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M
Mostafa, M., M. Saeed, A. Hasanin, S. Badawy, and D. KHALED, "Accuracy of thyromental height test for predicting difficult intubation in elderly.", Journal of anesthesia, vol. 34, issue 2, pp. 217-223, 2020. Abstract

BACKGROUND: Studies of the accuracy of different airway tests are lacking in elderly. We evaluated and compared the accuracy of thyromental height in predicting difficult intubation in relation to the other traditional airway tests in elderly.

METHODS: We included 120 patients aged ≥ 65 years scheduled for general anesthesia with tracheal intubation. Thyromental height, modified Mallampati test, thyromental distance and sternomental distance were evaluated. Cormack-Lehane grade > 2 was considered difficult laryngoscopy. Difficult tracheal intubation was considered if successful intubation required more than 2 attempts. The accuracy of different tests in predicting difficult intubation and difficult laryngoscopy were evaluated through area under receiver operating characteristic (AUROC) curves. Univariate and multivariate analyses were conducted to identify risk factors for difficult intubation and difficult laryngoscopy.

RESULTS: Our cohort had a mean age of 71(7) years. We encountered difficult laryngoscopy in 15/120 (12%) patients, difficult intubation in 20/120 (17%) patients, and failed laryngoscopy requiring alternative methods for securing the airway in 3/120 (3%) patients. For predicting difficult intubation, thyromental height and modified Mallampati test showed the highest accuracy AUROC (95% confidence interval): 0.9 (0.83-0.95), cut-off value ≤ 5.9 cm, and AUROC (95% confidence interval): 0.89 (0.82-0.94), cut-off value > 2, respectively. Low thyromental height and high modified Mallampati test were the only independent risk factors for difficult laryngoscopy and difficult intubation.

CONCLUSION: In elderly scheduled for elective procedure, both thyromental height and modified Mallampati tests showed good accuracy in predicting difficult intubation and difficult laryngoscopy, whilst thyromental distance and sternomental distance were poor predictors.

Mohamed, H., S. M. Abbas, and A. Hasanin, "Management of post laryngectomy tracheobronchial tear with the aid of cardiopulmonary bypass", Journal of Clinical Anesthesia, vol. 55, pp. 128-129, 2019.
Mahmoud, M., A. M. Hasanin, M. Mostafa, F. Alhamade, B. A. Elhamid, and M. Elsherbeeny, "Evaluation of super-obesity and super-super-obesity as risk factors for difficult intubation in patients undergoing bariatric surgery.", Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery, vol. 17, issue 7, pp. 1279-1285, 2021. Abstract

BACKGROUND: Super-obesity is a serious disorder which requires bariatric surgery. The association of super-obesity and difficult intubation was not adequately established.

OBJECTIVES: To determine if super-obesity and super-super-obesity are associated with difficult intubation or not.

SETTING: University Hospital.

METHODS: A cohort of obese patients scheduled for bariatric surgery was prospectively recruited. Super-obesity and super-super-obesity were defined as body mass index ≥50 kg/m and 60 kg/m, respectively. Intubation difficulty was assessed by 2 methods: (1) intubation difficulty scale; (2) number of intubation attempts. Risk factors for difficult intubation were recorded. Univariate and multivariate analysis for risk factors for difficult intubation and difficult mask ventilation were performed.

RESULTS: A total of 658 patients were enrolled in the study including 205 (31%) super-obese and 52 (8%) super-super-obese patients. Ninety-nine (15%) patients required more than 1 intubation attempt, while 215 (33%) patients had intubation difficulty scale ≥5. Ninety-four (14.4%) patients had mask ventilation of moderate difficulty, while only 2 (.3%) patients needed 2-person ventilation. The independent risk factors for difficult intubation using the two stated definitions were STOP-Bang and Mallampati score values. The independent risk factors for mask ventilation of moderate difficulty were STOP-Bang score, Mallampati score, and limited neck extension.

CONCLUSION: Within obese patients, neither super-obesity nor super-super-obesity was associated with difficult intubation or difficult mask ventilation. High STOP-Bang and Mallampati score are the independent factors for difficult intubation.

