M Moutafis

Hôpital Ambroise Paré – Hôpitaux universitaires Paris Ile-de-France Ouest, Billancourt, Île-de-France, France

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Publications (31)157.36 Total impact

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    ABSTRACT: The inhibitory effect of anaesthetic agents on hypoxic pulmonary vasoconstriction may depend upon their dose, especially when using a volatile agent. The aim of this randomized open study was to compare the effects of sevoflurane and propofol, as primary anaesthetic agents, on oxygenation during one-lung ventilation (OLV), with their administration being adjusted to maintain bispectral index (BIS) values between 40 and 60. Eighty patients scheduled for a lobectomy, receiving an epidural mixture of ropivacaine and sufentanil, were randomly assigned to Group S (maintenance with sevoflurane) or Group P (maintenance with propofol). After placement of a double-lumen tube, the lungs were ventilated at an inspiratory fraction of oxygen of 1.0, a tidal volume of 6 ml kg(-1), and 12 bpm. Arterial blood gas samples were taken as follows: during two-lung ventilation before OLV, and during the first 40 min of OLV. Fifteen patients were excluded (incorrect placement of the tube or BIS outside the desired range). The two groups were comparable in terms of demographic variables, haemodynamic, and BIS levels during the operation. Four patients in each group had a Sp(O2)<90%. Mean of the lowest Pa(O2) was 16.3 (7.5) kPa in Group S and 17.7 (9.3) kPa in Group P (ns). Sevoflurane and propofol had similar effect on Pa(O2) during OLV when their administration is titrated to maintain BIS between 40 and 60.
    BJA British Journal of Anaesthesia 04/2007; 98(4):539-44. · 4.24 Impact Factor
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    ABSTRACT: The inhibitory effect of anaesthetic agents on hypoxic pulmonary vasoconstriction may depend upon their dose, especially when using a volatile agent. The aim of this randomized open study was to compare the effects of sevoflurane and propofol, as primary anaesthetic agents, on oxygenation during one-lung ventilation (OLV), with their administration being adjusted to maintain bispectral index (BIS) values between 40 and 60. Eighty patients scheduled for a lobectomy, receiving an epidural mixture of ropivacaine and sufentanil, were randomly assigned to Group S (maintenance with sevoflurane) or Group P (maintenance with propofol). After placement of a double-lumen tube, the lungs were ventilated at an inspiratory fraction of oxygen of 1.0, a tidal volume of 6 ml kg(-1), and 12 bpm. Arterial blood gas samples were taken as follows: during two-lung ventilation before OLV, and during the first 40 min of OLV. Fifteen patients were excluded (incorrect placement of the tube or BIS outside the desired range). The two groups were comparable in terms of demographic variables, haemodynamic, and BIS levels during the operation. Four patients in each group had a Sp(O2)<90%. Mean of the lowest Pa(O2) was 16.3 (7.5) kPa in Group S and 17.7 (9.3) kPa in Group P (ns). Sevoflurane and propofol had similar effect on Pa(O2) during OLV when their administration is titrated to maintain BIS between 40 and 60.
    BJA British Journal of Anaesthesia 04/2007; 98(4):539-44. · 4.24 Impact Factor
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    ABSTRACT: The use of cardiopulmonary bypass (CPB) for lung transplantation (LTx) has been reported previously. This study reports the authors' experience of planned and unplanned use of cardiopulmonary bypass for LTx. Case series. A university teaching hospital. Patients undergoing LTx. A retrospective analysis of the charts of all patients having undergone LTx over the last 10 years. Among 140 LTx, 23 (16%) were performed with the use of CPB. CPB was planned in 11 cases and unplanned in the 12 other cases. The use of CPB is associated with a longer period of postoperative mechanical ventilation, more pulmonary edema, more blood transfusion requirement, and an increase in postoperative mortality at 48 hours and 1 month. Surgical difficulties related to the dissection of the native left lung and acute right ventricular failure are the main reasons for unscheduled use of CPB. Scheduled and unscheduled CPB for LTx are associated with an increased mortality at 1 month and 1 year.
    Journal of Cardiothoracic and Vascular Anesthesia 11/2006; 20(5):668-72. · 1.45 Impact Factor
  • New England Journal of Medicine 09/2004; 351(9):933-4; author reply 933-4. · 54.42 Impact Factor
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    ABSTRACT: We performed this prospective randomized double-blinded study to assess the ability of almitrine to treat hypoxemia during one-lung ventilation (OLV). Twenty-eight patients were anesthetized with propofol, sufentanil, and atracurium; lung separation was achieved with a double-lumen tube. A transesophageal Doppler probe was inserted to evaluate cardiac index. If SpO(2) was equal to or decreased to <95% during OLV (inspired fraction of oxygen of 0.6), patients were included in the study and received a placebo or almitrine (12 microg x kg(-1) x min(-1) for 10 min followed by 4 microg x kg(-1) x min(-1)) infusion until SpO(2) reached 90% or decreased to <90% (exclusion from the study). Eighteen of the 28 patients were included and received either almitrine (n = 9) or a placebo (n = 9). Treatment was discontinued in 1 patient in the almitrine group and 6 in the placebo group (P < 0.05). Treatment was successful (SpO(2) remaining >or=95% during OLV) in 8 patients in the almitrine group and 1 in the placebo group (P < 0.01). Heart rate, arterial blood pressure, and cardiac index did not change throughout the study, but we could obtain an adequate aortic blood flow signal in only half of the patients. Almitrine could be used to treat hypoxemia during OLV. IMPLICATIONS: IV almitrine improves oxygenation during one-lung ventilation without hemodynamic modification. Such treatment could be used when conventional ventilatory strategy fails to treat hypoxemia or cannot be used.
