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Shaker, A., A. Hasanin, M. Nagy, M. Mostafa, A. Z. Fouad, H. Mohamed, A. S. Abdallah, and M. Elsayad, "The Use of Lactate-Capillary Refill Time Product as Novel Index for Tissue Perfusion in Patients with Abdominal Sepsis: A Prospective Observational Study.", International journal of general medicine, vol. 15, pp. 7443-7448, 2022.
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.

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.

Sarhan, K. A., H. Hasaneen, A. Hasanin, H. Mohammed, R. Saleh, and A. Kamel, "Ultrasound Assessment of Gastric Fluid Volume in Children Scheduled for Elective Surgery After Clear Fluid Fasting for 1 Versus 2 Hours: A Randomized Controlled Trial.", Anesthesia and analgesia, vol. 136, issue 4, pp. 711-718, 2023. Abstract

BACKGROUND: This study aimed to compare the gastric fluid volume (GFV) in children who fasted 1 versus 2 hours using ultrasound, after ingestion of a defined volume of clear fluid.

METHODS: Children scheduled for elective surgery were enrolled in this randomized, double-blinded, controlled trial. After receiving 3 mL kg -1 clear fluid, participants were randomized to have a gastric ultrasound after fasting for either 1 hour (1-hour group, n = 116) or 2 hours (2-hour group, n = 111). Our primary outcome was the GFV. Other outcomes included the antral cross-sectional area, frequency of high risk and low risk of aspiration, and qualitative grading for the gastric antrum.

RESULTS: Two hundred and twenty-seven children were available for final analysis. The median (Q1-Q3) GFV was higher in the 1-hour group versus the 2-hour group (0.61 [0.41-0.9] mL kg -1 vs 0.32 [0.23-0.47] mL kg -1 ; P value = .001). None of the study groups had GFV ≥1.5 mL kg -1 . The frequency (%) of GFV ≥1.25 mL kg -1 was comparable between both groups (2 [1.7%] vs 0 [0%], P value = .165). However, the frequency of GFV ≥0.8 mL kg -1 was higher in 1-hour group than in 2-hour group (34.5% vs 4.5%), and grade 2 antral grading score was 56.9% in 1-hour group vs 0.9% in 2-hour group ( P value <.001).

CONCLUSIONS: In healthy children scheduled for elective surgery receiving 3 mL kg -1 clear fluid, the median GFV after 1-hour fasting was double the volume after conventional 2-hour fasting. These findings should be considered whether weighting the risk/benefit of a liberal approach to preoperative fasting versus the risk of pulmonary aspiration.

Sanfilippo, F., D. P. Gopalan, and A. Hasanin, "The COVID-19 pandemic: a gateway between one world and the next!", Anaesthesia, critical care & pain medicine, vol. 41, issue 5, pp. 101131, 2022.
Sanfilippo, F., A. Zeidan, and A. Hasanin, "Disposable versus reusable medical devices and carbon footprint: old is gold.", Anaesthesia, critical care & pain medicine, vol. 42, issue 5, pp. 101285, 2023.
Sabry, R., A. Hasanin, S. Refaat, S. A. E. Raouf, A. S. Abdallah, and N. Helmy, "Evaluation of Gastric Residual Volume in Fasting Diabetic Patients Using Gastric Ultrasound", Acta Anaesthesiologica Scandinavica, vol. 63, issue 5, pp. 615-619, 2019.