L
ahmed lotfy, A. Hasanin, M. Rashad, M. Mostafa, D. Saad, M. Mahmoud, W. Hamimy, and A. Z. Fouad, "Peripheral perfusion index as a predictor of failed weaning from mechanical ventilation.", Journal of clinical monitoring and computing, vol. 35, issue 2, pp. 405-412, 2021. Abstract

We hypothesized that impairment of peripheral perfusion index (PPI) during spontaneous breathing trial (SBT) might be predictive of weaning failure. We included 44 consecutive, adult, patients, who were scheduled for weaning after at least 48 h of invasive mechanical ventilation in this prospective observational study. Weaning failure was defined as failed SBT or reintubation within 48 h of extubation. PPI readings were obtained before initiation of the SBT, and every 5 min till the end of the SBT. PPI ratio was calculated at every time point as: PPI value/ baseline PPI. The primary outcome was the accuracy of PPI ratio at the end of the SBT in detecting failed weaning. Forty-three patients were available for the final analysis. Eighteen patients (42%) were considered failed weaning. PPI ratio was higher in patients with successful weaning compared to patients with failed weaning during the last 15 min of the SBT. PPI ratio at the end of SBT was higher in patients with successful weaning compared to patients with failed weaning. PPI ratio at the end of SBT had good predictive ability for weaning failure {area under receiver operating characteristic curve (95% confidence interval): 0.833(0.688-0.929), cutoff value ≤ 1.41}. The change in PPI during SBT is an independent predictor for re-intubation. PPI could be a useful tool for monitoring the patient response to SBT. Patients with successful weaning showed higher augmentation of PPI during the SBT compared to re-intubated patients. Failure of augmenting the PPI by 41% at the end of SBT could predict re-intubation with negative predictive value of 95%. Clinical trial identifier: NCT03974568. https://clinicaltrials.gov/ct2/show/NCT03974568?term=ahmed+hasanin&draw=3&rank=17.

Lefrant, J. - Y., R. Pirracchio, D. Benhamou, M. - O. Fischer, R. Njeim, B. Allaouchiche, S. Bastide, M. Biais, L. Bouvet, O. Brissaud, et al., "Peace, not war in Ukraine or anywhere else, please.", Anaesthesia, critical care & pain medicine, vol. 41, issue 3, pp. 101068, 2022.
Lefrant, J. - Y., D. Benhamou, M. - O. Fischer, R. Pirracchio, B. Allaouchiche, S. Bastide, M. Biais, A. Blet, L. Bouvet, O. Brissaud, et al., "Comments on: Reducing the Risks of Nuclear War-The Role of Health Professionals.", Anaesthesia, critical care & pain medicine, pp. 101314, 2023.
K
Kamel, M. M., A. Hasanin, B. Nawar, M. Mostafa, V. F. Jacob, H. Elhadi, W. Alsadek, and S. A. Elmetwally, "Evaluation of noninvasive hemoglobin monitoring in children with congenital heart diseases.", Paediatric anaesthesia, vol. 30, issue 5, pp. 571-576, 2020. Abstract

BACKGROUND: Noninvasive measurement of blood hemoglobin could save time and decrease the risk of anemia and infection. The accuracy of CO-oximetry-derived noninvasive hemoglobin (Sp-Hb) had been evaluated in pediatric population; however, its accuracy in children with congenital heart disease has not been studied till date. We evaluated the accuracy of Sp-Hb in relation to laboratory-measured hemoglobin (Lab-Hb) in children with congenital heart disease.

METHODS: This prospective observational study included children with congenital heart disease undergoing procedural intervention. Sp-Hb measurements were obtained using Radical-7 Masimo pulse CO-oximeter and were compared against simultaneous Lab-Hb measurements obtained from the arterial line. Children were divided in cyanotic and acyanotic, and separate analysis was performed for each group. The values of both measurements were analyzed using Spearman's correlation coefficient and Bland-Altman analysis. Correlation was performed between Sp-Hb and Lab-Hb bias and each of arterial oxygen saturation and perfusion index.

