Hasanin, A., F. Sanfilippo, M. W. Dünser, H. M. Ahmed, L. Zieleskiewicz, S. N. Myatra, and M. Mostafa, "The MINUTES bundle for the initial 30 min management of undifferentiated circulatory shock: an expert opinion.", International journal of emergency medicine, vol. 17, issue 1, pp. 96, 2024. Abstract

Acute circulatory shock is a life-threatening emergency requiring an efficient and timely management plan, which varies according to shock etiology and pathophysiology. Specific guidelines have been developed for each type of shock; however, there is a need for a clear timeline to promptly implement initial life-saving interventions during the early phase of shock recognition and management. A simple, easily memorable bundle of interventions could facilitate standardized management with clear targets and specified timeline. The authors propose the "MINUTES" acronym which summarizes essential interventions which should be performed within the first 30 min following shock recognition. All the interventions in the MINUTES bundle are suitable for any patient with undifferentiated shock. In addition to the acronym, we suggest a timeline for each step, balancing the feasibility and urgency of each intervention. The MINUTES acronym includes seven sequential steps which should be performed in the first 30 min following shock recognition: Maintain "ABCs", INfuse vasopressors and/or fluids (to support hemodynamic/perfusion) and INvestigate with simple blood tests, Ultrasound to detect the type of shock, Treat the underlying Etiology, and Stabilize organ perfusion.

Hasanin, A., M. Abdulatif, and M. Mostafa, "Alveolar recruitment in patients with obesity: Is it really effective?", Anaesthesia, critical care & pain medicine, vol. 40, issue 4, pp. 100900, 2021.
Mostafa, M., A. Hasanin, M. Mostafa, M. Y. Taha, M. Elsayad, F. A. Haggag, O. Taalab, A. Rady, and B. A. Elhamid, "Hemodynamic effects of norepinephrine versus phenylephrine infusion for prophylaxis against spinal anesthesia-induced hypotension in the elderly population undergoing hip fracture surgery: a randomized controlled trial.", Korean journal of anesthesiology, vol. 74, issue 4, pp. 308-316, 2021. Abstract

BACKGROUND: Elderly population are at increased risk of spinal anesthesia-induced hypotension increasing their risk for postoperative morbidity and mortality. This study aimed to compare the hemodynamic effects of prophylactic infusion of norepinephrine (NE) versus phenylephrine (PE) in elderly patients undergoing hip fracture surgery under spinal anesthesia.

METHODS: Elderly patients scheduled for hip fracture surgery were randomized to receive either NE infusion (8 µg/min) (NE group, n = 31) or PE infusion (100 µg/min) (PE group, n = 31) after spinal anesthesia. Outcomes included mean heart rate, mean blood pressure, cardiac output, incidence of spinal anesthesia-induced hypotension, incidence of bradycardia, and incidence of hypertension.

RESULTS: Sixty-two patients with a mean age of 71 ± 6 years were included in the final analysis (31 patients in each group). The NE group showed a higher mean heart rate and cardiac output than the PE group. The NE group had a lower incidence of reactive bradycardia (10% vs. 36%, P = 0.031) and hypertension (3% vs. 36%, P = 0.003) than the PE group. No study participant developed hypotension, and the mean blood pressure was comparable between the two groups.

CONCLUSIONS: Both NE and PE infusions effectively prevented spinal anesthesia-induced hypotension in elderly patients undergoing hip fracture surgery. However, NE provided more hemodynamic stability than PE; maintaining the heart rate, higher cardiac output, less reactive bradycardia, and hypertension.

Mostafa, M., N. A. Helmy, A. S. Ibrahim, M. Elsayad, and A. M. Hasanin, "Accuracy of infrared thermography in detecting febrile critically ill patients.", Anaesthesia, critical care & pain medicine, vol. 40, issue 5, pp. 100951, 2021.
Elshal, M. M., A. M. Hasanin, M. Mostafa, and R. M. Gamal, "Plethysmographic Peripheral Perfusion Index: Could It Be a New Vital Sign?", Frontiers in medicine, vol. 8, pp. 651909, 2021. Abstract

The plethysmographic peripheral perfusion index (PPI) is a very useful parameter with various emerging utilities in medical practice. The PPI represents the ratio between pulsatile and non-pulsatile portions in peripheral circulation and is mainly affected by two main determinants: cardiac output and balance between sympathetic and parasympathetic nervous systems. The PPI decreases in cases of sympathetic predominance and/or low cardiac output states; therefore, it is a useful predictor of patient outcomes in critical care units. The PPI could be a surrogate for cardiac output in tests for fluid responsiveness, as an objective measure of pain especially in un-cooperative patients, and as a predictor of successful weaning from mechanical ventilation. The PPI is simple to measure, easy to interpret, and has continuously displayed variables, making it a convenient parameter for detecting the adequacy of blood flow and sympathetic-parasympathetic balance.

Hasanin, A. M., maha m mostafa, and M. Abdulatif, "Comment on: "Perioperative goal-directed therapy in high-risk abdominal surgery. A multicenter randomized controlled superiority trial".", Journal of clinical anesthesia, vol. 75, pp. 110557, 2021.
Mostafa, M., and A. Hasanin, "Appropriate intraoperative haemodynamic targets. Comment on Br J Anaesth 2021; 127: 396-404.", British journal of anaesthesia, vol. 128, issue 1, pp. e13-e14, 2022.
Sarhan, K., A. Hasanin, R. Melad, R. Fouad, H. Elhadi, M. Elsherbeeny, A. Arafa, and M. Mostafa, "Evaluation of gastric contents using ultrasound in full-term pregnant women fasted for 8 h: a prospective observational study.", Journal of anesthesia, vol. 36, issue 1, pp. 137-142, 2022. Abstract

BACKGROUND: We aimed to evaluate the gastric volume and contents after an 8-h fasting period in full-term, non-laboring, pregnant women following a standardized meal.

METHODS: In this prospective observational study, we included full-term pregnant women scheduled for elective cesarean delivery. The participants were instructed to fast after a standardized meal (apple juice, bread, and cheese). Participants were scanned in the semi-recumbent and right-lateral positions 8 h after the standardized meal. The primary outcome was the proportion of patients with gastric volume > 1.5 mL kg calculated by two equations. Secondary outcomes included the antral cross-sectional area and gastric volume. Data are expressed as frequency (%, 95% confidence interval [CI]), mean ± standard deviation (95% CI of the mean), or median (quartiles) as appropriate.

RESULTS: Forty-one women were available for the final analysis. For the primary outcome, one participant (2.4%, 95% CI of 0.06 to 12.8%) had gastric volume > 1.5 mL kg, and none had solids in the antrum. For the secondary outcomes, the mean (95% CI of the mean) of the antral cross-sectional area was 2.11 ± 0.72 (1.88 to 2.34) cm and 4.08 ± 1.80 (3.51 to 4.65) cm during the semi-recumbent and right-lateral position, respectively. The median (quartiles) gastric volume was 0.53 (0.32, 0.66) mL kg and 0.33 (0.13, 0.52) mL kg as estimated by Perlas et al. and Roukhomovsky et al. equations, respectively.

CONCLUSION: After 8-h fasting following a standardized meal, full-term pregnant non-laboring women are less likely to have a high residual gastric volume.

Hasanin, A., and S. A. El Beih, "Appropriate fluid management in emergency abdominal surgery. Comment on Br J Anaesth 2021; 127: 521-31.", British journal of anaesthesia, vol. 128, issue 2, pp. e58-e59, 2022.
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