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Hasanin, A., A. Aiyad, A. Elsakka, M. OSMAN, A. Kamel, A. Mokhar, S. Refaat, R. Fouad, and Y. Hassabelnaby, "Leg elevation decreases the incidence of post-spinal hypotension in cesarean section: a randomized controlled trial", BMC Anesthesiology, vol. 17, issue 1, pp. 60, 2017.
Hasanin, A., and M. Abdulatif, "Phenylephrine and norepinephrine for the management of spinal-induced hypotension in preeclamptic patients: Hypothesis-study design mismatch.", European journal of anaesthesiology, vol. 39, issue 3, pp. 291-292, 2022.
Hasanin, A., S. Amin, N. Agiza, M. Hassan, and S. Refaat, "Norepinephrine Infusion for Preventing Postspinal Anesthesia Hypotension during Cesarean Delivery: A Randomized Dose-finding Trial.", Anesthesiology, vol. 130, issue 1, pp. 55-62, 2019.
Hasanin, A., K. de Vasconcellos, and M. Abdulatif, "COVID-19 in Africa: Current difficulties and future challenges considering the ACCCOS study.", Anaesthesia, critical care & pain medicine, vol. 40, issue 4, pp. 100912, 2021.
Hasanin, A., R. Soryal, T. Kaddah, S. A. E. Raouf, Y. Abdelwahab, K. Elshafaei, M. Elsayad, B. A. Elhamid, R. Fouad, D. Mahmoud, et al., "Hemodynamic effects of lateral tilt before and after spinal anesthesia during cesarean delivery: an observational study.", BMC anesthesiology, vol. 18, issue 1, pp. 8, 2018 01 15. Abstract

BACKGROUND: Post-spinal hypotension is a common maternal complication during cesarean delivery. Aortocaval compression by the gravid uterus has been assumed as a precipitating factor for post-spinal hypotension. The role of left lateral tilting position in improving maternal cardiac output after subarachnoid block (SAB) is unclear. The aim of this work is to investigate the effect of left lateral tilting on maternal hemodynamics after SAB.

METHODS: A prospective observational study was conducted including 105 full term pregnant women scheduled for cesarean delivery. Mean arterial pressure, heart rate, cardiac output (measured by electrical cardiometry), stroke volume, and systemic vascular resistance were recorded in three positions (supine, 15, and 30left lateral positions) before SAB, after SAB, and after delivery of the fetus.

RESULTS: Before SAB, no significant hemodynamic changes were reported with left lateral tilting. A significant decrease was reported in mean arterial pressure, cardiac output, stroke volume, and systemic vascular resistance after SAB (in supine position). When performing left lateral tilting, there was an increase in cardiac output, heart rate, and mean arterial pressure. No difference was reported between the two tilt angles (15and 30).

CONCLUSIONS: Changing position of full term pregnant woman after SAB from supine to left lateral tilted position results increased cardiac output and mean arterial pressure. There is no difference between the two tilt angles (15and 30).

TRIAL REGISTRATION: ( NCT02828176 ) retrospectively registered.

Hasanin, A., and M. Mostafa, "A reply to a letter", Journal of anesthesia, vol. 34, pp. 631, 2020.
Hasanin, A., A. Abdelmottaleb, H. Elhadi, A. S. Arafa, and M. Mostafa, "Evaluation of gastric residual volume using ultrasound in fasting patients with uncomplicated appendicitis scheduled for appendectomy.", Anaesthesia, critical care & pain medicine, vol. 40, issue 3, pp. 100869, 2021.
Hasanin, A., N. Karam, M. Mostafa, A. Abdelnasser, W. Hamimy, A. Z. Fouad, akram eladawy, and ahmed lotfy, "THE ACCURACY OF INFERIOR VENA CAVA DISTENSIBILITY THROUGH THE TRANSHEPATIC APPROACH TO PREDICT FLUID RESPONSIVENESS IN PATIENTS WITH SEPTIC SHOCK AFTER EMERGENCY LAPAROTOMY.", Shock (Augusta, Ga.), vol. 60, issue 4, pp. 560-564, 2023. Abstract