RESULTS: One-hundred and eleven pairs of readings were obtained from 65 children. The median (quartiles) age and weight of the children were 1 (1.2-4) years and 11 (8-17) kg, respectively. There was moderate correlation between Lab-Hb and Sp-Hb with a correlation coefficient (95% confidence interval [CI]) of 0.75 (0.63-0.83) in acyanotic children and 0.62 (0.37-0.79) in cyanotic children. The mean bias (95% limits of agreements) was -0.4 g/dL (-2.4 to 1.6 g/dL) and 1 g/dL (-2.7 to 4.6 g/dL) in acyanotic and cyanotic children, respectively. The mean bias between Sp-Hb and Lab-Hb showed a weak negative correlation with oxygen saturation (r [95% CI]): (-0.36 [-0.51--0.18]), and a weak positive correlation with the perfusion index (r [95% CI]): (0.19 [0.01-0.37]).

CONCLUSION: The large bias and the wide limits of agreement between Sp-Hb and Lab-Hb denote that Masimo-derived Sp-Hb is not accurate in children with congenital heart disease especially in the cyanotic group; the error in Sp-Hb increases when oxygen saturation decreases.

H
Helmy, M. A., A. Hasanin, L. Magdy Milad, M. Mostafa, and S. Fathy, "Parasternal intercostal muscle thickening as a predictor of non-invasive ventilation failure in patients with COVID-19.", Anaesthesia, critical care & pain medicine, vol. 41, issue 3, pp. 101063, 2022.
Helmy, M. A., L. Magdy Milad, A. Hasanin, Y. S. Elbasha, H. A. ElSabbagh, M. S. ElMarzouky, M. Mostafa, A. K. Abdelhakeem, and M. A. E. - M. Morsy, "Ability of IMPROVE and IMPROVE-DD scores to predict outcomes in patients with severe COVID-19: a prospective observational study.", Scientific reports, vol. 12, issue 1, pp. 13323, 2022. Abstract

In this study we aimed to evaluate the ability of IMPROVE and IMPROVE-DD scores in predicting in-hospital mortality in patients with severe COVID-19. This prospective observational study included adult patients with severe COVID-19 within 12 h from admission. We recorded patients' demographic and laboratory data, Charlson comorbidity index (CCI), SpO at room air, acute physiology and chronic health evaluation II (APACHE II), IMPROVE score and IMPROVE-DD score. In-hospital mortality and incidence of clinical worsening (the need for invasive mechanical ventilation, vasopressors, renal replacement therapy) were recorded. Our outcomes included the ability of the IMPROVE and IMPROVE-DD to predict in-hospital mortality and clinical worsening using the area under receiver operating characteristic curve (AUC) analysis. Multivariate analysis was used to detect independent risk factors for the study outcomes. Eighty-nine patients were available for the final analysis. The IMPROVE and IMPROVE-DD score showed the highest ability for predicting in-hospital mortality (AUC [95% confidence intervals {CI}] 0.96 [0.90-0.99] and 0.96 [0.90-0.99], respectively) in comparison to other risk stratification tools (APACHE II, CCI, SpO). The AUC (95% CI) for IMPROVE and IMPROVE-DD to predict clinical worsening were 0.80 (0.70-0.88) and 0.79 (0.69-0.87), respectively. Using multivariate analysis, IMPROVE-DD and SpO were the only predictors for in-hospital mortality and clinical worsening. In patients with severe COVID-19, high IMPROVE and IMOROVE-DD scores showed excellent ability to predict in-hospital mortality and clinical worsening. Independent risk factors for in-hospital mortality and clinical worsening were IMPROVE-DD and SpO.

Helmy, M. A., L. M. Milad, A. M. Hasanin, M. Mostafa, A. H. Mannaa, M. M. Youssef, M. Abdelaziz, R. Alkonaiesy, M. M. Elshal, and Osama Hosny, "Parasternal intercostal thickening at hospital admission: a promising indicator for mechanical ventilation risk in subjects with severe COVID-19.", Journal of clinical monitoring and computing, vol. 37, issue 5, pp. 1287-1293, 2023. Abstract

