Elsheemy, M. S., W. Ghoneima, W. Aboulela, K. Daw, A. M. Shouman, A. I. Shoukry, S. M. Soaida, D. M. Salah, H. Bazaraa, F. I. Fadel, et al., "Risk factors for urological complications following living donor renal transplantation in children", Pediatric Transplantation, vol. 22, issue 1, pp. DOI: 10.1111/petr.13083, 2018.
Naim, H. A. E., K. A. Elshafaie, S. M. Soaida, M. M. Abdel-Haq, and K. M. Nawar, "Systemic versus perineural dexamethasone as an adjuvant to bupivacaine in combined femoral and sciatic nerve blocks in lower-limb vascular surgeries: a prospective randomized study", Ain-Shams Journal of Anaesthesiology, vol. 9, issue 4, Cairo , pp. :569–575, 2016.
application/pdf iconain-shamsjanaesthesiol94569-3179637_084956.pdf
Soaida, S. M., M. S. Elsheemy, A. M. Shouman, A. I. Shoukry, H. A. Morsi, D. M. Salah, F. I. Fadel, and H. M. Bazaraa, "Caudal extradural catheterization in pediatric renal transplant and its effect on perioperative hemodynamics and pain scoring: a prospective randomized study", Journal of anesthesia, vol. 30, issue DOI: 10.1007/s00540-015-2087-8, pp. 47-54, 2016. Abstract

Purpose:
'Hockey stick incision' used in renal transplant is large enough to cause severe postoperative morbidity especially in pediatric recipients. Although epidural analgesia is known to be effective in pain control, the resulting sympathectomy might affect hemodynamics interfering with the transplant process. In our study, we evaluated the feasibility and safety of inserting an epidural catheter to the thoracic level via the caudal route, and the effect of using epidural local anesthetics at low concentrations on hemodynamics.

Methods:
After approval from the ethical committee at Kasr Al Ainy University Hospital and consent from parents/legal guardians, sixty patients aged 3-12 years who were scheduled for renal transplant were randomly divided into two equal groups. Group I (epidural group) received continuous caudal epidural bupivacaine 0.125 % with fentanyl together with intravenous (IV) fentanyl and paracetamol. Group II (control group) received only IV fentanyl and paracetamol. Intraoperative data included heart rate (HR), mean arterial blood pressure (MAP) and central venous pressure (CVP). Postoperative variables included HR, MAP, CVP, pain score and complications.

Results:
Threading failure via the caudal route occurred in 6.67 % of cases. Intraoperative differences in hemodynamics and CVP were not clinically significant between groups. Postoperative HR, MAP, and CVP were generally higher in the control group. Pain control was more satisfactory and postoperative complications were less in the epidural group.

Conclusion:
Caudal epidural anesthesia in pediatric renal transplant is a valuable addition to general anesthesia as it provides stable perioperative hemodynamics, excellent postoperative analgesia and is associated with fewer complications than narcotic-dependent analgesia.

Clinical trial registration number:
NCT02037802.

Soaida, S. M., E. S. Basha, M. G. Hanna, and H. H. Refaee, "Intraperitoneal instillation of l-bupivacaine in laparoscopic pediatric procedures: a randomized-controlled study", Ain-Shams Journal of Anesthesiology, vol. 8, issue 2, pp. 247–251, 2015. Abstract

