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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.

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 .

Adel, A., W. Awada, B. A. Elhamid, H. Omar, O. A. E. Dayem, A. Hasanin, and A. Rady, "Accuracy and trending of non-invasive hemoglobin measurement during different volume and perfusion statuses.", Journal of clinical monitoring and computing, 2018 Jan 15. Abstract

The evolution of non-invasive hemoglobin measuring technology would save time and improve transfusion practice. The validity of pulse co-oximetry hemoglobin (SpHb) measurement in the perioperative setting was previously evaluated; however, the accuracy of SpHb in different volume statuses as well as in different perfusion states was not well investigated. The aim of this work is to evaluate the accuracy and trending of SpHb in comparison to laboratory hemoglobin (Lab-Hb) during acute bleeding and after resuscitation. Seventy patients scheduled for major orthopedic procedures with anticipated major blood loss were included. Radical-7 device was used for continuous assessment of SpHb, volume status [via pleth variability index (PVI)] and perfusion status [via perfusion index (PI)]. Lab-Hb and SpHb were measured at three time-points, a baseline reading, after major bleeding, and after resuscitation. Samples were divided into fluid-responsive and fluid non-responsive samples, and were also divided into high-PI and low-PI samples. Accuracy of SpHb was determined using Bland-Altman analysis. Trending of SpHb was evaluated using polar plot analysis. We obtained 210 time-matched readings. Fluid non-responsive samples were 106 (50.5%) whereas fluid responsive samples were 104 (49.5%). Excellent correlation was reported between Lab-Hb and SpHb (r = 0.938). Excellent accuracy with moderate levels of agreement was also reported between both measures among all samples, fluid non-responsive samples, fluid-responsive samples, high-PI samples, and low-PI samples [Mean bias (limits of agreement): 0.01 (- 1.33 and 1.34) g/dL, - 0.08 (- 1.27 and 1.11) g/dL, 0.09 (- 1.36 and 1.54) g/dL, 0.01 (- 1.34 to 1.31) g/dL, and 0.04 (- 1.31 to 1.39) g/dL respectively]. Polar plot analysis showed good trending ability for SpHb as a follow up monitor. In conclusion, SpHb showed excellent correlation with Lab-Hb in fluid responders, fluid non-responders, low-PI, and high PI states. Despite a favorable mean bias of 0.01 g/dL for SpHb, the relatively wide levels of agreement (- 1.3 to 1.3 g/dL) might limit its accuracy. SpHb showed good performance as a trend monitor.

Mostafa, M. M. A., A. M. Hasanin, F. Alhamade, B. A. Elhamid, A. G. Safina, S. M. Kasem, Osama Hosny, M. Mahmoud, E. fouad, A. Rady, et al., "Accuracy and trending of non-invasive oscillometric blood pressure monitoring at the wrist in obese patients.", Anaesthesia, critical care & pain medicine, vol. 39, issue 2, pp. 221-227, 2020. Abstract

BACKGROUND: In obese patients, non-invasive blood pressure monitoring in the arm is difficult due to the arm size and morphology. We compared the non-invasive oscillometric wrist blood pressure measurement with the arm and forearm in obese patients monitored with invasive radial blood pressure (reference standard).

METHODS: This prospective observational study included adult obese patients scheduled for bariatric surgery. Non-invasive blood pressure was measured at the arm, upper forearm and wrist of one upper extremity, while invasive blood pressure was simultaneously measured through a radial arterial catheter in the contralateral upper extremity. The accuracy of non-invasive blood pressure reading at each site was evaluated for absolute and trending values using the Bland-Altman analysis and Spearman's correlation coefficient.

RESULTS: In 40 patients, 262, 259, and 263 pairs of non-invasive blood pressure readings were obtained from the arm, forearm, and wrist sites, respectively. As primary outcome, the correlation coefficient for systolic blood pressure was higher for the wrist (0.92, 95% confidence interval (CI) [0.9-0.94]) than for the arm (0.74, 95% CI [0.68-0.79]) and the forearm (0.71, 95% CI [0.64-0.76]) (P<0.05). The non-invasive systolic wrist blood pressure showed the least mean bias and the narrowest limits of agreement (-0.3±7.6mmHg) when compared with forearm (4.3±16) and arm measurements (14.2±13.6) (P<0.05). For trending values, the correlation coefficient was the highest at the wrist.

CONCLUSION: In obese patients undergoing bariatric surgery, non-invasive blood pressure measured at the wrist showed the highest accuracy in comparison with the arm and forearm.

