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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.
Hammad, Y., A. Hasanin, A. Elsakka, A. Refaie, D. Abdelfattah, and S. A. El Rahman, "Thoracic Fluid Content: A Novel Parameter for Detection of Pulmonary Edema in Parturients With Preeclampsia", Journal of Clinical Monitoring and Computing, vol. 33, issue 4, pp. 413-418, 2019.
Hasanin, A., A. Mukhtar, and H. Nassar, "Perfusion indices revisited", Journal of Intensive Care, vol. 5, pp. 24, 2017.
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, "Evaluation of fluid responsiveness during COVID-19 pandemic: what are the remaining choices?", Journal of anesthesia, vol. 34, pp. 758-764, 2020.
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., T. Zanata, S. Osman, Y. Abdelwahab, R. Samer, M. Mahmoud, M. Elsherbiny, K. Elshafaei, F. Morsy, and A. Omran, "Pulse Pressure Variation-Guided Fluid Therapy during Supratentorial Brain Tumour Excision: A Randomized Controlled Trial.", Open Access Macedonian Journal of Medical Sciences, vol. 7, issue 15, pp. 2474-2479, 2019.
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., 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., 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., 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.
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., 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., and M. Mostafa, "A reply to a letter", Journal of anesthesia, vol. 34, pp. 631, 2020.
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.
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., 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., 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. 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., 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., 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., "Fluid responsiveness in acute circulatory failure", Journal of Intensive Care, vol. 3, pp. 50, 2015.
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., 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.
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.