Background and aim
Pain following laparoscopy is mostly because of irritation of the diaphragm and stretching
of the peritoneum associated with carbon dioxide insufflation. In this study, we evaluate the
effectiveness of periportal xylocaine infiltration and intraperitoneal instillation of l-bupivacaine
at the beginning of laparoscopy in pediatrics in reducing postoperative pain, delaying the onset
and reducing the total dose of rescue analgesia, and improving perioperative hemodynamics.
Patients and methods
After receiving ethical committee approval in Kasr Al Ainy University Hospital and parents’
consent, 40 ASA I and II children were allocated randomly to two groups. In group I,
l-bupivacaine 0.5% instilled into the peritoneal cavity immediately after gas insufflation at a
dose 2 mg/kg. In group II, normal saline was instilled instead of l-bupivacaine. All patients
were subjected to preincisional periportal lidocaine 1% infi ltration. Heart rate (HR) and blood
pressure were recorded at 5 min intervals starting from the preoperative period until 6 h
postoperatively. The Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) score was
used, and the onset and dose of pethidine were recorded.
Results
HR was lower in group I and HR4 was significantly lower (P < 0.001). The mean arterial
blood pressure ( MAP) was also lower in group I. It was significantly lower in MAP3 and MAP4
(P = 0.049 and 0.004, respectively). The median pain score was significantly lower in group I
(P = 0.001). Onset of rescue analgesia demand was longer in group I and the total dose of
pethidine was significantly lower in group I (P < 0.001).
Conclusion
Periportal lidocaine infiltration and intraperitoneal l-bupivacaine instillation in pediatric laparoscopy, after pneumoperitoneum, reduced postoperative pain and improved perioperative
hemodynamics.

Hafez, M. H. E. S., M. H. E. D. A. E. Hamid, S. A. E. Raouf, S. M. Soaida, and M. M. Marie, "Bipolar versus monopolar transurethral prostate resection: Comparison of hemodynamic and biochemical changes", Egyptian Journal of Anaesthesia, vol. 30, issue 1, pp. 47–52, 2014.
Naim, H. E. A., S. A. R. Mohamed, S. M. Soaida, and H. H. A. Eltrabily, "The importance of neck circumference to thyromental distance ratio (NC/TM) as a predictor of difficult intubation in obstructive sleep apnea (OSA) patients", Egyptian Journal of Anaesthesia, vol. 30, issue 3, pp. 219–225, 2014. Abstract

Abstract Background: The trial to find a bedside examination that is helpful for foreseeing difficult
intubation is quite inspiring. It was reported that thyromental distance (TM), body mass index
(BMI), neck circumference (NC) and a Mallampati score >3 were the only helpful bedside test predictors.
By using magnetic resonance imaging, it was established that more fat was present in areas
around the collapsible parts of the pharynx in OSA patients. So distribution of fat may provide a
better suggestion of difficult intubation than neck circumference. The current work studied the neck
circumference to thyromental distance ratio as a new predictor of difficult intubation in obstructive
sleep apnea (OSA) patients and comparing it to the formally standard Mallampati score.
Patients and methods: After approval of the ethical committee in Kasr Al Ainy University hospital
and patients consent 50 ASA class 1 and II OSA patients, 18–60 years of both sexes, undergoing
surgery under general anesthesia with tracheal intubation were enrolled in the study. It was a single
group study. Body mass index, neck circumference (cm), thyromental distance (cm) and the ratio of
the NC to TM (NC/TM) and Mallampati classification were recorded. Difficulty of intubation was
assessed using the Intubation Difficulty Scale (IDS). Correlation between all variables and IDS,
comparison between NC/TM ratio and Mallampati score as reliable tests for predicting difficult
intubation and also measuring sensitivity and specificity of both.
Results: Among the 50 patients, 11 patients experienced difficult intubation according to IDS scale.
The Mallampati score and NC/TM were the only statistically significant variables that wereassociated with a difficult intubation. NC/TM ratio was strongly correlated to difficult intubation
where P value =0.01 odds ratio 37.5 with cut-off point is NC/TM P5.15, but the correlation of
Mallampati score was weaker P value =0.05 and odds ratio was 14.5. Moreover, NC/TM ratio
showed higher sensitivity (100%) and a negative predictive value (82%), than the Mallampati score
sensitivity (90%) and specificity (61%).
Conclusion: Difficult intubation in OSA obese patients was independently associated with a
Mallampati score of III or IV, and NC/TM P5.15. Moreover, NC/TM yielded a high sensitivity,
specificity and a negative predictive value.