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.

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.
Mostafa, M., A. M. Hasanin, O. S. Elsayed, M. M. Mostafa, and K. Sarhan, "Accuracy of oscillometric blood pressure measurement at both arms in the lateral position.", Blood pressure monitoring, vol. 26, issue 5, pp. 364-372, 2021. Abstract

PURPOSE: To evaluate the accuracy of noninvasive blood pressure (NIBP) measurement at the dependent- and nondependent arms in the lateral position, using invasive blood pressure (IBP) as reference.

METHODS: This prospective observational study included 42 adult patients undergoing surgery in the lateral position. Paired readings of IBP and NIBP were obtained at either arm. The accuracy of both arms in detecting mean arterial pressure (MAP) <70 mmHg was evaluated using the area under the receiver operating characteristic curve (AUC). The agreement between the IBP and NIBP was evaluated using the Bland-Altman and error grid analyses.

RESULTS: We analyzed 350 and 347 paired readings at the dependent- and nondependent arms. The AUC for detecting hypotension was comparable in both arms. The negative and positive predictive values (95% confidence interval) were 100% (99-100%) and 24% (14-34%), respectively for the dependent arm at cutoff value MAP ≤86 mmHg; and were 99% (96-100%) and 21% (13-30%), respectively for the nondependent arm at cutoff value MAP ≤75 mmHg. The mean bias for MAP was -6.0 ± 9.1 and 6.3 ± 10.1 mmHg; and for systolic blood pressure was 0.3 ± 11.6 and 13.2 ± 12.6 mmHg, in the dependent- and nondependent arm, respectively. Error grid analysis showed that the proportions of paired MAP readings in risk zone A were 71 and 82% in the dependent- and the nondependent arms, respectively.

CONCLUSION: In the lateral position, the NIBP readings at both arms are not interchangeable with the corresponding IBP readings. However, NIBP measurement at both arms can be used to accurately rule out hypotension.

Mukhtar, A., A. Rady, A. Hasanin, ahmed lotfy, akram eladawy, A. Hussein, I. El-Hefnawy, M. Hassan, and hanan mostafa, "Admission SpO and ROX index predict outcome in patients with COVID-19.", The American journal of emergency medicine, vol. 50, pp. 106-110, 2021. Abstract

BACKGROUND: This study aimed to evaluate the accuracy of pulse oximetry-derived oxygen saturation (SpO) on room air, determined at hospital admission, as a predictor for the need for mechanical ventilatory support in patients with Coronavirus Disease-2019 (COVID-19).

METHODS: In this retrospective observational study, demographic and clinical details of the patients were obtained during ICU admission. SpO and respiratory rate (RR) on room air were determined within the first 6 h of hospital admission. As all measurements were obtained on room air, we calculated the simplified respiratory rate‑oxygenation (ROX) index by dividing the SpO by the RR. Based on the use of any assistance of mechanical ventilator (invasive or noninvasive), patients were divided into mechanical ventilation (MV) group and oxygen therapy group. The accuracy of the SpO, CT score, and ROX index to predict the need to MV were determined using the Area under receiver operating curve (AUC).

RESULTS: We included 72 critically ill patients who tested COVID-19-positive. SpO on the room air could predict any MV requirement (AUC [95% confidence interval]: 0.9 [0.8-0.96], sensitivity: 70%, specificity 100%, cut-off value ≤78%, P < 0.001). Within the MV group, the use of noninvasive ventilation (NIV) was successful in 37 (74%) patients, whereas 13 patients (26%) required endotracheal intubation. The cut-off ROX value for predicting early NIV failure was ≤1.4, with a sensitivity of 85%, a specificity of 86%, and an AUC of 0.86 (95% confidence interval of 0.73-0.94, P < 0.0001).

CONCLUSIONS: A baseline SpO ≤78% is an excellent predictor of MV requirement with a positive predictive value of 100%. Moreover, the ROX index measured within the first 6 h of hospital admission is a good indicator of early NIV failure.

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.
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.
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.
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.
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.


Amin, S. M., A. Hasanin, O. S. Elsayed, M. Mostafa, D. KHALED, A. S. Arafa, and A. Hassan, "Comparison of the hemodynamic effects of opioid-based versus lidocaine-based induction of anesthesia with propofol in older adults: a randomized controlled trial.", Anaesthesia, critical care & pain medicine, vol. 42, issue 4, pp. 101225, 2023. Abstract

BACKGROUND: The present study aims to compare the hemodynamic profile of lidocaine and fentanyl during propofol induction of general anesthesia.