Background: We aimed to evaluate the ability of inferior vena cava (IVC) distensibility using the transhepatic approach to predict fluid responsiveness in mechanically ventilated patients with septic shock after emergency laparotomy. Methods: This prospective observational study included mechanically ventilated paralyzed adult who had septic shock after emergency laparotomy. The IVC dimensions were measured through the transhepatic and subxiphoid approaches. The fluid responsiveness was confirmed with >15% increase in cardiac output after 500 mL of fluid bolus. The outcomes were the ability of transhepatic (primary outcome) and subxiphoid approach to predict fluid responders using the area under the receiver operating characteristics curve analysis. The gray zone for the two approaches was calculated. Results: Data from 51 patients were analyzed, and the number of fluid responders was 30 of 52 (58%). The transhepatic approach was feasible in all patients, whereas the subxiphoid approach was only feasible in 42 patients. The area under the receiver operating characteristics curve (95% confidence interval) for the transhepatic IVC distensibility was 0.88 (0.76-0.95), and it was comparable with that of the subxiphoid approach (0.81 [0.66-0.92], P = 0.417). The gray zone for the transhepatic IVC distensibility was 17% to 35% including 24 of 51 patients (47%), whereas the gray zone for the subxiphoid IVC distensibility was 13% to 34% including 18 of 42 patients (43%). Conclusion: In conclusion, the transhepatic approach for evaluation of IVC distensibility showed good accuracy in predicting fluid responsiveness in patients with septic shock after emergency laparotomy. The transhepatic approach showed the same accuracy as the subxiphoid approach with the advantage of being feasible in larger number of patients.

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.
Hasanin, A., A. Mukhtar, A. El-adawy, H. Nassar, D. Saad, S. Osman, A. Ahmed, A. Zaghlol, M. Sarhan, and M. Reda, "The Friday of Rage of the Egyptian Revolution: A Unique Role for Anesthesiologists", Anesthesia and Analgesia, vol. 114, issue 4, pp. 862-65, 2012.
Hasanin, A., A. Mukhtar, and H. Nassar, "Perfusion indices revisited", Journal of Intensive Care, vol. 5, pp. 24, 2017.
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.
Hasanin, A., A. Aboelela, M. Mostafa, R. M. Mansour, and A. Kareem, "The Use of Topical Nitroglycerin to Facilitate Radial Arterial Catheter Insertion in Children: A Randomized Controlled Trial.", Journal of cardiothoracic and vascular anesthesia, vol. 34, issue 12, pp. 3354-3360, 2020. Abstract

OBJECTIVES: To determine whether the use of topical nitroglycerin patch increases radial artery diameter and facilitate cannulation in children.

DESIGN: Randomized controlled trial.

SETTING: Cairo University Hospital.

PARTICIPANTS: Children aged 2 to 8 years old scheduled for cardiac surgery.

INTERVENTION: In the nitroglycerin group (n = 20), a gauze-covered, half-sized nitroglycerin patch (5 mg) was applied at the site of radial pulsation 1 hour before induction of anesthesia. In the control group (n = 20), a gauze pad was applied to the bare skin at the site of radial pulsation with no intervention.

MEASUREMENTS AND MAIN RESULTS: The primary outcome was the diameter of the radial artery in both limbs using ultrasonography. Other outcomes included the degree of arterial palpability, number of arterial punctures, and incidence of successful first puncture cannulation. The radial artery diameter increased after 30 minutes and 60 minutes compared with the baseline value in the nitroglycerin group in both limbs, whereas no change was reported in the radial artery diameter in the control group. The nitroglycerin group showed a greater incidence of successful first cannulation trial, a fewer number of trials, and a shorter cannulation time compared with the control group. There were no significant hypotensive episodes in any patient.

CONCLUSION: Local application of a half-sized, 5 mg nitroglycerin patch for 60 minutes in children increased the radial artery diameter bilaterally, increased the rate of first trial success, and decreased the time needed for arterial cannulation without significant hypotensive episodes.

