Abeer M. Elnakera

Zagazig University

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Rinaldo Bellomo

Austin Health

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В. В. Ломиворотов

Meshalkin National Medical Research Center

Luca Severi

Azienda Ospedaliera San Camillo-Forlanini

Chong Lei

Air Force Medical University

Rehab A. Wahdan

Zagazig University

Cristiana Carollo

University of Padua

Mohamed R. El Tahan

Imam Abdulrahman Bin Faisal University

Gordana Gazivoda

Institute for Cardiovascular Diseases of Vojvodina

Alberto Zangrillo

Vita-Salute San Raffaele University

Rosalba Lembo

Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele

Cooperative Institutions

Vita-Salute San Raffaele University

Istituti di Ricovero e Cura a Carattere Scientifico

Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele

Zagazig University

IRCCS Ospedale San Raffaele

San Raffaele University of Rome

Ministry of Health of the Russian Federation

Sapienza University of Rome

University of Milan

University of Melbourne

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End-tidal carbon dioxide’s change to fluid challenge versus internal jugular vein dispensability index for predicting fluid responsiveness in septic patients: A prospective, observational study

Indian Journal of Anaesthesia (2023)

Abeer M. Elnakera Radwa Muhammad Abdullah Heba M. Matar

The prediction of fluid responsiveness is crucial for the fluid management of septic shock patients. This prospective, observational study was conducted to compare end-tidal carbon dioxide (ETCO2) change due to fluid challenge (FC-induced ΔETCO2) versus internal jugular vein distensibility index (IJVDI) as predictors of fluid responsiveness in such patients.Septic hypoperfused mechanically ventilated patients were classified as fluid responders (Rs) and non-responders (NRs) according to the improvement of left ventricular outflow tract-velocity time integral (ΔLVOT-VTI) after fluid challenge (FC). The receiver operating characteristic (ROC) curves of FC-induced ΔETCO2, pre-(FC) IJVDI and their combination for prediction of fluid responsiveness were compared to that of ΔLVOT-VTI% as a gold standard.Of 140 patients who completed the study, 51 (36.4%) patients were classified as Rs and 89 (63.6%) patients as NRs. With regard to the prediction of fluid responsiveness, no significant difference (P. 0. 384) was found between the diagnostic accuracy of FC-induced ΔETCO2 >2 mmHg (area under the ROC curve [AUC] 0.908, P < 0.001) and that of pre-(FC) IJVDI >18% (AUC 0.938, P < 0.001), but a prediction model combining both markers, ΔETCO2 ≥3 mmHg and IJVDI ≥16%, achieved significantly higher accuracy (AUC 0.982, P < 0.001) than each independent one (P < 0.05).Under stable ventilatory and metabolic conditions, the predictivity of FC-induced ΔETCO2 >2 mmHg can be comparable to that of pre-(FC) IJVDI >18%. A predictive model combining both FC-induced ΔETCO2 ≥3 mmHg and IJVDI ≥16% can provide higher accuracy than that recorded for each one independently.

Ventricular outflow tract

10.4103/ija.ija_52_23

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Continuous infusion of magnesium–lidocaine mixture for prevention of ventricular arrhythmias during on-pump coronary artery bypass grafting surgery

Egyptian Journal of Anaesthesia (2013)

