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Journal Article
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., 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: clinicaltrials.gov ( NCT02828176 ) retrospectively registered.

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.

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.
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., 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.
Mukhtar, A., A. Hasanin, A. Abelaal, and G. Obayah, "Infection complications and pattern of bacterial resistance in living-donor liver transplantation: A multicenter epidemiologic study in Egypt", transplantation proceedings, vol. 46, issue 5, pp. 1444-7, 2014.
Ahmed Mukhtar, Ahmed Hasanin, G. O. A. A., "Intraoperative Terlipressin Therapy Reduces the Incidence of Postoperative Acute Kidney Injury After Living Donor Liver Transplantation", Journal of cardiothoracic and vascular anesthesia, 2015.
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.
Ali, H., B. M. A. Elhamid, A. M. Hasanin, A. Abou Amer, and A. Rady, "Ketamine-based Versus Fentanyl-based Regimen for Rapid-sequence Endotracheal Intubation in Patients with Septic Shock: A Randomised Controlled Trial.", Romanian journal of anaesthesia and intensive care, vol. 28, issue 2, pp. 98-104, 2021. Abstract

OBJECTIVE: The aim of this work is to compared ketamine-based versus fentanyl-based regimens for endotracheal intubation in patients with septic shock undergoing emergency surgery.

DESIGN: This was a randomised double-blinded controlled trial.

PARTICIPANTS: Patients with septic shock on norepinephrine infusion scheduled for emergency surgery.

SETTING AND INTERVENTIONS: At induction of anaesthesia, patients were allocated into ketamine group (n=23) in which the participants received ketamine 1 mg/kg, and fentanyl group (n=19) in which the participants received fentanyl 2.5 mcg/ kg. Both groups received midazolam (0.05 mg/kg) and succinyl choline (1 mg/kg).

MEASUREMENT: The primary outcome was mean arterial blood pressure. The secondary outcomes included: heart rate, cardiac output, and incidence of postintubation hypotension defined as mean arterial pressure ≤80% of baseline value.

RESULTS: Forty-two patients were available for final analysis. The mean blood pressure was higher in the ketamine group than in the fentanyl group at 1, 2 and 5 minutes after the induction of anaesthesia. Furthermore, the incidence of postinduction hypotension was lower in the ketamine group than in the fentanyl group (11 [47.8%] versus 16 [84.2%], P-value= 0.014). Other hypodynamic parameters, namely the heart rate and cardiac output, were comparable between both groups; and were generally maintained in relation to the baseline reading in each group.

CONCLUSION: The ketamine-based regimen provided better hemodynamic profile compared to fentanyl-based regimen for rapid-sequence intubation in patients with septic shock undergoing emergency surgery.

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.
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.
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., 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., 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., S. Amin, S. Refaat, S. Habib, M. Zayed, and Y. Abdelwahab, "Norepinephrine Versus Phenylephrine Infusion for Prophylaxis Against Post-Spinal Anaesthesia Hypotension During Elective Caesarean Delivery: A Randomised Controlled Trial", Anaesthesia Critical Care & Pain Medicine, vol. 38, issue 6, pp. 601-607, 2019.
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.

Mukhtar, A., M. AbdelGhany, A. Hasanin, W. Hamimy, A. Abougabal, H. Nasser, A. Elsayed, and E. Ayman, "The Novel Use of Point-of-Care Ultrasound to Predict Resting Energy Expenditure in Critically Ill Patients.", Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, vol. 40, issue 8, pp. 1581-1589, 2021. Abstract

OBJECTIVES: Accurate estimation of a critically ill patient's caloric requirements is essential for a proper nutritional plan. This study aimed to evaluate the use of point-of-care ultrasound (US) to predict the resting energy expenditure (REE) in critically ill patients.

METHODS: In 69 critically ill patients, we measured the REE using indirect calorimetry (REE_IC), muscle layer thicknesses (MLTs), and cardiac output (CO). Muscle thickness was measured at the biceps and the quadriceps muscles. Patients were randomly split into a model development group (n = 46) and a cross-validation group (n = 23). In the model development group, a multiple regression analysis was applied to generate REE using US (REE_US) values. In the cross-validation group, REE was calculated by the REE_US and the resting energy expenditure using the Harris-Benedict equation (REE_HB), and both were compared to the REE_IC.

RESULTS: In the model development group, the REE_US was predicted by the following formula: predicted REE_US (kcal/d) = 206 + 173.5 × CO (L/min) + 137 × MLT (cm) - 230 × (women = 1; men = 0) (R  = 0.8; P < .0001). In the cross-validated group, the REE_IC and REE_US values were comparable (mean difference, -66 [-3.3%] kcal/d; P = .14). However, the difference between the mean REE_IC and the mean REE_HB was 455.8 (26%) kcal/d (P < .001). According to a Bland-Altman analysis, the REE_US agreed well with the REE_IC, whereas the REE_HB did not.

CONCLUSIONS: Resting energy expenditure could be estimated from US measurements of MLTs and CO. Our point-of-care US model explains 80% of the change in the REE in critically ill patients.

Mukhtar, A., ahmed lotfy, A. Hasanin, I. El-Hefnawy, and A. El-adawy, "Outcome of non-invasive ventilation in COVID-19 critically ill patients: A Retrospective observational Study", Anaesthesia Critical care & Pain Medicine, vol. 39, pp. 579-580, 2020.
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. 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.

Mostafa, M., M. A. Helmy, L. Magdy Milad, and A. Hasanin, "Patient self-induced lung injury risk in severe COVID-19.", Anaesthesia, critical care & pain medicine, vol. 41, issue 2, pp. 101018, 2022.
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.
Hasanin, A., A. Mukhtar, and H. Nassar, "Perfusion indices revisited", Journal of Intensive Care, vol. 5, pp. 24, 2017.
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