Papers by Philippe Sitbon
Anesthésie & Réanimation
Critical Care Medicine, 1999
To compare in the same patient with septic shock, respective effects of epinephrine, norepinephri... more To compare in the same patient with septic shock, respective effects of epinephrine, norepinephrine, and the combination of norepinephrine and dobutamine (5 microg/kg/min) on systemic hemodynamic parameters and gastric mucosal perfusion using gastric tonometry and laser-Doppler flowmetry techniques. Prospective, controlled, randomized, crossover study. University hospital intensive care unit. Twelve patients with septic shock. Each patient received in a random succession epinephrine, norepinephrine, and norepinephrine plus dobutamine. Dosages of epinephrine and norepinephrine were adjusted to achieve a mean arterial pressure between 70 and 80 mm Hg. A laser-Doppler probe and a tonometer were introduced into the gastric lumen. The increase in gastric mucosal perfusion detected by laser-Doppler flowmetry was higher with epinephrine and the combination of norepinephrine and dobutamine than with norepinephrine alone (p < .05). In addition, the ratio of gastric mucosal perfusion (local oxygen delivery) to systemic oxygen delivery was increased after norepinephrine plus dobutamine as compared with norepinephrine alone and epinephrine (p< .05). Although values of intramucosal pH and gastroarterial PCO2 tended to be higher with norepinephrine plus dobutamine compared with those obtained with norepinephrine and epinephrine, differences were not statistically significant. For the same mean arterial pressure in patients with septic shock, our study showed that administration of epinephrine increased gastric mucosal perfusion more than norepinephrine administration alone. Addition of dobutamine (5 microg/kg/ min) to norepinephrine improved gastric mucosal perfusion. This result could be explained by a vasodilating effect of dobutamine on gastric mucosal microcirculation.
Anesthesiology, 2008
Background Opioid-induced hyperalgesia can develop rapidly after opioid exposure. Neuropathic pai... more Background Opioid-induced hyperalgesia can develop rapidly after opioid exposure. Neuropathic pain and opioid-induced hyperalgesia share common pathophysiologic mechanisms. Gabapentin is effective for the management of neuropathic pain and may therefore prevent opioid-induced hyperalgesia. This study tested the effectiveness of gabapentin for prevention of long-lasting hyperalgesia induced by acute systemic fentanyl in uninjured rats. Involvement of the alpha2delta auxiliary subunits of voltage-gated calcium channels in the prevention of opioid-induced hyperalgesia by gabapentin also was assessed. Methods Hyperalgesia was induced in male Sprague-Dawley rats with subcutaneous fentanyl (four injections, 20, 60, or 100 microg/kg per injection at 15-min intervals). Intraperitoneal (30, 75, 150, or 300 mg/kg) or intrathecal (300 microg) gabapentin was administered 30 min before or 300 min after (intraperitoneal 150 mg/kg) the first fentanyl injection. Sensitivity to nociceptive stimuli (...
Anesthesia & Analgesia, 2011
Ketamine and gabapentin have been shown to prevent the delayed hyperalgesia induced by short-term... more Ketamine and gabapentin have been shown to prevent the delayed hyperalgesia induced by short-term use of systemic opioids. The mechanism of this action is believed to be likely at the spinal level, through an antagonism of the N-methyl-D-aspartate receptors for ketamine, and through a specific binding site for gabapentin. In this study, we sought to determine the nature of the interaction of these 2 mechanistically distinct antihyperalgesic drugs in a model of opioid-induced hyperalgesia in rats. The median effective antihyperalgesic doses of each drug and of their combination were first defined, to assess the nature of the interaction using an isobolographic analysis.
Anesthesia & Analgesia, 1996
The aim of this prospective study was to evaluate plasma lidocaine concentrations in infants and ... more The aim of this prospective study was to evaluate plasma lidocaine concentrations in infants and children after laryngeal spray using a calibrated device. Twentyone patients aged 3 to 24 mo requiring laryngoscopy or bronchoscopy were included in the study. Anesthesia was induced via a mask with halothane up to 2% in 100% 0,. Lidocaine was administered using a 5% lido-Caine spray. For patients weighing less than 10 kg, one spray (8 mg of lidocaine) was administered. For those weighing from 10 to 20 kg, two sprays (16 mg) were given. The dose of lidocaine administered ranged between 0.9 and 2.6 mg/kg. Maximum plasma lidocaine concentration (C,,,) was 1.05 + 0.55 pg/mL (mean + SD; range 0.24-2.29 pg/mL). With this procedure, we demonstrated the safety of administering lidocaine to children by laryngeal spraying using a 5% sprayer.