METHODS: This randomized controlled trial included patients aged above 60 years undergoing elective non-cardiac surgery. The included patients received either 1 mg/kg lidocaine (n = 50) or 1 mcg/kg fentanyl (n = 50) based on total body weight with propofol induction of anesthesia. Patient's hemodynamics were recorded every minute for the first 5 min then every 2 min until 15 min after induction of anesthesia. Hypotension (mean arterial pressure [MAP] <65 mmHg or >30% reduction from baseline) was treated by intravenous 4 mcg bolus of norepinephrine. Outcomes included norepinephrine requirements (primary), the incidence of postinduction hypotension, MAP, heart rate, intubation condition, and postoperative delirium via the cognitive assessment method.

RESULTS: Forty-seven patients in the lidocaine group and 46 patients in the fentanyl group were analyzed. None in the lidocaine group experienced hypotension, while 28/46 (61%) of patients in the fentanyl group developed at least one episode of hypotension requiring a median (25th and 75th quartiles) norepinephrine dose of 4 (0,5) mcg, p-value <0.001 for both outcomes. The average MAP was lower in the fentanyl group than in the lidocaine group at all time points after anesthesia induction. The average heart rate was comparable between the two groups nearly at all time points after anesthesia induction. The overall intubation condition was comparable between the two groups. None of the included patients developed postoperative delirium.

CONCLUSION: Lidocaine-based regimen for induction of anesthesia reduced the risk of postinduction hypotension in older patients compared to the fentanyl-based regimen.

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 registry system on January 4, 2019 Clinical trial identifier: NCT03792906.

Habib, S., A. Mukhtar, H. Abdelreeem, M. Khorshied, R. E. Sayed, M. Hafez, H. Gouda, doaa ghaith, A. Hasanin, A. El-adawy, et al., "Diagnostic values of CD64, C-reactive protein and procalcitonin in ventilator-associated pneumonia in adult trauma patients: a pilot study", Clinical Chemistry and Laboratory Medicine, vol. 54, issue 5, pp. 889-95, 2016.
Sarhan, K. A., R. Emad, D. Mahmoud, A. Hasanin, Osama Hosny, M. Al-Sonbaty, A. Aboel-ela, and S. Othman, "The effect of hyperventilation versus normoventilation on cerebral oxygenation using near infrared spectroscopy in children undergoing posterior fossa tumor resection: A randomized controlled cross-over trial.", Anaesthesia, critical care & pain medicine, vol. 42, issue 3, pp. 101190, 2023. Abstract

BACKGROUND: This study aims to compare the effect of two different ventilation strategies on cerebral oxygenation in children undergoing posterior fossa tumor excision surgeries.

METHODS: Children scheduled for posterior fossa tumor surgeries were enrolled in this randomized, double-blinded, controlled cross-over trial. After induction of general anesthesia and positioning, participants were randomized to have mild hyperventilation for 30 min (phase 1) followed by normal ventilation for another 30 min (phase2) (early hyperventilation group, n = 23), or normal ventilation for 30 min (phase 1) followed by hyperventilation for 30 min (phase 2) (early normoventilation group, n = 19). Our primary outcome was cerebral oxygenation, measured using near-infrared spectroscopy (NIRS). Other outcomes included the intracranial pressure (ICP), brain relaxation score at the end of phase 1, and frequency of nadir NIRS.

RESULTS: Forty-two children were available for final per protocol analysis. The cerebral oxygenation decreased after the hyperventilation phase compared to the baseline values and the corresponding phases of normoventilation. The mean difference [95% confidence intervals (CI)] in cerebral oxygen saturation between the hyperventilation and normal ventilation readings was 13.45 ± 1.14% [11.14-15.76] and 11.47 ± 0.96% [11.14-15.76] in the left and right sides, respectively (p-values <0.0001). Both carryover and period effects were not significant. The ICP at the end of phase 1 did not differ between the two groups: 22.12 ± 3.75 mmHg vs. 23.26 ± 4.33, mean difference [95%CI]: -0.78 [-3.05 to 1.5], p = 0.49. Brain relaxation score was similar in the two groups.

CONCLUSION: In children undergoing posterior fossa craniotomy, moderate hyperventilation reduced cerebral oxygenation without significant improvement of the surgical brain relaxation or the ICP.

