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Eltrabili, H. H., A. Hasanin, M. S. Soliman, A. M. Lotfy, W. I. Hamimy, and A. H. M. E. D. M. MUKHTAR, "Evaluation of Diaphragmatic Ultrasound Indices as Predictors of Successful Liberation From Mechanical Ventilation in Subjects With Abdominal Sepsis", Respiratory Care, vol. 64, issue 5, pp. 564-569, 2019.
Elsherbiny, M., A. Hasanin, S. Kasem, M. Abouzeid, M. Mostafa, A. Fouad, and Y. Abdelwahab, "Comparison of different ratios of propofol-ketamine admixture in rapid-sequence induction of anesthesia for emergency laparotomy: a randomized controlled trial.", BMC anesthesiology, vol. 23, issue 1, pp. 329, 2023. Abstract

BACKGROUND: We aimed to compare the hemodynamic effect of two ratios of propofol and ketamine (ketofol), namely 1:1 and 1:3 ratios, in rapid-sequence induction of anesthesia for emergency laparotomy.

METHODS: This randomized controlled study included adult patients undergoing emergency laparotomy under general anesthesia. The patients were randomized to receive either ketofol ratio of 1:1 (n = 37) or ketofol ratio of 1:3 (n = 37). Hypotension (mean arterial pressure < 70 mmHg) was managed by 5-mcg norepinephrine. The primary outcome was total norepinephrine requirements during the postinduction period. Secondary outcomes included the incidence of postinduction hypotension, and the intubation condition (excellent, good, or poor).

RESULTS: Thirty-seven patients in the ketofol-1:1 and 35 patients in the ketofol 1:3 group were analyzed. The total norepinephrine requirement was less in the ketofol-1:1 group than in the ketofol-1:3 group, P-values: 0.043. The incidence of postinduction hypotension was less in the ketofol-1:1 group (4 [12%]) than in ketofol-1:3 group (12 [35%]), P-value 0.022. All the included patients had excellent intubation condition.

CONCLUSION: In patients undergoing emergency laparotomy, the use of ketofol in 1:1 ratio for rapid-sequence induction of anesthesia was associated with less incidence of postinduction hypotension and vasopressor consumption in comparison to the 1:3 ratio with comparable intubation conditions.

CLINICAL TRIAL REGISTRATION: NCT05166330. URL: https://clinicaltrials.gov/ct2/show/NCT05166330 .

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.

Elmetwally, S. A., A. Hasanin, L. Sobh, M. Gohary, K. Sarhan, and D. Ghazy, "Semi-sitting position enhances gastric emptying of clear fluids in children: A randomized controlled trial", Egyptian Journal of Anaesthesia, vol. 36, pp. 170-175, 2020.
Elhamid, B. A., mohamed emam, M. Mostafa, A. Hasanin, W. Awada, A. Rady, and H. Omar, "The ability of perfusion index to detect segmental ulnar nerve sparing after supraclavicular nerve block.", Journal of clinical monitoring and computing, vol. 34, issue 6, pp. 1185-1191, 2020. Abstract

Supraclavicular nerve block (SCB) is a commonly used regional block for upper extremity surgery. The most common form of failure of SCB is ulnar segmental sparing. We aimed to evaluate the accuracy of perfusion index (PI) in early detection of segmental sparing of the ulnar component of SCB. A prospective observational study included adult patients scheduled for surgery under ultrasound-guided SCB. PI was simultaneously measured at the index finger and little finger. PI was recorded every minute for the first 10 min after SCB. PI ratio was calculated at every measurement point as PI/baseline PI. The area under the receiver operating characteristic (AUROC) curve was calculated for the ability of PI ratio to detect segmental ulnar sparing with comparison of little finger readings to the index finger readings. Forty-nine patients were available for the final analysis. Nine patients (18%) had segmental ulnar sparing. PI ratio at the little finger showed excellent predictive ability for ulnar sparing starting from the fifth minute (AUROC 0.92 [0.8-0.98], cutoff value ≤ 1.71) and reached the highest value at the seventh minute (AUROC 0.96 [0.86-1], cutoff value ≤ 1.35), whereas PI ratio at the index finger showed poor predictive ability. When using the PI for evaluation of successful SCB, segmental ulnar sparing could be accurately detected when the PI was measured at the little finger and not at the index finger. An increase of 71% in PI at the little finger 5 min after SCB could accurately rule out ulnar sparing.Clinical trial identifier NCT03880201. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT03880201?term=NCT03880201&amp;draw=2&amp;rank=1 .

Eley, V., A. Hasanin, R. Landau, D. Benhamou, F. J. Mercier, and L. Bouvet, "Antibiotic prophylaxis in obstetric care: is universal administration warranted?", Anaesthesia, critical care & pain medicine, vol. 42, issue 3, pp. 101235, 2023.
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