    Anesthesia & Analgesia 04/2004; 98(3):590-4, table of contents. · 3.30 Impact Factor
  • L Raffin, M Moutafis, N Dalibon
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    ABSTRACT: Surgery for emphysema is considered as one of the most challenging procedure for anaesthesiologist. Because of the critical illness of such patient, perioperative monitoring is important. Ventilatory monitoring is often difficult or impossible due to a possible massive air leak during the procedure. This case described how ETCO2 was assessed by capnography monitoring on the chest tube drainage.
    Annales Françaises d Anesthésie et de Réanimation 06/2003; 22(5):484-6. · 0.84 Impact Factor
  • L RAFFIN, M MOUTAFIS, N DALIBON
    Annales Francaises D Anesthesie Et De Reanimation - ANN FR ANESTH REANIM. 01/2003; 22(5):484-486.
  • L. Raffin, M. Moutafis, N. Dalibon
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    ABSTRACT: Surgery for emphysema is considered as one of the most challenging procedure for anaesthesiologist. Because of the critical illness of such patient, perioperative monitoring is important. Ventilatory monitoring is often difficult or impossible due to a possible massive air leak during the procedure. This case described how ETCO2 was assessed by capnography monitoring on the chest tube drainage.
    Annales Françaises d Anesthésie et de Réanimation 01/2003; 22(5):484-486. · 0.84 Impact Factor
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    ABSTRACT: One-lung ventilation (OLV) induces an increase in pulmonary shunt sometimes associated with a decrease in PaO2 despite ventilation with 100% oxygen. PaO2 improvement has been reported in one-lung ventilated animals receiving IV almitrine, a pulmonary vasoconstrictor. We evaluated the ability of almitrine to prevent a decrease in PaO2 during OLV. Patients without pulmonary hypertension undergoing OLV for lung surgery were randomly assigned to receive either placebo (Group P, n = 8) or almitrine infusion at a rate of 8 microg x kg(-1) x min(-1) (Group A, n = 8) from the start of OLV. Gasometric and hemodynamic values were recorded with the patient in the lateral decubitus position during two-lung ventilation and at 10-min intervals during OLV over a 30-min period (OLV-10, OLV-20, OLV-30). Compared with the values found during two-lung ventilation (434 +/- 22 mm Hg in Group P and 426 +/- 23 mm Hg in Group A), PaO2 decreased at OLV-10 (305 +/- 46 mm Hg), OLV-20 (203 +/- 20 mm Hg), and OLV-30 (178 +/- 18 mm Hg) in Group P (P < 0.05) and at OLV-20 (354 +/- 25 mm Hg) and OLV-30 (325 +/- 17 mm Hg) in Group A (P < 0.05). PaO2 values differed between the groups at OLV-20 and OLV-30 (P < 0.05). Pulmonary artery pressure and cardiac output did not change. In conclusion, 8 microg x kg(-1) x min(-1) IV almitrine prevents and limits the OLV-induced decrease in PaO2 without causing any hemodynamic modification. IMPLICATIONS: Eight microg x kg(-1) x min(-1) IV almitrine limits one-lung ventilation-induced decrease in PaO2 without causing any hemodynamic modification in patients without pulmonary hypertension.
    Anesthesia & Analgesia 05/2002; 94(4):830-4, table of contents. · 3.30 Impact Factor
  • The Lancet 05/2002; 359(9314):1347-8. · 39.21 Impact Factor
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    ABSTRACT: We compared the analgesic effect of lumbar intrathecal (IT) 0.5 mg morphine (Group M, n = 10), 50 microg sufentanil (Group S, n = 10), and their combination (Group S-M, n = 10) given before general anesthesia and patient-controlled analgesia with IV morphine (Group C, n = 19) in a randomized, double-blinded study performed in patients undergoing thoracotomy. Pain visual analog scale (VAS) and morphine consumption were assessed for 24 h. In Group S-M the number of patients initially titrated with IV morphine was less than in group C (30 vs 84%, P < 0.05). Morphine requirement was higher in Group C (71 +/- 30 mg) than in Groups S (46 +/- 34 mg, P < 0.05), M (38 +/- 31 mg, P < 0.05) and S-M (23 +/- 16 mg, P < 0.01). VAS scores were significantly decreased during the first 0-11 postoperative h at rest and during the first 0-8 postoperative h on coughing in Groups M and S-M rather than in Group C. The incidence of side effects was infrequent except for urinary retention. Preoperative IT morphine or combined sufentanil and morphine could be given as a booster to achieve rapidly effective analgesia in the immediate postoperative period. Implications: As compared with IV patient-controlled analgesia, intrathecal morphine or combined sufentanil and morphine provided superior postoperative pain relief both at rest (11 h) and on coughing (8 h) than did IV patient-controlled analgesia morphine alone. IV morphine requirement was decreased during the first postoperative day after posterolateral thoracotomy.