Anesthesia & Analgesia, 2005
An active pronociceptive process involving N-methyl-D-aspartate (NMDA) receptor activation is ini... more An active pronociceptive process involving N-methyl-D-aspartate (NMDA) receptor activation is initiated by opioid administration, leading to opioid-induced pain sensitivity. Experimental observations in rats have reported reduction of baseline nociceptive threshold after prolonged spinal opioid administration. In this study we sought to determine whether a single dose of intrathecal morphine can induce hyperalgesia in uninjured rats and to assess the effects of pretreatment with the NMDA-antagonist ketamine on nociceptive thresholds. Sensitivity to nociceptive stimuli (paw pressure test) was assessed for several days after an acute intrathecal injection of morphine (5 microg and 10 microg) in male Sprague-Dawley rats. The effects of subcutaneously administered NMDA-receptor antagonist ketamine (10 mg/kg) before intrathecally administered morphine were also evaluated. A single intrathecal injection of morphine led to a biphasic effect on nociception; early analgesia associated with an increase in the nociceptive threshold lasting 3-5 h was followed by delayed hyperalgesia associated with a decrease in the nociceptive threshold lasting 1-2 days. Subcutaneous ketamine did not significantly modify the early analgesic component but almost completely prevented the delayed decrease in nociceptive threshold after intrathecal administration of morphine. A single intrathecal injection of morphine in rats produces a delayed and sustained hyperalgesia linked to the development of opioid-induced pain sensitivity.
American Journal of Respiratory and Critical Care Medicine, 1996
We described here an original device for laser Doppler (LD) flowmetry measurements of gastric muc... more We described here an original device for laser Doppler (LD) flowmetry measurements of gastric mucosal perfusion, which was used here in healthy volunteers. A modified nasogastric tube containing the LD probe was inserted. Aspiration via a catheter, fixed in parallel to the probe, held the probe against the gastric wall. This new device was used to assess gastric mucosal perfusion in seven volunteers during simulated hypovolemia induced by lower body negative pressure (LBNP) application. The LBNP consisted of three successive levels of depression (-10, -20, and -30 mm Hg). Although mean arterial pressure remained unchanged during negative pressure application, there was a significant decrease in cardiac output (transthoracic electrical impedance) at each stage of LBNP. In contrast, gastric mucosal perfusion decreased significantly only at higher level of sympathetic stimulation corresponding to unloading of both cardiopulmonary and arterial baroreflexes (-30 mm Hg). It may be hypothetized that local vascular mechanisms exist to maintain gastric mucosal perfusion during moderate sympathetic stimulation induced by selective unloading of cardiopulmonary receptors. In the healthy volunteers studied, we found that LD flowmetry is a valuable tool to evaluate gastric mucosal perfusion when the probe is maintained in a constant position by the technique described here.
Purpose: Although epidural analgesia (EA) is recommended for laparotomic (LT) rectal surgery, the... more Purpose: Although epidural analgesia (EA) is recommended for laparotomic (LT) rectal surgery, there is no consensus regarding pain management in laparoscopic or robotic (LR) rectal cancer surgery. According to our local guidelines, EA is usually chosen for LT rectal procedures and intravenous analgesia for LR rectal procedures. Methods: This retrospective study included patients who underwent rectal cancer surgery in our center from January 2016 to February 2020 using either laparotomy (LT) or laparoscopic or robotic (LR) techniques. Analgesia technique varied according to surgery technique, the choice of patient and anesthesia provider. Data were acquired from electronic databases and consisted of pain scores in the recovery room and the three postoperative days, morphine consumption and total length of hospital stay. Results: 151 patients were included: 92 in the LR group and 59 in the LT group. Epidural analgesia was used for 8/92 LR patients and of 48/59 LT patients. Pain scores...
A&A practice, 2021
Efficient pain management is essential for postoperative rehabilitation in patients undergoing a ... more Efficient pain management is essential for postoperative rehabilitation in patients undergoing a tumor resection with an immediate reconstructive surgery. Ultrasound-guided quadratus lumborum block has been described for abdominal or hip surgery, but not for concomitant surgery in the abdomen and the thigh. The paraspinous transmuscular approach has easy landmarks to perform this block. We present a case of a patient undergoing a resection of a sarcoma in the lower limb with an immediate reconstruction with a pedicled vertical designed deep inferior epigastric perforator flap, in whom a successful paraspinous transmuscular quadratus lumborum block for postoperative analgesia was performed.