Hasanin, A., M. Abdulatif, and M. Mostafa, "Is invasive blood pressure monitoring harmful?", European journal of anaesthesiology, vol. 39, issue 2, pp. 178-180, 2022.
Hasanin, A., A. Kamal, S. Amin, D. Zakaria, R. E. Sayed, kareem mahmoud, and A. Mukhtar, "Incidence and outcome of cardiac injury in patients with severe head trauma", Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, vol. 24, pp. 58, 2016.
Hasanin, A., S. Habib, Y. Abdelwahab, M. Elsayad, M. Mostafa, and M. Zayed, "Variable Versus Fixed-Rate Infusion of Phenylephrine During Cesarean Delivery: A Randomized Controlled Trial", BMC Anesthesiology, vol. 19, issue 1, pp. 197, 2019.
Hasanin, A., H. Tarek, M. M. A. Mostafa, A. Arafa, A. G. Safina, M. H. Elsherbiny, Osama Hosny, A. A. Gado, T. Almenesey, G. A. Hamden, et al., "Modified-ramped position: a new position for intubation of obese females: a randomized controlled pilot study.", BMC anesthesiology, vol. 20, issue 1, pp. 151, 2020. Abstract

BACKGROUND: Endotracheal intubation requires optimum position of the head and neck. In obese females, the usual ramped position might not provide adequate intubating conditions. We hypothesized that a new position, termed modified-ramped position, during induction of anesthesia would facilitate endotracheal intubation through bringing the breasts away from the laryngoscope and would also improve the laryngeal visualization.

METHODS: Sixty obese female patients scheduled for general anesthesia were randomly assigned into either ramped or modified-ramped position during induction of anesthesia. In the ramped position (n = 30), the patient head and shoulders were elevated to achieve alignment of the sternal notch and the external auditory meatus; while in the modified-ramped position (n = 30), the patient shoulders were elevated using a special pillow, and the head was extended to the most possible range. Our primary outcome was the incidence of failed laryngoscopic insertion in the oral cavity (the need for patient repositioning). Other outcomes included time till vocal cord visualization, time till successful endotracheal intubation, difficulty of the mask ventilation, and Cormack-Lehane grade for laryngeal view.

RESULTS: Fourteen patients (47%) in ramped group required repositioning to facilitate introduction of the laryngoscope in the oral cavity in comparison to one patient (3%) in the modified-ramped position (p < 0.001). Modified-ramped position showed lower incidence of difficult mask ventilation, shorter time for glottic visualization, and shorter time for endotracheal tube insertion compared to the ramped position. The Cormack-Lehane grade was better in the modified-ramped position.

CONCLUSION: Modified-ramped position provided better intubating conditions, improved the laryngeal view, and eliminated the need for repositioning of obese female patients during insertion of the laryngoscope compared to ramped position.

CLINICAL TRIAL REGISTRATION: Identifier: NCT03640442. Date: August 2018.

Hasanin, A., and M. Mostafa, "Tocilizumab in patients with COVID-19: which patient, time, and dose?", Journal of anesthesia, 2021. Abstract

Tocilizumab (TCZ) is a recombinant anti-interleukin-6 monoclonal antibody which showed uprising evidence as an anti-inflammatory agent which modulates the cytokine storm in patients with COVID-19. However, proper use of the drug requires selection of the appropriate patient and timing. The two main factors which might improve patient selection are the degree of respiratory failure and systemic inflammation. TCZ can decrease the mortality and progression to invasive mechanical ventilation in patients with severe COVID-19 who are not yet invasively ventilated. However, its use in invasively ventilated patients did not yet gain the same level of evidence especially when administered after > 1 day from mechanical ventilation. Being an anti-inflammatory and immunomodulatory drug, TCZ was mostly used in patients with COVID-19 who have clear signs of cytokine storm. However, the drug still showed positive response in some studies which did not strictly select patients with elevated markers of systemic inflammation. Thus, it is warranted to investigate and/or re-analyze the role of the drug in patients with severe COVID-19 and with no signs of systemic inflammation. TCZ is used in a dose of 8 mg/kg which can be repeated if there was no clinical improvement. However, there are no clear criteria for judgment of the success of the first dose. Being a drug with a major effect on gross outcomes in a serious pandemic with millions of mortalities, TCZ should be meticulously investigated to reach definitive indications and number of doses to avoid drug overuse, shortage, and side effects.

