Overview

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.

Publications

Greenhouse gases: the choice of volatile anesthetic does matter
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Richard Alexander, Andrew Poznikoff, Stephan Malherbe
DOI: 10.1007/s12630-017-1006-x
11/2017

Changes in cardiac index and blood pressure on positioning children prone for scoliosis surgery
Anaesthesia
Z. E. Brown, M. Görges, E. Cooke, S. Malherbe, G. A. Dumont, J. M. Ansermino
DOI: 10.1111/anae.12310
05/2013

Usability and performance characteristics of the pediatric air-Q® intubating laryngeal airway
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Simon D. Whyte, Erin Cooke, Stephan Malherbe
DOI: 10.1007/s12630-013-9918-6
03/2013

Cranial conjoined twins: Surgical and anesthetic challenges for a routine procedure: Adenoidectomy and examination of ears
International Journal of Pediatric Otorhinolaryngology
Frederick K. Kozak, Marcela Fandiño, Luthiana F. Carpes, Kawshala Peiris, Stephan Malherbe, Robert Purdy
DOI: 10.1016/j.ijporl.2010.12.019
03/2011

Total intravenous anesthesia and spontaneous respiration for airway endoscopy in children - a prospective evaluation
Pediatric Anesthesia
STEPHAN MALHERBE, SIMON WHYTE, PERMENDRA SINGH, ERICA AMARI, ASHLEE KING, J. MARK ANSERMINO
DOI: 10.1111/j.1460-9592.2010.03290.x
05/2010

The effect of age on the dose of remifentanil for tracheal intubation in infants and children
Pediatric Anesthesia
HELEN HUME-SMITH, JON McCORMACK, CAROLYNE MONTGOMERY, ROLLIN BRANT, STEPHAN MALHERBE, DISHA MEHTA, J MARK ANSERMINO
DOI: 10.1111/j.1460-9592.2009.03190.x
01/2010

Total Intravenous Anesthesia and Spontaneous Ventilation for Foreign Body Removal in ChildrenHow Much Drug?
Anesthesia & Analgesia
Stephan Malherbe, J. Mark Ansermino
DOI: 10.1213/ane.0b013e3181f5ba04
2010

Applications of ultrasound in paediatric anaesthesia
Current Anaesthesia & Critical Care
Jon G. McCormack, Stephan Malherbe
DOI: 10.1016/j.cacc.2008.09.004
10/2008

Relationship between age and spontaneous ventilation during intravenous anesthesia in children
Pediatric Anesthesia
NIGEL BARKER, JOANNE LIM, ERICA AMARI, STEPHAN MALHERBE, J. MARK ANSERMINO
DOI: 10.1111/j.1460-9592.2007.02301.x
10/2007

Low-dose ketamine does not reduce morphine use after spine surgery
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Ban Tsui, Alese Wagner, Stephan Malherbe, J. Mahood, M. Moreau
DOI: 10.1007/bf03019987
06/2007

Age and spontaneous respiration with remifentanil
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
J. Mark Ansermino, Nigel Barker, Joanne Lim, E. Amari, S. Malherbe
DOI: 10.1007/bf03019907
06/2007

Placebo equal to nalbuphine for pruritus in pediatrics
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Nao Nakatsuka, Sean C Minogue, Joanne Lim, Carolyne J Montgomery, Colleen A Court, J Mark Ansermino, Stephan Malherbe, Yvonne Csanyi-Fritz, Ramona A Kearney, Leeann Phillips, Kathy Reid
DOI: 10.1007/bf03023185
06/2005

Intravenous Ketamine Infusion as an Adjuvant to Morphine in a 2-Year-Old With Severe Cancer Pain From Metastatic Neuroblastoma
Journal of Pediatric Hematology/Oncology
Ban C. H Tsui, Dawn Davies, Sunil Desai, Stephan Malherbe
DOI: 10.1097/01.mph.0000140656.96085.2c
10/2004

Inadvertent Cervical Epidural Catheter Placement via the Caudal Route Using Electrical Stimulation
Anesthesia & Analgesia
Ban C. H. Tsui, Stephan Malherbe
DOI: 10.1213/01.ane.0000120082.85977.f7
07/2004

Argatroban as Anticoagulant in Cardiopulmonary Bypass in an Infant and Attempted Reversal with Recombinant Activated Factor VII
Anesthesiology
Stephan Malherbe, Ban C. H. Tsui, Kent Stobart, John Koller
DOI: 10.1097/00000542-200402000-00038
02/2004

The Incidence of Laryngospasm with a "No Touch" Extubation Technique After Tonsillectomy and Adenoidectomy
Anesthesia & Analgesia
Ban C. H. Tsui and Alese Wagner and Dominic Cave and Clark Elliott and Hamdy El-Hakim and Stephan Malherbe
DOI: 10.1213/01.ane.0000097185.70171.89
02/2004

Reversal of an Unintentional Spinal Anesthetic by Cerebrospinal Lavage
Anesthesia & Analgesia
Ban C. H. Tsui, Stephan Malherbe, John Koller, Keith Aronyk
DOI: 10.1213/01.ane.0000095152.81728.dc
02/2004

Nebulization of Lidocaine with Varied Oxygen Flow Rates
Anesthesia & Analgesia
Ban Ch. Tsui, Stephan Malherbe
DOI: 10.1213/01.ane.0000074540.87625.5f
07/2003

Research

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.

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:

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