Abeer M. Elnakera Tamer Alawady

BackgroundDuring on-pump coronary artery bypass grafting (CABG) surgery, the incidence of reperfusion ventricular fibrillation (VF) is high and post-bypass ventricular arrhythmias are common. Both reperfusion VF and ventricular arrhythmias can cause additional myocardial injury to the already ischemic myocardium. This trial aimed to test the assumption that continuous combined magnesium and lidocaine infusion would be efficient and long lasting for the prevention of post-myocardial vascularization ventricular arrhythmias including VF.MethodsEighty ASA III patients, who were candidates for CABG surgery, were randomly assigned into two groups: Group I (control group, n = 40) and Group II (Group ML, n = 40). After endotracheal intubation, patients of control group were infused with plain normal saline in a volume equivalent to study drugs' mixture volume. Patients of Group ML were infused with magnesium–lidocaine mixture to achieve a bolus of magnesium sulfate 2 g and lidocaine 100 mg followed by continuous infusion of Mg sulfate 500 mg/h and lidocaine 1 mg/min. The initial cardiac rhythm after aortic cross clamp (ACC) release and the occurrence of post-CPB significant ventricular arrhythmias were recorded.ResultsThe incidences of reperfusion VF and post-CPB ventricular arrhythmias in Group ML were significantly lower than that in control group (22.5% vs. 72.5%) (P < 0.001) and (7.5% vs. 25%) (P < 0.05), respectively. However, in Group ML, this beneficial effect was associated with higher incidence of sinus bradycardia (72.5% vs. 17.5%) and hence pacing needs (22.5% vs. 0.0%) when compared with control group.ConclusionOur study concluded that, during on-pump CABG surgery, the combined administration of magnesium and lidocaine as a bolus dose starting after intubation followed by continuous infusion reduced the incidence of reperfusion VF by 62% and post-CPB ventricular arrhythmias by 70% on expense of increased the incidence of sinus bradycardia and pacing.

Aortic cross-clamp

Bolus (digestion)

10.1016/j.egja.2013.05.002

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Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery

New England Journal of Medicine (2019)

Giovanni Landoni В. В. Ломиворотов Caetano Nigro Neto Fabrizio Monaco Vadim Pasyuga

Volatile (inhaled) anesthetic agents have cardioprotective effects, which might improve clinical outcomes in patients undergoing coronary-artery bypass grafting (CABG).We conducted a pragmatic, multicenter, single-blind, controlled trial at 36 centers in 13 countries. Patients scheduled to undergo elective CABG were randomly assigned to an intraoperative anesthetic regimen that included a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or to total intravenous anesthesia. The primary outcome was death from any cause at 1 year.A total of 5400 patients were randomly assigned: 2709 to the volatile anesthetics group and 2691 to the total intravenous anesthesia group. On-pump CABG was performed in 64% of patients, with a mean duration of cardiopulmonary bypass of 79 minutes. The two groups were similar with respect to demographic and clinical characteristics at baseline, the duration of cardiopulmonary bypass, and the number of grafts. At the time of the second interim analysis, the data and safety monitoring board advised that the trial should be stopped for futility. No significant difference between the groups with respect to deaths from any cause was seen at 1 year (2.8% in the volatile anesthetics group and 3.0% in the total intravenous anesthesia group; relative risk, 0.94; 95% confidence interval [CI], 0.69 to 1.29; P = 0.71), with data available for 5353 patients (99.1%), or at 30 days (1.4% and 1.3%, respectively; relative risk, 1.11; 95% CI, 0.70 to 1.76), with data available for 5398 patients (99.9%). There were no significant differences between the groups in any of the secondary outcomes or in the incidence of prespecified adverse events, including myocardial infarction.Among patients undergoing elective CABG, anesthesia with a volatile agent did not result in significantly fewer deaths at 1 year than total intravenous anesthesia. (Funded by the Italian Ministry of Health; MYRIAD ClinicalTrials.gov number, NCT02105610.).

Desflurane

Volatile anesthetic

10.1056/nejmoa1816476

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Cerebral Oxygenation During Cardiac Surgery

Abeer M. Elnakera

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MortalitY in caRdIAc surgery (MYRIAD): A randomizeD controlled trial of volatile anesthetics. Rationale and design

Contemporary Clinical Trials (2017)

Giovanni Landoni В. В. Ломиворотов Antonio Pisano Caetano Nigro Neto Umberto Benedetto

Clinical endpoint

10.1016/j.cct.2017.05.011

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Intraperitoneal Installation Of Bupivacaine With Either Dexmedetomidine Or Ketamine For Postoperative Analgesia After Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Study

