Sarhan, K., A. Hasanin, R. Melad, R. Fouad, H. Elhadi, M. Elsherbeeny, A. Arafa, and M. Mostafa, "Correction to: 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. 143, 2022.
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.

Helmy, M. A., A. Hasanin, L. Magdy Milad, M. Mostafa, and S. Fathy, "Parasternal intercostal muscle thickening as a predictor of non-invasive ventilation failure in patients with COVID-19.", Anaesthesia, critical care & pain medicine, vol. 41, issue 3, pp. 101063, 2022.
Mostafa, M., and A. Hasanin, "Appropriate intraoperative haemodynamic targets. Comment on Br J Anaesth 2021; 127: 396-404.", British journal of anaesthesia, vol. 128, issue 1, pp. e13-e14, 2022.
Hasanin, A., M. Mostafa, and M. Abdulatif, "Combined Thoracic Spinal-Epidural Anesthesia in Laparoscopic Sleeve Gastrectomy: a Risk-Benefit Assessment.", Obesity surgery, vol. 32, issue 6, pp. 2092-2093, 2022.
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 clinicaltrial.gov registry system on January 4, 2019 Clinical trial identifier: NCT03792906.

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.

Mostafa, M., M. A. Helmy, L. Magdy Milad, and A. Hasanin, "Patient self-induced lung injury risk in severe COVID-19.", Anaesthesia, critical care & pain medicine, vol. 41, issue 2, pp. 101018, 2022.
Mostafa, M., A. Hasanin, M. Mostafa, M. Y. Taha, M. Elsayad, F. A. Haggag, O. Taalab, A. Rady, and B. A. Elhamid, "Hemodynamic effects of norepinephrine versus phenylephrine infusion for prophylaxis against spinal anesthesia-induced hypotension in the elderly population undergoing hip fracture surgery: a randomized controlled trial.", Korean journal of anesthesiology, vol. 74, issue 4, pp. 308-316, 2021. Abstract

BACKGROUND: Elderly population are at increased risk of spinal anesthesia-induced hypotension increasing their risk for postoperative morbidity and mortality. This study aimed to compare the hemodynamic effects of prophylactic infusion of norepinephrine (NE) versus phenylephrine (PE) in elderly patients undergoing hip fracture surgery under spinal anesthesia.

METHODS: Elderly patients scheduled for hip fracture surgery were randomized to receive either NE infusion (8 µg/min) (NE group, n = 31) or PE infusion (100 µg/min) (PE group, n = 31) after spinal anesthesia. Outcomes included mean heart rate, mean blood pressure, cardiac output, incidence of spinal anesthesia-induced hypotension, incidence of bradycardia, and incidence of hypertension.

RESULTS: Sixty-two patients with a mean age of 71 ± 6 years were included in the final analysis (31 patients in each group). The NE group showed a higher mean heart rate and cardiac output than the PE group. The NE group had a lower incidence of reactive bradycardia (10% vs. 36%, P = 0.031) and hypertension (3% vs. 36%, P = 0.003) than the PE group. No study participant developed hypotension, and the mean blood pressure was comparable between the two groups.

CONCLUSIONS: Both NE and PE infusions effectively prevented spinal anesthesia-induced hypotension in elderly patients undergoing hip fracture surgery. However, NE provided more hemodynamic stability than PE; maintaining the heart rate, higher cardiac output, less reactive bradycardia, and hypertension.

Helmy, M. A., L. Magdy Milad, A. Hasanin, and M. Mostafa, "The novel use of diaphragmatic excursion on hospital admission to predict the need for ventilatory support in patients with coronavirus disease 2019.", Anaesthesia, critical care & pain medicine, vol. 40, issue 6, pp. 100976, 2021. Abstract

BACKGROUND: We aimed to evaluate the ability of diaphragmatic excursion at hospital admission to predict outcomes in patients with coronavirus disease-2019 (COVID-19).

METHODS: In this prospective observational study, we included adult patients with severe COVID-19 admitted to a tertiary hospital. Ultrasound examination of the diaphragm was performed within 12 h of admission. Other collected data included peripheral oxygen saturation (SpO), respiratory rate, and computed tomography (CT) score. The outcomes included the ability of diaphragmatic excursion, respiratory rate, SpO, and CT score at admission to predict the need for ventilatory support (need for non-invasive or invasive ventilation) and patient mortality using the area under the receiver operating characteristic curve (AUC) analysis. Univariate and multivariable analyses about the need for ventilatory support and mortality were performed.

RESULTS: Diaphragmatic excursion showed an excellent ability to predict the need for ventilatory support, which was the highest among respiratory rate, SpO, and CT score; the AUCs (95% confidence interval [CI]) was 0.96 (0.85-1.00) for the right diaphragmatic excursion and 0.94 (0.82-0.99) for the left diaphragmatic excursion. The right diaphragmatic excursion also had the highest AUC for predicting mortality in relation to respiratory rate, SpO, and CT score. Multivariable analysis revealed that low diaphragmatic excursion was an independent predictor of mortality with an odds ratio (95% CI) of 0.55 (0.31-0.98).

CONCLUSION: Diaphragmatic excursion on hospital admission can accurately predict the need for ventilatory support and mortality in patients with severe COVID-19. Low diaphragmatic excursion was an independent risk factor for in-hospital mortality.