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HM, N., A. - A. IR, I. FZM, S. RH, H. SF, and S. SM, "Intravascular volume assessment using internal jugular vein ultrasonography in pediatric renal transplant surgery: a prospective observational study", Egypt J Cardiothorac Anesth, vol. 15, pp. 42-47, 2021.
Nassar, H., A. Hasanin, M. Sewilam, H. Ahmed, M. Abo-elsoud, O. Taalab, A. Rady, and H. A. Zoheir, "Transmuscular Quadratus Lumborum Block versus Suprainguinal Fascia Iliaca Block for Hip Arthroplasty: A Randomized, Controlled Pilot Study.", Local and regional anesthesia, vol. 14, pp. 67-74, 2021. Abstract

BACKGROUND: This study aimed to investigate the analgesic efficacy and motor block profile of single-shot transmuscular quadratus lumborum block (QLB) in comparison with those of suprainguinal fascia iliaca block (FIB) in patients undergoing hip arthroplasty.

METHODS: This randomized, double-blinded, controlled trial included adult patients undergoing hip arthroplasty under spinal anesthesia. Patients were allocated to one of two groups according to the regional block received: FIB group (n=19) or QLB group (n=17). Both study groups were compared with regard to the duration of analgesia (primary outcome), block performance time, pain during positioning for spinal anesthesia, total morphine consumption in the first postoperative 24-h period, quadriceps muscle power, and static and dynamic visual analog scale.

RESULTS: Thirty-six patients were included in the final analysis. Both study groups had comparable durations of analgesia. Postoperative visual analog scale (static and dynamic) values were comparable between the two groups in most readings. The block performance time was shorter in the FIB group. The number of patients with pain during positioning for the subarachnoid block was lower in the QLB group. The total morphine requirement during the first 24 h was marginally lower in the FIB group, whereas the quadriceps motor grade was higher in the FIB group than in the QLB group at 4 h and 6 h after surgery.

CONCLUSION: Both single-shot blocks, namely the suprainguinal FIB and transmuscular QLB, provide effective postoperative analgesia after hip arthroplasty. FIB showed slightly lower 24-h morphine consumption, while QLB showed better quadriceps motor power.

CLINICAL TRIAL REGISTRATION: The study was registered at clinical trials registry system before enrollment of the first participant (NCT04005326; initial release date, 2 July 2019;

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.

Hasanin, A., A. Mukhtar, and H. Nassar, "Perfusion indices revisited.", Journal of intensive care, vol. 5, pp. 24, 2017. Abstract

Monitoring of tissue perfusion is an essential step in the management of acute circulatory failure. The presence of cellular dysfunction has been a basic component of shock definition even in the absence of hypotension. Monitoring of tissue perfusion includes biomarkers of global tissue perfusion and measures for assessment of perfusion in non-vital organs. The presence of poor tissue perfusion in a shocked patient is usually associated with worse outcome. Persistently impaired perfusion despite adequate resuscitation is also associated with worse outcome. Thus, normalization of some perfusion indices has become one of the resuscitation targets in patients with septic shock. Although the collective evidence shows the clear relation between impaired peripheral perfusion and mortality, the use of different perfusion indices as a resuscitation target needs more research.

Farouk, M., R. Saleh, H. Nassar, and T. Fathy, "Effect of nalbuphine as an adjuvant on levobupivacaine induced caudal analgesia in children undergoing surgical procedures, controlled randomized double blinded study ", Egyptian Journal of Anaesthesia, vol. 32, issue 1, pp. 97-102, 2016.
Abdulatif, M., M. Fawzy, H. Nassar, A. Hasanin, M. Ollaek, and H. Mohamed, "The effects of perineural dexmedetomidine on the pharmacodynamic profile of femoral nerve block: a dose-finding randomised, controlled, double-blind study.", Anaesthesia, vol. 71, issue 10, pp. 1177-85, 2016. Abstract

This randomised, controlled, double-blind study investigated the effects of different doses of perineural dexmedetomidine on the pharmacodynamic profile of femoral nerve block in patients undergoing arthroscopic knee surgery. Ultrasound-guided femoral nerve block was performed before general anaesthesia using 25 ml of bupivacaine 0.5% combined with normal saline in the control group, and 25 μg, 50 μg or 75 μg of dexmedetomidine in three treatment groups (n = 15 for each group). All patients received a standard general anaesthetic and multimodal postoperative analgesic regimen. The use of the 50 μg and 75 μg dose levels of dexmedetomidine was associated with reduction of the onset time, extension of the duration of block, prolonged time to the first postoperative request for rescue analgesia, and reduced postoperative morphine requirements. The times to first request for postoperative analgesia were mean (SD) 10.8 (1.6) h in the control group and 11.0 (7.1), 21.8 (3.0) and 28.6 (10.0) in the 25 μg, 50 μg and 75 μg treatment groups, respectively. These times were significantly longer in the 50 μg and 75 μg treatment groups compared with the 25 μg (p < 0.0001) and control group (p < 0.0001). The total 24-h postoperative morphine consumption was 7.6 (5.1) mg in the control group, and 6.5 (3.5), 3.9 (3.4), 1.8 (2.6) in the 25 μg, 50 μg and 75 μg treatment groups, respectively. Postoperative morphine consumption was significantly higher in the control group compared with the 50 μg (p = 0.045) and the 75 μg (p = 0.001) treatment groups. The best analgesic profile was achieved at the 75 μg dose, but this was associated with increased risk of hypotension.

Hasanin, A., A. Mukhtar, A. El-adawy, H. Elazizi, ahmed lotfy, H. Nassar, and doaa ghaith, "Ventilator associated pneumonia caused by extensive-drug resistant Acinetobacter species: Colistin is the remaining choice", Egyptian Journal of Anaesthesia, vol. 32, issue 3, pp. 409-413, 2016.
Abdel-Aal, I. R., M. El-Gohary, H. Nassar, and H. S. E. - D. A. El-Hamid, Ultrasound Guided Single Injection Thoracic Paravertebral Block versus Preemptive Surgical Incision Infiltration in Pediatric Renal Surgery, , Cairo, Cairo University, 2015.
AlSadek, W. M., M. M. Al-Gohary, M. I. Elsonbaty, H. M. Nassar, and R. M. Alkonaeisy, "Ultrasound guided TAP block versus ultrasound guided caudal block for pain relief in children undergoing lower abdominal surgeries", Egyptian Journal of Anaesthesia, vol. 41, issue 2, 2015.
doss, L., N. Gouda, H. Nassar, and M. elayashy, Surgical transversus abdominis plane (TAP) block for pain relief in children undergoing splenectomy , , Cairo, Cairo University, 2014.
El-sadek, W., M. El-Gohary, M. El-Sonbaty, H. Nassar, and R. El-Konaeisy, Ultrasound guided TAP block versus ultrasound guided caudal block for pain relief in children undergoing lower abdominal surgeries., , Cairo, Cairo University, 2014.
Doss, L. H., A. Abo-Elela, H. Nassar, and M. Zarif, Transversus Abdominis Plane (TAP) block a novel approach in trunk block, , 2013.
Mukhtar, A., A. Hasanin, A. El-adawy, S. Osman, A. Ahmed, H. Nassar, D. Saad, A. Zaghloul, 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. 862-5, 2012.
Abdallah, I., T. Roshdy, H. Nassar, and D. M. Mohammed, Role of glutamic acid in immunonutrition of abdominal sepsis in intensive care unit patients, , Cairo, Cairo University, 2012.