Hasanin, A., M. Mostafa, and M. Abdulatif, "Combined Thoracic Spinal-Epidural Anesthesia in Laparoscopic Sleeve Gastrectomy: a Risk-Benefit Assessment.", Obesity surgery, vol. 32, issue 6, pp. 2092-2093, 2022.
Hasanin, A., "Fluid responsiveness in acute circulatory failure", Journal of Intensive Care, vol. 3, pp. 50, 2015.
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.
Hasanin, A., and Y. Hassabelnaby, "Perioperative non-invasive haemodynamic optimisation: Is photoplethysmography really useless?", Anaesthesia Critical care & Pain Medicine, vol. 39, pp. 625, 2020.
Hasanin, A., N. Karam, A. H. M. E. D. M. MUKHTAR, and S. F. Habib, "The ability of pulse oximetry-derived peripheral perfusion index to detect fluid responsiveness in patients with septic shock.", Journal of anesthesia, vol. 35, issue 2, pp. 254-261, 2021. Abstract

BACKGROUND: Fluid challenge test is a widely used method for the detection of fluid responsiveness in acute circulatory failure. However, detection of the patient's response to the fluid challenge requires monitoring of cardiac output which is not feasible in many settings. We investigated whether the changes in the pulse oximetry-derived peripheral perfusion index (PPI), as a non-invasive surrogate of cardiac output, can detect fluid responsiveness using the fluid challenge test or not.

METHODS: We prospectively enrolled 58 patients with septic shock on norepinephrine infusion. Fluid challenge test, using 200 mL crystalloid solution, was performed in all study subjects. All patients received an additional 300 mL crystalloid infusion to confirm fluid responsiveness. Velocity time integral (VTI) (using transthoracic echocardiography), and PPI were measured at the baseline, after 200 mL fluid challenge, and after completion of 500 mL crystalloids. Fluid responsiveness was defined by 10% increase in the VTI after completion of the 500 mL. The predictive ability of ∆PPI [Calculated as (PPI after 200 mL - baseline PPI)/baseline PPI] to detect fluid responders was obtained using the receiver operating characteristic curve.

RESULTS: Forty-two patients (74%) were fluid responders; in whom, the mean arterial pressure, the central venous pressure, the VTI, and the PPI increased after fluid administration compared to the baseline values. ∆PPI showed moderate ability to detect fluid responders [area under receiver operating characteristic curve (95% confidence interval) 0.82 (0.70-0.91), sensitivity 76%, specificity 80%, positive predictive value 92%, negative predictive value 54%, cutoff value ≥ 5%]. There was a significant correlation between ∆PPI and ∆VTI induced by the fluid challenge.

CONCLUSION: ∆PPI showed moderate ability to detect fluid responsiveness in patients with septic shock on norepinephrine infusion. Increased PPI after 200 mL crystalloid challenge can detect fluid responsiveness with a positive predictive value of 92%; however, failure of the PPI to increase does not exclude fluid responsiveness.

CLINICAL TRIAL IDENTIFIER: NCT03805321. Date of registration: 15 January 2019. Clinical trial registration URL:;rank=9 .

Hasanin, A., M. N. Salem, and M. Abdulatif, "Should we infuse more fluids in liver resection surgery?", European journal of anaesthesiology, vol. 39, issue 9, pp. 789-790, 2022.
Hasanin, A., N. Sherif, M. Elbarbary, and D. Mansor, "Providing medical care in unfamiliar settings; experience of an Egyptian campaign in Uganda", Pan African Medical Journal, vol. 17, pp. 111, 2014.