and the clinical and therapeutic uses of magnesium in the critical ill patients. Methods: references were obtained from Medline, Google Scholar and Ovid from 1960 to 2017. All categories of articles (clinical trials, reviews, or metaanalyses) on this topic were selected. Conclusion: magnesium is a critical physiological ion; it has many known indications in anesthesiology and intensive care because of its interactions with drugs used in intensive care. Intensive care specialists need to have a clear understanding of the role of this important cation. Magnesium is gaining recognition as a clinically important electrolyte in intensive care and emergency medicine .Recent clinical trials and case reports increase interest of magnesium as an effective therapeutic agent for potentially life-threatening problems such as torsade de pointes, digitalis toxicity, bronchospasm and alcohol withdrawal, subarachnoid hemorrhage, acute myocardial infarction, preecalmsia , eclamsia ,hypertension , diabetes , metabolic syndrome and cardiac arrhthymias .

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Background: In the elderly and high risk patients, it is logic to prefer local anaesthesia rather than general anaesthesia. The fascia iliaca compartment block is an easy, available method for peri-operative analgesia in patients with painful conditions affecting the thigh, the hip joint and/or the femur. Lumbar plexus block is another form of deep blocks which is used to provide anesthesia and/or analgesia for the entire distribution of the lumbar plexus. Aim of Study: Intraoperative assessment of CFIB versus CLPB. Material and Methods: 40 patients with fracture neck femur were randomized intone of 2 blocks, CFIB and CLPB. Results: CFIB was significantly superior to CLPB as regards shorter time for catheter insertion (CIT) (p<0.001), earlier maximum motor block (p<0.001) and earlier peak of sensory block (p=0.008), intraoperative hemodynamic stability (p<0.001) while CLPB group showed significantly rapid onset of motor and sensory block (p<0.001, p<0.001). Conclusion: Continuous infusion fascia iliaca block gives better quality analgesia. It is an easy procedure that could be done in the emergency room. It is faster, safer and more applicable technique than continuous lumbar plexus block.

Background: It is thought that both CFIB and CLPB can decrease the length of hospital stay, morbidity and help early ambulation in patients with fracture neck of femur. Aim of the Study:To compare the postoperative analgesic efficacy and opioid spare effect of continuous ultrasoundguided lumbar plexus block and fascia iliaca compartment block in patients undergoing surgery for fractured neck of femur.Material and Methods: 40 patients with fracture neck femur were randomized intone of 2 blocks, CFIB and CLPB.Results: CFIB was superior to CLPB in total consumed dose of morphine, sensory and motor block for 48 hours postoperatively (p=0.006), hemodynamic stability (p<0.001), incidence of side effects (p=0.04) and patient satisfaction (p=0.06). Conclusion:Single injection lumbar plexus block provides postoperative analgesia for up to 18 hours, with avoidance of troubles of continuous infusion, with lower VAS scores and good patient satisfaction. However, it is considered a difficult technique with higher rate of complications and failure. On the other hand, Continuous infusion fascia iliaca block gives better quality analgesia, for up to 48 hours, and high patient satisfaction.