We aimed to evaluate the ability of parasternal intercostal thickening fraction (PIC TF) to predict the need for mechanical ventilation, and survival in subjects with severe Coronavirus disease-2019 (COVID-19). This prospective observational study included adult subjects with severe COVID-19. The following data were collected within 12 h of admission: PIC TF, respiratory rate oxygenation index, [Formula: see text] ratio, chest CT, and acute physiology and chronic health evaluation II score. The ability of PIC TF to predict the need for ventilatory support (primary outcome) and a composite of invasive mechanical ventilation and/or 30-days mortality were performed using the area under the receiver operating characteristic (AUC) analysis. Multivariate analysis was done to identify the independent predictors for the outcomes. Fifty subjects were available for the final evaluation. The AUC (95% confidence interval [CI]) for the right and left PIC TF ability to predict the need for ventilator support was 0.94 (0.83-0.99), 0.94 (0.84-0.99), respectively, with a cut off value of > 8.3% and positive predictive value of 90-100%. The AUC for the right and left PIC TF to predict invasive mechanical ventilation and/or 30 days mortality was 0.95 (0.85-0.99) and 0.90 (0.78-0.97), respectively. In the multivariate analysis, only the PIC TF was found to independently predict invasive mechanical ventilation and/or 30-days mortality. In subjects with severe COVID-19, PIC TF of 8.3% can predict the need to ventilatory support with a positive predictive value of 90-100%. PIC TF is an independent risk factor for the need for invasive mechanical ventilation and/or 30-days mortality.

Helmy, M. A., L. M. Milad, A. Hasanin, E. A. Elsayed, O. Y. Kamel, M. Mostafa, S. Fathy, and M. Elsayad, "Bleeding and thrombotic complications in patients with severe COVID-19: A prospective observational study.", Health science reports, vol. 5, issue 4, pp. e736, 2022.
Helmy, M. A., L. Magdy Milad, S. H. Osman, M. A. Ali, and A. Hasanin, "Diaphragmatic excursion: A possible key player for predicting successful weaning in patients with severe COVID-19.", Anaesthesia, critical care & pain medicine, vol. 40, issue 3, pp. 100875, 2021.
Helmy, M. A., L. Magdy Milad, A. Hasanin, and M. Mostafa, "The novel use of diaphragmatic excursion on hospital admission to predict the need for ventilatory support in patients with coronavirus disease 2019.", Anaesthesia, critical care & pain medicine, vol. 40, issue 6, pp. 100976, 2021. Abstract

BACKGROUND: We aimed to evaluate the ability of diaphragmatic excursion at hospital admission to predict outcomes in patients with coronavirus disease-2019 (COVID-19).

METHODS: In this prospective observational study, we included adult patients with severe COVID-19 admitted to a tertiary hospital. Ultrasound examination of the diaphragm was performed within 12 h of admission. Other collected data included peripheral oxygen saturation (SpO), respiratory rate, and computed tomography (CT) score. The outcomes included the ability of diaphragmatic excursion, respiratory rate, SpO, and CT score at admission to predict the need for ventilatory support (need for non-invasive or invasive ventilation) and patient mortality using the area under the receiver operating characteristic curve (AUC) analysis. Univariate and multivariable analyses about the need for ventilatory support and mortality were performed.

RESULTS: Diaphragmatic excursion showed an excellent ability to predict the need for ventilatory support, which was the highest among respiratory rate, SpO, and CT score; the AUCs (95% confidence interval [CI]) was 0.96 (0.85-1.00) for the right diaphragmatic excursion and 0.94 (0.82-0.99) for the left diaphragmatic excursion. The right diaphragmatic excursion also had the highest AUC for predicting mortality in relation to respiratory rate, SpO, and CT score. Multivariable analysis revealed that low diaphragmatic excursion was an independent predictor of mortality with an odds ratio (95% CI) of 0.55 (0.31-0.98).

CONCLUSION: Diaphragmatic excursion on hospital admission can accurately predict the need for ventilatory support and mortality in patients with severe COVID-19. Low diaphragmatic excursion was an independent risk factor for in-hospital mortality.

Hassabelnaby, Y. S., A. M. Hasanin, N. Adly, M. M. A. Mostafa, S. Refaat, E. fouad, M. Elsonbaty, H. A. Hussein, M. Mahmoud, Y. M. Abdelwahab, et al., "Comparison of two Norepinephrine rescue bolus for Management of Post-spinal Hypotension during Cesarean Delivery: a randomized controlled trial.", BMC anesthesiology, vol. 20, issue 1, pp. 84, 2020. Abstract

BACKGROUND: Data on the best norepinephrine bolus dose for management of hypotension are limited. The aim of this study was to compare the efficacy and safety of two norepinephrine bolus doses in the rescue management of maternal hypotension during cesarean delivery.

