Elhamid, B. A., S. Samy, A. Abdullah, A. Saad, M. Ollaek, and A. Ahmed, "Ketamine versus neostigmine as adjuvants to bupivacaine during ultrasound-guided serratus anterior plane block in modified radical mastectomy. A randomized controlled trial", Egyptian Journal of Anesthesia. , vol. 37, issue 1, pp. 356–363, 2021.
Ahmed, A., A. Lotfy, J. Elkholy, B. A. Elhamid, and M. Ollaek, "Perfusion index as an objective measure of postoperative pain in children undergoing adenotonsillectomy: a cohort study", Journal of Clinical Monitoring and Computing, 2021.
Ahmed, A., A. H. Sayed, J. Elkholy|, S. ElShal, A. Badwy, B. A. Elhamid, and M. Ollaek, "Intraoperative MgSO4 infusion protects oxygenation and lung mechanics in COPD patients during general anesthesia. A randomized clinical trial", Acta Anaesthesiologica Scandinavica, vol. 64, pp. 1460–1468, 2020.
Ahmed, A., M. Abdulatif, S. Abdullah, N. Abdularhman, and A. Mukhtar, "The use of peripheral perfusion index as a predictor for patient’s response to deliberate hypotension during functional endoscopic sinus surgery. A prospective observational study", Egyptian Journal Of Anesthesia, vol. 35, issue 1, pp. 88-, 2019.
Ahmed, A., M. Fawzy, M. A. R. Nasr, A. HussamHussam, E. fouad, H. Aboueldahab, D. Saad, S. Osman, R. S. Fahmy, M. Farid, et al., "Ultrasound-guided quadratus lumborum block for postoperative pain control in patients undergoing unilateral inguinal hernia repair, a comparative study between two approaches", BMC, vol. 19, issue 1, pp. 184, 2019.
Ahmed, A., D. Saad, and Abdel Rahman Youness, "Superior Laryngeal Nerve block as an adjuvant to General Anesthesia during endoscopic laryngeal surgeries. A randomized controlled trial.", Egyptian Journal of Anaesthesia , vol. 31, pp. 167-174, 2015. Abstract

Background: Direct rigid endoscopic laryngosurgery is a short procedure usually performed
under general anesthesia. This is a double blinded randomized placebo-controlled trial, that was
designed to evaluate the effect of bilateral block of the internal branch of superior laryngeal nerve
(SLN) as an adjuvant to general anesthesia during endoscopic laryngeal surgery when smaller dose of
muscle relaxant is used.
Method: Seventy-six patients required endoscopic laryngosurgery in whom general anesthesia was
preceded by bilateral superior laryngeal nerve block either with 2%lidocaine (L-group) or with saline
(C- group).
Results: the reaction to endotracheal tube insertion was better in L-group as less frequent cough
occurred in L-group (one patient) compared with (8 patients) in C-group (P value < 0.05). The
maximum pressor response was observed immediately after intubation, at which the increase in MAP
from baseline in C-group (24.4%) was significantly higher than in L-group (6.4%) (P<0.05) and the
increase in HR from baseline in C-group (29.5 %) was significantly higher than in L- group (14.8 %)
(P<0.05). The MAP and HR remain significantly higher in C-group than that of the L-group all through
the intraoperative period. The incidence of severe cough was significantly higher in C-group just before
extubation (bucking), 5min & 30 minutes post extubation. Incidence and severity of postoperative sore
throat was significantly higher in C-group in the first 4 hours postoperatively.
Conclusion: During endoscopic laryngeal surgeries,using bilateral block of the internal branch of
superior laryngeal nerve as an adjuvant to general anesthesia was associated with better intubation
conditions, better intraoperative hemodynamic response to intubation and surgical procedure and
better recovery profile in form of improved postoperative cough and sore throat.

rahman, N. A. I., Eman A. Fouad, A. Ahmed, and K. Taha, "Difficult airway management patterns among anesthesiologists practicing in Cairo University Hospitals A survey study", Egyptian Journal of Anesthesia , vol. 32, pp. 67-75, 2016. Abstract

Study objectives: This study was designed to evaluate how the anesthesiologists in Cairo
University Hospitals are adherent in their practice to the latest ASA guidelines for management of
difficult airway in order to stand on the current status and establish a basis for improvement.
Methods: This is a survey study included 190 anesthesiologists from the faculty members of Cairo
university hospitals. All of them completed the study questionnaire.
Main results: A 77.9% of the responders admitted their use of the ASA Algorithm during their
practice. For anticipated difficult airway, 74% would employ regional anesthesia as first choice
while 52% and 54% would use Supraglottic airway devices and awake Fiberoptic respectively.
For unanticipated failed intubation with adequate mask ventilation, 90% would use a supraglottic
airway device as their first choice while 85% and 90% would wake up the patient, perform awake
fiberoptic intubation and make an emergency invasive airway access respectively. For failed intubation
with difficult/impossible mask ventilation, 87%would use a supraglottic airway device while 51%and
28% would perform needle cricothyroidotomy and percutaneous tracheostomy respectively. Awake
fiberoptic intubation and intubation with direct laryngoscope using intravenous induction and succinylcholine
were the most frequently used techniques in different clinical scenarios.
Conclusion: The practice of anesthesiologists in Cairo university hospitals is close to the recommendations
of the ASA guidelines for management of difficult airway. There is increased skills in fiberoptic
bronchoscopes and SGA with increased frequency of difficult airway managements training courses;
however, they need to improve their skills in awake fiberoptic intubations technique and they need to
be trained on invasive airway management access to close the discrepancy between their theoretical
choices in different situations and their actual skills.