Anesthesia & Analgesia, 1998
maintained during CPB. Thus, in the present study, we tested the hypothesis that GMRBC flux asses... more maintained during CPB. Thus, in the present study, we tested the hypothesis that GMRBC flux assessed by LD flowmetry could be improved by maintaining systemic DO, at pre-CPB values during CPB.
Acta Anaesthesiologica Scandinavica, 2003
Common practice in intubation without muscle relaxant is to inject the opioid drug prior to the h... more Common practice in intubation without muscle relaxant is to inject the opioid drug prior to the hypnotic drug. Because remifentanil reaches adequate cerebral concentration more rapidly than does propofol, we tested the hypothesis that injection of remifentanil after propofol might lead to better intubating conditions. Thirty ASA I-II patients scheduled for elective surgery and with no anticipated difficult intubation were enrolled in the study. Five minutes after midazolam 30 microg kg(-1), patients were randomized into two groups: group PR received propofol 2.5 mg kg(-1) followed by remifentanil 1 microg kg(-1), and group RP received remifentanil 1 microg kg(-1) followed by propofol 2.5 mg kg(-1). Intubating conditions were compared using a well-validated score, and continuous arterial pressure was recorded non-invasively. Compared with group RP, intubating conditions were significantly better in group PR. The mean arterial pressure decrease was more pronounced in group RP. We therefore conclude that in premedicated healthy patients with no anticipated risk of difficult intubation, intubating and haemodynamic conditions are better when remifentanil is injected after propofol.
Journal of Surgical Oncology, 2021
Cancer surgery during the COVID-19 pandemic: The experience of a comprehensive cancer center perf... more Cancer surgery during the COVID-19 pandemic: The experience of a comprehensive cancer center performing preopera ve screening by RT-PCR and chest CT scan Joanne Guerlain , Fabienne Haroun , Alexandra Voicu , Charles Honoré , Franck Griscelli , Stéphane Temam , Nadia Benmoussa , Philippe Gorphe , Thierry de Baere , Samy Ammari , Gabriel Garcia , Corinne Balleyguier , Françoise Rimareix , Sébas en Gouy , Philippe Sitbon , Bertrand Gachot , Ingrid Breuskin , Stéphanie Suria and Antoine Moya-Plana 815
Diagnostics
Background: End-tidal carbon dioxide pressure (PetCO2) is unreliable for monitoring PaCO2 in seve... more Background: End-tidal carbon dioxide pressure (PetCO2) is unreliable for monitoring PaCO2 in several conditions because of the unpredictable value of the PaCO2–PetCO2 gradient. We hypothesised that increasing both the end-inspiratory pause and the expiratory time would reduce this gradient in patients ventilated for COVID-19 with Acute Respiratory Distress Syndrome and in patients anaesthetised for surgery. Methods: On the occasion of an arterial blood gas sample, an extension in inspiratory pause was carried out either by recruitment manoeuvre or by extending the end-inspiratory pause to 10 s. The end-expired PCO2 was measured (expiratory time: 4 s) after this manoeuvre (PACO2) in comparison with the PetCO2 measured by the monitor. We analysed 67 Δ(a-et)CO2, Δ(a-A)CO2 pairs for 7 patients in the COVID group and for 27 patients in the anaesthesia group. Results are expressed as mean ± standard deviation. Results: Prolongation of the inspiratory pause significantly reduced PaCO2–PetC...
European Journal of Clinical Medicine
Background: Despite its anticipation, postoperative pain may be still poorly managed in some case... more Background: Despite its anticipation, postoperative pain may be still poorly managed in some cases, such as in patients undergoing major cervicofacial cancer surgery. Indeed, the postoperative pain associated with these surgeries is complex and multifactorial. Objective: To assess the profile of postoperative pain scores and opioid requirements in a cohort of consecutive patients undergoing major cancer cervicofacial surgery with or without reconstruction. Methods: A cohort of 42 consecutive patients was studied. The following parameters were recorded: patients characteristics, type of surgery, preoperative medication preoperative pain scores, and postoperative pain score (5-point numerical verbal scale) upon arrival at the postanesthesia care unit (PACU) and at Day 1 to Day 7 (11-point visual numeric scale), the presence or absence of neuropathic and/or chronic pain one year later (determined by a phone interview), and morphine consumption. Results: All patients had a pain score of...
Uploads
Papers by Philippe Sitbon