METHODS: This randomized, controlled trial included mothers scheduled for cesarean delivery with spinal anesthesia with a prophylactic norepinephrine infusion. Following spinal anaesthesia administration, a participant was considered hypotensive if systolic blood pressure was ≤80% compared to the baseline reading. Participants were allocated to receive either 6 mcg or 10 mcg norepinephrine bolus for the management of hypotensive episodes. The hemodynamic response after administration of norepinephrine bolus was recorded. The episode was considered successfully managed if systolic blood pressure returned to within 80% from the baseline reading within 2 min after norepinephrine bolus administration, and did not drop again within 6 min after the norepinephrine bolus. The primary outcome was the incidence of successful management of the first hypotensive episode. Other outcomes included systolic blood pressure, heart rate, incidence of maternal bradycardia, and reactive hypertension.

RESULTS: One hundred and ten mothers developed hypotensive episodes and received norepinephrine boluses for management. The number of successfully managed first hypotensive episodes was 50/57 (88%) in the 6 mcg-treated episodes and 45/53 (85%) in the 10 mcg-treated episodes (p = 0.78). Systolic blood pressure was comparable after administration of either bolus dose. Heart rate was lower after administration of 10 mcg bolus compared to 6 mcg bolus, without significant bradycardia requiring atropine administration. The incidence of reactive hypertension was comparable between both groups.

CONCLUSION: In mothers undergoing elective cesarean delivery under prophylactic norepinephrine infusion at 0.05 mcg/kg/min, there was no advantage to the use of 10 mcg norepinephrine bolus over 6 mcg norepinephrine bolus for the rescue management of first hypotensive episode. Neither of the 2 bolus doses reached a 100% success rate. The incidences of bradycardia and reactive hypertension were comparable between both norepinephrine doses.

TRIAL REGISTRATION: At clinicaltrial.gov registry system on January 4, 2019 Clinical trial identifier: NCT03792906.

Hasanin, A., and S. Fathy, "In response: Was ketamine-lidocaine an adequate hypnotic agent in patients with septic shock?", Anaesthesia, critical care & pain medicine, vol. 41, issue 2, pp. 101041, 2022.
Hasanin, A., M. Abdulatif, and M. Mostafa, "Maternal hypotension and neonatal sequelae. Comment on Br J Anaesth 2020; 125: 588-95.", British journal of anaesthesia, vol. 127, issue 1, pp. e10-e11, 2021.
Hasanin, A. M., A. Abou Amer, Y. S. Hassabelnaby, M. Mostafa, A. Abdelnasser, S. M. Amin, M. Elsherbiny, and S. Refaat, "The use of epinephrine infusion for the prevention of spinal hypotension during Caesarean delivery: A randomized controlled dose-finding trial.", Anaesthesia, critical care & pain medicine, vol. 42, issue 3, pp. 101204, 2023. Abstract

BACKGROUND: This study aimed to compare three epinephrine doses for the prevention of spinal hypotension during Caesarean delivery.

METHODS: This randomized controlled trial included full-term pregnant women undergoing elective Caesarean delivery under spinal anesthesia. The participants received prophylactic epinephrine infusions at rates of 0.01, 0.02, or 0.03 mcg/kg/min. Spinal hypotension (systolic blood pressure <80% of baseline) was managed with a 9-mg ephedrine bolus. The primary outcome was the incidence of spinal hypotension. Secondary outcomes included total ephedrine requirement, the incidence of severe spinal hypotension, excessive tachycardia and hypertension, and neonatal outcomes.

RESULTS: The final analysis included 271 patients. The incidence of hypotension was lowest in the 0.03 mcg group (11/90 [12%]), followed by the 0.02 mcg (32/91 [35%]) and the 0.01 mcg (55/90 [61%]) groups (p < 0.001). The median ephedrine requirements (quartiles) were also the lowest in the 0.03 mcg group (0 [0-0] mg), followed by the 0.02 mcg (0 [0-9] mg) and the 0.01 mcg (9 [0-18] mg) groups. The incidence of severe hypotension was lower in the 0.03 mcg and 0.02 mcg groups than in the 0.01 mcg group (3/90 [3%], 5/91 [6%], and 15/90 [17%], respectively). The incidences of excessive tachycardia, hypertension, and neonatal outcomes were comparable among the groups.