Perioperative Care and Operating Room Management (2025)

Asmaa Mohammed Galal El-Deen Abeer M. Elnakera Rehab A. Wahdan

Dexmedetomidine

Sleeve gastrectomy

10.1016/j.pcorm.2025.100481

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Effect of Two Different Doses of Gabapentin on the Intraocular Pressure and Hemodynamic Stress Responses to Laryngoscopy and Tracheal Intubation

ISRN Anesthesiology (2013)

Amani A. Ali Abeer M. Elnakera Ahmed Samir

Background . The stress response to laryngoscopy and intubation causes an undesirable increase in heart rate, blood pressure, and intraocular pressure. This study was designed to compare the effect of two doses of gabapentin on the stress response to laryngoscopy and intubation. Patients and Methods . (ASA I and II) 60 patients, aged from 18 to 60 years undergoing elective eye surgery requiring endotracheal intubation, were randomly allocated into 3 groups, 20 patients each. 2 hours before the surgery, group I received oral placebo, and groups II and III received oral gabapentin 800 mg and 1200 mg, respectively. Heart rate (HR), mean arterial pressure (MAP), and intraocular pressure (IOP) were measured before and after induction of anesthesia, immediately after, 5 minutes, and 10 minutes after intubation. Results . Gabapentin 1200 mg prevented the increase in HR, MAP, and IOP, secondary to laryngoscopy and intubation, and kept them below the baseline till 10 minutes after intubation (), while with gabapentin 800 mg, the increase in HR, MAP, and IOP was nonsignificant () and returned to levels below the baseline at 5 and 10 minutes after intubation. Conclusion . Preoperative gabapentin 1200 mg effectively prevented the stress response to laryngoscopy and intubation; meanwhile, gabapentin 800 mg only prevented significant stress response.

Mean arterial pressure

10.1155/2013/698205

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Enhanced Recovery after lumbar laminectomy using combined epidural and general anesthesia with tolerable endotracheal tube: Randomized controlled study.

Ain-Shams Journal of Anaesthesiology (2024)

Abeer Mohamed Abdelbaky Elnakera Ashraf S. A. El‐Sayed Tarek Yousef Gaafar Abeer M. Elnakera

Background: Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative management pathways that can facilitate early recovery. This prospective randomized controlled study was to investigate if combining single shot epidural blockade and general anesthesia (CEGA) using a tolerable endotracheal tube (TET), can enhance recovery after lumbar laminectomy. 40 patients were included in the study and allocated into one of two groups (20 patients each); group I (general anesthesia (GA) group) and group II (CEGA using TET group) in which patients received an epidural single shot bupivacaine 15 ml of 0.25% followed by a standard general anesthetic technique using TET through its side small channel, a dose of 2mg/kg, lidocaine 2% was instilled immediately after intubation and repeated 10 minutes before anesthetic discontinuation. The primary objectives were post-anesthesia care unit (PACU) stay, time to tracheal extubation, and hospital stay. Results: PACU stay was significantly shorter in in CEGA with the TET group (median 10 IQR 8.25- 14.25 mins) compared to GA group (median 24.5 IQR 18.5-31.5) (p <0.001) and time to extubation was also significantly shorter in CEGA with the TET group (median 12 IQR 10- 14.75) compared to GA group (median 15.5 IQR 15- 18) (p <0.001) with no difference regarding hospital stay (p 0.341).Conclusions: CEGA, including a single shot epidural bupivacaine 0.25% and laryngeal lidocaine instillation through TET can reduce time to tracheal extubation and PACU stay and the incidence of peri-extubation cough with no effect on the time to home readiness after lumbar laminectomy.

