• Malherbe, Stephan


    Investigator, BC Children's Hospital
    Clinical Associate Professor, Division of Pediatric Anesthesiology, Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia
    Pediatric Anesthesiologist, BC Children's Hospital

    Degrees / Designations
    Primary Area of Research
    Evidence to Innovation
    Secondary Area(s) of Research
    Lab Phone
    Mailing Address

    BC Children's Hospital
    Room 1L7
    4480 Oak Street
    Vancouver, BC V6H 3V4

    Affiliate Websites
    Research Areas
    • Pediatric Anesthesia
    • Spontaneous Ventilation
    I developed an interest in pharmacology and intravenous pharmacokinetics in children after having realized that the lack of published data and consequent lack of understanding in this field leads to enormous potential for research.

    Clinicians are administering intravenous anesthetic agents without fully understanding the pharmacokinetic effects and without well described guidelines. I believe there is enormous potential for research in this area as there is a lack of published data and consequent lack of understanding in this field.
    Current Projects

    Spontaneous Ventilation using Total Intravenous Anesthesia for Endoscopy in Children
    The anesthetic management for removal of foreign bodies in children is challenging. The literature is divided as to the most appropriate anesthetic technique for this procedure. Most standard texts emphasize the desirability of maintaining spontaneous ventilation during retrieval of the foreign body, but some authors specifically recommend the use of muscle relaxants and light inhalation anesthesia.

    The aims of this study are three fold: 

    1. to conduct a retrospective review on current clinical practice for airway endoscopy
    2. to formulate clinical guidelines for anesthetic management of endoscopy
    3. to assess the efficacy and safety of using TIVA with propofol and remifentanil to perform this procedure in spontaneously breathing patients.

    Optimal Dose of Remifentanil for Endotracheal Intubation in Infants and Children
    Many Children will require intubation to help with their breathing while they are asleep. Medicines are routinely given through an intravenous (IV) cannula to allow placement of the breathing tube (intubation) by relaxing the muscles of the throat. The traditional medications given to relax the muscles of the throat are drugs which temporarily cause muscle paralysis. These drugs have a number of unwanted side effects, but an alternative to their use has not existed.

    The introduction of an anesthetic drug, propofol, and an ultra short acting pain medicine, remifentanil, may provide an alternative to the use of muscle relaxant drugs. Propofol and remifentanil have been used for more than ten years, but like most medicines, the majority of experience has been gained with adults. We have limited published information, particularly in small children, on what the optimum dose combination for intubation is, although we know from our daily practice that the combination of propofol and remifentanil provide conditions that allow safe intubation.

    Sometimes, as the breathing tube is inserted, the child may cough. This is especially the case in small children due to their altered break-down of drugs. The purpose of this study is to find the dose of remifentanil when combined with propofol which provides the best conditions for intubation without cough in infants and small children.

    Our group of investigators, led by Dr. Malherbe, has the skills and dedication to complete this study to ensure that all infants and small children will have the safest health care possible.

    Selected Publications

    McCormack J, Malherbe S. Applications of ultrasound in paediatric anaesthesia. Curr Anaesth Crit Care, 2008; 19: 302-8.

    Barker N, Lim J, Amari E, Malherbe 5, Ansermino JM. Relationship between age and spontaneous ventilation during intravenous anaesthesia in children Pediatric Anesthesia 2007; 17(10); 948-55.

    Nakatsuka N, Minogue 5, Lim J, Montgomery C, Court CA, Malherbe 5, Csanyi-Fritz Y, Kearney R, Phillips L, Reid K, Kingsley J, Ansermino JM. Intravenous nalbuphine 50 mcg/kg is ineffective for opioidinduced pruritus in pediatrics. Can J Anesth 2006; 53(11): 1103-1110.

    Tsui BCH, Malherbe S. Response to letter-to-editor. Anesthesia and Analgesia 2005;100:296-7. Tsui BCH, Davies D, Desi 5, Malherbe S. Intravenous ketamine as an adjuvant to morphine in a 2-year- old with severe cancer pain from metastatic neuroblastoma. Journal of Pediatric Hematology/Oncology 2004;26:678-80.

    Tsui ECH, Malherbe 5, Koller J, Aronyk K. Reversal of an unintentional spinal anesthetic by cerebrospinal lavage. Anesthesia and Analgesia 2004; 98:434-6.

    Tsui BCH, Malherbe S. Inadvertent cervical epidural placement via the caudal route using electrical stimulation. Anesthesia and Analgesia 2004;99:259-61.

    Malherbe 5, Tsui BCH, Stobart K, Koller J. Argatroban as anticoagulant in cardiopulmonary bypass in an infant and attempted reversal with recombinant Activated Factor VII. Anesthesiology 2004;100:443-5.

    Tsui BCH, Wagner A, Cave D, Elliott C, El-Hakim H and Malherbe S. The incidence of laryngospasm with a "no touch" extubation technique after tonsillectomy and adenoidectomy. Anesthesia and Analgesia

    Maiherbe 5, Conradie 5, Coetzee A. The effect of magnesium on myocardial ischemia and reperfusion injury. South African Medical Journal 1999;89:Cardiovasc suppl 3, C135-40.

    Honours & Awards
    Research Group Members

    The research manager, research assistants and research fellows of the Anesthesia Research Team.