Helmy, A., A. Mukhtar, A. Ahmed, N. E. Sief, and A. Hussein, "The intraoperative therapeutic equivalence of balanced vs saline-based 6% hydroxyethyl starch 130/0.4 and their influence on perioperative acid-base status and renal functions.", Journal of clinical anesthesia, vol. 32, pp. 267-73, 2016 Aug. Abstract

STUDY OBJECTIVE: This study was designed to evaluate the therapeutic equivalence of balanced 6% hydroxyethyl starch (HES) 130/0.4 (Tetraspan) vs saline-based 6% HES 130/0.4 (Voluven) regarding the volume effect and the effect on acid-base status and renal functions in patients undergoing major urologic procedures.

DESIGN: Randomized comparative trial.

SETTING: Operating room and ward.

PATIENTS: Forty patients, American Society of Anesthesiologists statuses 1 and 2.

INTERVENTION: Patients were randomly allocated to receive either Voluven (n = 20) or Tetraspan (n = 20).

MEASUREMENTS: Hemodynamic variables. Laboratory variables in the form of arterial blood gases, serum chloride and sodium levels, hemoglobin level, international normalized ratio, and kidney and liver functions were measured after induction of anesthesia (T1), at the end of surgery (T2), and on the first postoperative day (T3).

MAIN RESULTS: Both groups were comparable regarding the total amount of study drugs and crystalloid consumption. No significant difference in hemoglobin levels between both groups, but there were significant differences between T1 and T2 hemoglobin within both groups and T3 hemoglobin in the Tetraspan group. Both groups were comparable regarding the renal functions, but there was a significant difference between T1 and T2 creatinine within both groups. No significant differences between both groups in liver functions and coagulation profile, but there were significant differences between values at T1, T2 and T3 within each group. Relative to baseline, both pH and bicarbonate decrease significantly in both groups. In the Voluven group, bicarbonate decreased significantly at the end of surgery relative to the Tetraspan group. Serum electrolytes did not vary between both groups.

CONCLUSION: Both balanced 6% HES 130/0.4 (Tetraspan) and saline-based 6% HES 130/0.4 (Voluven) were equally effective for hemodynamic stabilization of patients undergoing major urologic procedures without any significant impact on acid-base status or renal functions.

Abdel-Aziz, M., A. Ahmed, N. Naguib, and M. I. Abdel-Khalik, "The effect of steroid injection of the tongue base on reducing postoperative airway obstruction in cleft palate repair.", International journal of oral and maxillofacial surgery, vol. 41, issue 5, pp. 612-5, 2012 May. Abstract

Upper airway obstruction (UAO) is a well known complication of cleft palate repair. The aim of this study was to evaluate the efficacy of local tongue base steroid injection in preventing or reducing the lingual oedema that can cause UAO following palatoplasty. Thirty children with unilateral complete cleft palate were included. They were randomly divided into two equal groups. Children in group I received intravenous dexamethasone whilst children in group II received both intravenous dexamethasone and local betamethasone injected at the tongue base. Both groups underwent the same technique of palatoplasty, postoperative breathing was assessed and UAO was rated as mild, moderate or severe. Postoperative UAO developed in six cases (40%) in group I and in two cases (13%) in group II. In group I, it was mild in three cases, moderate in one case, and severe in two cases. In group II, it was mild in one case and moderate in another case. Despite the differences in the number and severity of the condition in both groups, comparison was statistically insignificant. Local steroid injection of the tongue base during cleft palate surgery reduced the incidence and severity of post-palatoplasty UAO.

Badawy, S. S. I., N. M. Meckawy, and A. Ahmed, "Norepinephrine versus terlipressin in patients with type 1 hepatorenal syndrome refractory to treatment with octreotide, midodrine, and albumin: a prospective randomized comparative study", The Egyptian Journal of Cardiothoracic Anesthesia , vol. 7, pp. 13-18, 2013. Abstract

Background and objectives
Hepatorenal syndrome (HRS) is a functional renal failure complicating end-stage liver
disease. Management of HRS is based on therapy with vasoconstrictors and albumin.
The aim of this prospective, randomized, comparative study was to evaluate the
efficacy of norepinephrine versus terlipressin in the management of patients with type
1 HRS refractory to treatment with octreotide, midodrine, and albumin.
This study included 60 patients with type 1 HRS refractory to treatment with
octreotide, midodrine, and albumin for 72 h. Patients were randomized to receive
norepinephrine or terlipressin plus albumin. The outcomes assessed were as follows:
kidney functions, reversal of HRS, survival rate at day 30, and cost of the study
The final statistical analysis included 51 patients; 26 in the terlipressin group and 25 in
the norepinephrine group. Demographic data and baseline patient characteristics were
comparable in the two groups. The incidences of HRS reversal were comparable in
the two groups. In both groups, there was an improvement in kidney functions.
The responders in both groups showed a significant improvement in kidney functions
at the end of the study compared with baseline. There was a significant progressive
decrease in serum creatinine (Pr0.05) levels and a significant progressive increase in
creatinine clearance (Pr0.05) and urine output (Pr0.05) compared with baseline.
Both groups were comparable throughout the study. The survival rates at day 30 were
comparable in the two groups. The cost of norepinephrine therapy was significantly
lower than that of terlipressin therapy (57 560± 16 870 vs. 13 492± 7694 Egyptian
pounds; Pr0.05).
The results of this study suggested that norepinephrine is as effective as terlipressin in
the management of patients with type 1 HRS.