Youssef, M. M. I., K. Girgis, and S. M. Soaida, "Clonidine versus fentanyl as adjuvants to bupivacaine in peribulbar anesthesia", Egyptian Journal of Anaesthesia, vol. 30, issue 3, pp. 267–272, 2014.
Elsheemy, M. S., A. M. Shouman, A. I. Shoukry, S. Soaida, D. M. Salah, A. M. Yousef, H. A. Morsi, F. I. Fadel, and S. Z. Sadek, "Surgical complications and graft function following live-donor extraperitoneal renal transplantation in children 20 kg or less", Journal of Pediatric Urology, vol. 10, issue 4, pp. 737-43, 2014. Abstract

Objectives: To evaluate the effect of patient, surgical, and medical factors on surgical
complications and graft function following renal transplantation (Tx) in children weighing
20 kg, because the number of this challenging group of children is increasing.
Patients and methods: Between June 2009 and October 2013, 26 patients received living donor
renal allotransplant using the extraperitoneal approach (EPA). The immunosuppression
regimen was composed of prednisolone, mycophenolate mofetil, and ciclosporin or tacrolimus.
Results: The mean weight was 16.46  2.61 kg. Mean cold ischemia time was
53.85  12.35 min. The graft survival rate (GSR) and patient survival rate (PSR) were 96% at
3 years. Acute rejection episodes (AREs) occurred in eight patients (30%). Postoperative surgical
complications were ureteral leakage (3), vesicoureteric reflux (2), and renal vein thrombosis
(2) (with one graft nephrectomy). Mean follow-up was 37.5  7.4 months.
Conclusion: Excellent PSR and GSR can be achieved in low weight (<20 kg) recipients. Even in
very low weight patients, the EPA was used. No cases were reported with primary graft nonfunction
due to use of living donors, increasing pre-Tx body weight to at least 10 kg and maintaining
adequate filling pressure before graft reperfusion. The presence of related donors and
use of induction therapy and tacrolimus decreased the rate of ARE while the presence of pre-Tx lower urinary tract surgical interventions increased the rate of ureteric complications, but
this was statistically insignificant.

Soaida, S. M., M. G. Hanna, M. M. I. Youssef, and M. Mahmoud, "Pressure support ventilation versus spontaneous ventilation in infants undergoing brachial plexus exploration: a comparative study", Ain-Shams Journal of Anesthesiology, vol. 07, pp. 509–513, 2014. Abstract

Background
General anesthesia and muscle relaxants have the potential to decrease or even abolish action
potentials, interfering with surgical nerve exploration. Prolonged surgeries in spontaneously
breathing infants lead to muscle fatigue, shallow breathing, and CO2 accumulation. This
randomized study aimed to evaluate the effi ciency of pressure support ventilation ( PSV) in
infants undergoing brachial plexus exploration without muscle relaxants in maintaining normal
end-tidal CO2 (EtCO2) and hemodynamics.
Patients and methods
After the approval of the ethical committee in Kasr Al Ainy University Hospital, and parents’
consent, 16 ASA I and II infants (4–12 months) were allocated randomly to two main groups.
In group I, PSV was used from the start. In group II, spontaneous ventilation was started,
followed by switch to PSV once fatigue occurred; group II was subdivided into group IIa
(spontaneous ventilation) and group IIb (PSV). Recorded variables included tidal volume,
EtCO2, oxygen saturation, respiratory rate (RR), heart rate (HR), blood pressure, and arterial
blood sample analysis.
Results
Systolic and diastolic blood pressure and HR were higher in group IIa than group I (P = 0.0047,
0.0135, and 0.3575, respectively). EtCO2 and RR were also higher (P < 0.05). Vt was higher
in group I (P = 0.0092). Comparing groups IIa and IIb, systolic and diastolic blood pressure,
HR, RR, EtCO2, and PaCO2 were significantly higher in group IIa (P < 0.05). Vt was higher in
group IIb (P = 0.0053).
Conclusion
PSV in infants undergoing prolonged surgery without muscle relaxants is efficient in maintaining
normal EtCO2 and hemodynamics through avoidance of fatigue and maintaining normal Vt.