CONCLUSION: The use of epinephrine to prevent spinal hypotension during Caesarean delivery is feasible and effective. An initial dose of 0.03 mcg/kg/min produced the lowest incidence of hypotension compared to 0.02 mcg/kg/min and 0.01 mcg/kg/min doses. The three doses were comparable in terms of the incidence of tachycardia, hypertension, and neonatal outcomes.

STUDY REGISTRATION: ClinicalTrials.gov Identifier: NCT05279703.

Hasanin, A., K. Taha, B. A. Elhamid, and S. M. Amin, "Evaluation of the effects of dexmedetomidine infusion on oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease", BMC Anesthesiology, vol. 18, issue 1, pp. 104, 2018.
Hasanin, A., "Reply to: Pulse oximeter perfusion index for assessment of brachial plexus block: a holy grail or a design fail?", British journal of anaesthesia, vol. 119, issue 6, pp. 1239, 2017 Dec 01.
Hasanin, A., and M. Mostafa, "Evaluation of fluid responsiveness during COVID-19 pandemic: what are the remaining choices?", Journal of anesthesia, vol. 34, pp. 758-764, 2020.
Hasanin, A. M., M. Mostafa, and M. Abdulatif, "The effect of intrathecal morphine on urinary bladder function after Caesarean delivery: risk-benefit dilemma.", Anaesthesia, critical care & pain medicine, vol. 42, issue 6, pp. 101287, 2023.
Hasanin, A., A. Mukhtar, and A. Mokhtar, "Syrian revolution: A field hospital under attack", American Journal Of Disaster Medicine, vol. 8, issue 4, pp. 259-65, 2013.
Hasanin, A. M., A. M. Mokhtar, S. M. Amin, and A. A. Sayed, "Preprocedural ultrasound examination versus manual palpation for thoracic epidural catheter insertion.", Saudi journal of anaesthesia, vol. 11, issue 1, pp. 62-66, 2017 Jan-Mar. Abstract

BACKGROUND AND AIMS: Ultrasound imaging before neuraxial blocks was reported to improve the ease of insertion and minimize the traumatic trials. However, the data about the use of ultrasound in thoracic epidural block are scanty. In this study, pre-insertion ultrasound scanning was compared to traditional manual palpation technique for insertion of the thoracic epidural catheter in abdominal operations.

SUBJECTS AND METHODS: Forty-eight patients scheduled to midline laparotomy under combined general anesthesia with thoracic epidural analgesia were included in the study. Patients were divided into two groups with regard to technique of epidural catheter insertion; ultrasound group (done ultrasound screening to determine the needle insertion point, angle of insertion, and depth of epidural space) and manual palpation group (used the traditional manual palpation technique). Number of puncture attempts, number of puncture levels, and number of needle redirection attempts were reported. Time of catheter insertion and complications were also reported in both groups.

RESULTS: Ultrasound group showed lower number of puncture attempts (1 [1, 1.25] vs. 1.5 [1, 2.75],= 0.008), puncture levels (1 (1, 1) vs. 1 [1, 2],= 0.002), and needle redirection attempts (0 [0, 2.25] vs. 3.5 [2, 5],= 0.00). Ultrasound-guided group showed shorter time for catheter insertion compared to manual palpation group (140 ± 24 s vs. 213 ± 71 s= 0.00).

CONCLUSION: Preprocedural ultrasound imaging increased the incidence of first pass success in thoracic epidural catheter insertion and reduced the catheter insertion time compared to manual palpation method.

Hasanin, A., K. H. Mourad, I. Farouk, S. Refaat, A. Nabih, S. A. E. Raouf, and H. Ezzat, "The Impact of Goal-Directed Fluid Therapy in Prolonged Major Abdominal Surgery on Extravascular Lung Water and Oxygenation: A Randomized Controlled Trial.", Open Access Macedonian Journal of Medical Sciences, vol. 7, issue 8, pp. 1276-1281, 2019.
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