Zayed, M., H. Nassar, A. Hasanin, A. H. Saleh, P. Hassan, D. Saad, S. A. H. A. R. MAHMOUD, G. A. Bakr, E. fouad, N. Saleh, et al., "Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial.", BMC anesthesiology, vol. 20, issue 1, pp. 85, 2020. Abstract

BACKGROUND: Deliberate hypotension is used to provide a bloodless field during functional endoscopic sinus surgery; however, the impact of controlled hypotension during anesthesia on peripheral tissue perfusion has not been extensively evaluated. The aim of this study was to compare the impact of nitroglycerin- versus labetalol-induced hypotension on peripheral perfusion.

METHODS: The present randomized, double-blinded, controlled trial included adult patients undergoing endoscopic sinus surgery. Patients were allocated to one of two groups according to the drug received for induction of deliberate hypotension: nitroglycerin (n = 20) or labetalol (n = 20). Mean arterial pressure was maintained at 55-65 mmHg in both groups. Both study groups were compared according to pulse oximeter-derived peripheral perfusion index (primary outcome), serum lactate level, mean arterial pressure, heart rate, surgical field score, and intraoperative blood loss.

RESULTS: Forty patients were included in the final analysis. The nitroglycerin group exhibited a higher peripheral perfusion index at nearly all records (p < 0.0001) and lower postoperative serum lactate levels (1.3 ± 0.2 mmol/L vs. 1.7 ± 0.4 mmol/L; p = 0.001) than the labetalol group. The peripheral perfusion index was higher in the nitroglycerin group than at baseline at most intraoperative readings. The median surgical field score was modestly lower in the labetalol group than in the nitroglycerin group in the first 20 min (2 [interquartile range (IQR) 2-2.5] versus 1.5 [IQR 1-2]; p = 0.001). Both groups demonstrated comparable and acceptable surgical field scores in all subsequent readings.

CONCLUSION: Nitroglycerin-induced deliberate hypotension was accompanied by higher peripheral perfusion index and lower serum lactate levels than labetalol-induced deliberate hypotension during sinus endoscopic surgery.

TRIAL REGISTRATION: The study was registered at clinicaltrials registry system with trial number: NCT03809065. Registered at 19 January 2019. This study adheres to CONSORT guidelines.

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.
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., 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.
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.

Gamal, M., B. A. Elhamid, D. Zakaria, O. A. E. Dayem, A. Rady, M. Fawzy, and A. Hasanin, "Evaluation of Noninvasive Hemoglobin Monitoring in Trauma Patients with Low Hemoglobin Levels.", Shock (Augusta, Ga.), vol. 49, issue 2, pp. 150-153, 2018 Feb. Abstract

OBJECTIVE: Bleeding is a leading cause of death among trauma patients. Delayed assessment of blood hemoglobin level might result in either unnecessary blood transfusion in nonindicated patients or delayed blood transfusion in critically bleeding patients. In this study, we evaluate the precision of noninvasive hemoglobin monitoring in trauma patients with low hemoglobin levels.

METHODS: We included trauma patients with low hemoglobin levels (less than 8 g/dL) scheduled for surgical intervention. Blood samples were obtained on admission and after each blood unit with concomitant measurement of serum hemoglobin using radical-7 Masimo device. The change in blood hemoglobin after every transfused blood unit was also assessed by both methods (change in noninvasive Masimo hemoglobin [Delta-Sp-Hb] and change in laboratory hemoglobin [Delta-Lab-Hb]). The precision of Masimo hemoglobin level (Sp-Hb) compared with Laboratory hemoglobin level (Lab-Hb) was determined using both Bland-Altman and Pearson correlation analyses.

RESULTS: One hundred eighty-four time-matched samples were available for final analysis. Bland-Altman analysis showed excellent accuracy of Sp-Hb compared with Lab-Hb with mean bias of 0.12 g/dL and limits of agreement between -0.56 g/dL and 0.79 g/dL. Excellent correlation was reported between both measures with Pearson correlation coefficient of 0.872. Excellent agreement was also reported between both Delta-Sp-Hb and Delta-Lab-Hb with mean bias of -0.05 and limits of agreement from -0.62 to 0.51 CONCLUSIONS:: Sp-Hb showed accurate precision in both absolute values and trend values compared with Lab-Hb measurement in trauma patients with low hemoglobin levels.

Hasanin, A., S. A. R. Mohamed, and A. El-adawy, "Evaluation of perfusion index as a tool for pain assessment in critically ill patients", Journal of clinical monitoring and computing, vol. 31, issue 5, pp. 961-65, 2017.
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.