Endotracheal tube

10.21608/asja.2024.250869.1018

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Inferior vena cava collapsibility index as a predictor of hypotension after induction of general anesthesia in hypertensive patients

BMC Anesthesiology (2023)

Mohamed Metwaly Fathy Rehab A. Wahdan Amal Abdul Azeem Salah Abeer M. Elnakera

Abstract Background Hypertensive patients are more susceptible to develop hypotension after the induction of general anesthesia (GA), most likely due to hypovolemia. An inferior vena cava collapsibility index (IVCCI) > 40–50% can predict hypotension after the induction of GA in the general population by variable accuracies. The current study aimed to investigate IVCCI% as a predictor of postinduction hypotension in hypertensive patients undergoing noncardiac surgery. Methods Ultrasound IVCCI % was assessed for all controlled hypertensive patients immediately before induction of GA. After induction of GA, patients were diagnosed with postinduction hypotension if their systolic arterial pressure (SAP) dropped by ≥ 30% of the baseline value and/or mean arterial pressure (MAP) dropped to < 65 mmHg up to 15 min after intubation. The receiver operating characteristic (ROC) curve of IVCCI% was compared to patients’ classification either developing hypotension after induction of GA or not as a gold standard. Results Of the 153 patients who completed the study, 62 (40.5%) developed hypotension after the induction of GA, and 91 (59.5%) did not. An IVCCI > 39% predicted the occurrence of postinduction hypotension with high accuracy (84%) (AUC 0.908, P < 0.001). The area of uncertainty (by gray zone analysis) of IVCCI lies at values from 39 to 45%. This gray zone included 21 patients (13.7% of all patients). Conclusion An inferior vena cava collapsibility index > 39% before anesthetic induction can be a simple noninvasive reliable predictor of hypotension after the induction of GA for hypertensive patients not treated with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and undergoing noncardiac surgery. Trial registration This clinical trial was approved by the Institutional Review Board (IRB) at Zagazig University (ZUIRB #9424 dated 03/04/2022), and patients’ informed consent for participation in the study was obtained during the period from May 2022 to May 2023. All study procedures were carried out in accordance with the ethical standards of the Helsinki Declaration of 2013.

Pain medicine

10.1186/s12871-023-02355-y

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Preoperative gabapentin versus bisoprolol for haemodynamic and surgical field optimisation during endoscopic sinus surgery: A randomised controlled trial

Indian Journal of Anaesthesia (2021)

Abeer M. Elnakera MaramH Wagdy AymenA Abd-Elgelyl MohamedW EL-Anwar

Appropriate premedication can optimise haemodynamics and hence surgical field visibility during endoscopic sinus surgery (ESS). This study aimed to compare the intraoperative effect of gabapentin 1200 mg versus bisoprolol 2.5 mg, given 2 hours before ESS.Patients were assigned into one of three groups. Patients of gabapentin group received preoperative oral gabapentin 1200 mg while, patients of bisoprolol and control groups received oral bisoprolol 2.5 mg and placebo respectively 2 hours before ESS. Primary outcome: reduction of blood loss and surgical field quality. Secondary outcome: haemodynamic control. mean arterial pressure (MAP) and heart rate (HR) were recorded as baseline, before and after induction of anaesthesia, at 1, 5, 10, 15 minutes after intubation and then every 15 minutes until the end of surgery. Data also included Fromm and Boezaart category scale (assessed every 15 min), intraoperative blood loss, surgeon satisfaction score, intraoperative anaesthetic/analgesic and vasoactive medications requirements.Out of 66 eligible patients, 60 patients completed the study. Intraoperative MAP and HR were significantly lower and more stable in gabapentin and bisoprolol groups compared to control group (p < 0.05). The volume of blood loss was significantly lower (p 0.000) and operative field was more visible in gabapentin and bisoprolol groups than those in control group (p 0.000).The beneficial effect of gabapentin 1200 mg on intraoperative haemodynamic control and surgical field visibility is comparable to that of bisoprolol 2.5 mg when either of them is given as a single oral dose 2 hours before ESS.

Bisoprolol

Labetalol

10.4103/ija.ija_619_20

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Citations (4)