    Anesthesia & Analgesia 01/2001; 92(1):31-6. · 3.30 Impact Factor
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    ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
    Anesthesiology 10/2000; 93(3):903-4. · 5.16 Impact Factor
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    Anesthesia & Analgesia 09/1999; 89(2):302-4. · 3.30 Impact Factor
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    ABSTRACT: Evaluation of the magnitude of pulmonary air trapping during routine thoracic surgery and single-lung transplantation. Prospective study on consecutive patients. Single institution, university hospital. Sixteen patients with no or moderate obstructive lung disease undergoing routine thoracic surgery (group 1), six patients with severe emphysema (group 2), and six patients with severe fibrosis (group 3) undergoing single-lung transplantation. Occlusion maneuver timed at the end of expiration to measure auto-positive end-expiratory pressure (auto-PEEP) and trapped volume (delta FRC). The maneuver was performed during two-lung ventilation in supine (2LV supine) and lateral decubitus (2LV lateral) positions and during one-lung ventilation (OLV) in lateral decubitus position. At the same time, airway pressures and PaO2 measurements were performed. In group 1, consistent values of auto-PEEP and delta FRC occurred only during OLV: 4.8 +/- 2.5 cm H2O and 109 +/- 61 mL (mean +/- standard deviation). In group 2, auto-PEEP and delta FRC values were 11.7 +/- 6.9 cm H2O and 355 +/- 125 mL during 2LV supine, 8.8 +/- 5.7 cm H2O and 320 +/- 122 mL during 2LV lateral, and 15.9 +/- 3.9 cm H2O and 284 +/- 45 mL during OLV. In group 3, pulmonary air trapping was low. For the three groups together, auto-PEEP and delta FRC (p < 0.0001) related inversely to the ratio of forced expired volume in 1 second (FEV1) to forced vital capacity (FVC) expressed in percent (FEV1/FVC%) during OLV. In contrast, there was no correlation between PaO2 and auto-PEEP or delta FRC. Pulmonary air trapping must be suspected in patients with no or moderate obstructive lung disease during OLV and in those with severe obstructive disease as soon as 2LV is initiated.
    Journal of Cardiothoracic and Vascular Anesthesia 02/1999; 13(1):35-9. · 1.45 Impact Factor
  • Annales Françaises d Anesthésie et de Réanimation 01/1998; 17(8):866-866. · 0.84 Impact Factor
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    ABSTRACT: The aim of this study was to assess whether hypoxemia during one-lung ventilation (OLV) can be prevented by inhaled nitric oxide (NO) (Part I) or by its combination with intravenous (IV) almitrine (Part II) in 40 patients undergoing thoracoscopic procedures. In Part I, 20 patients were divided into two groups: one received O2 (Group 1) and one received O2/NO (Group 2). In Part II, 20 patients were divided into two groups: one received O2 (Group 3) and one received O2/NO/almitrine (Group 4). In Groups 2 and 4, NO (20 ppm) was administered during the entire period of OLV, and almitrine was continuously infused (16 microg x kg(-1) x min[-1]) in Group 4. Arterial blood gases were measured during two-lung ventilation with patients in the supine position, after positioning in the lateral decubitus position, and then every 5 min for a 30-min period during OLV. During OLV, Pao2 values decreased similarly in Groups 1 and 2. After 30 min of OLV, the mean Pao2 values in Groups 1 and 2 were 132 +/- 14 mm Hg (mean +/- sem) and 149 +/- 27 mm Hg (not significant [NS]), and the Pao2 value was less than 100 mm Hg in four patients in Group 1 and five patients in Group 2. Pao2 values were greater in Group 4 than in Group 3 after 15 and 30 min of OLV. After 30 min of OLV, the mean Pao2 values were 146 +/- 16 mm Hg in Group 3 and 408 +/- 33 mm Hg in Group 4 (P < 0.001). Pao2 was less than 100 mm Hg during OLV (NS) in four patients in Group 3 and in no patient in Group 4. We conclude that NO inhalation alone has no effect on Pao2 evolution during OLV, although its combination with IV almitrine limits the decrease of Pao2 during OLV. This beneficial effect of NO/almitrine could be attributed to an improvement in ventilation-perfusion relationships. IMPLICATIONS: Decrease in oxygenation during one-lung ventilation is quite common. Our study showed that inhaled nitric oxide alone did not influence Pao2 evolution. We then tried adding intravenous almitrine to nitric oxide with amazingly good results on Pao2. This nonventilatory technique should be of great use during special thoracic acts, such as thoracoscopic procedures.
    Anesthesia & Analgesia 11/1997; 85(5):1130-5. · 3.30 Impact Factor
  • Annales Françaises d Anesthésie et de Réanimation 09/1997; 16(6):745-745. · 0.84 Impact Factor
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    ABSTRACT: Haemodynamic alterations occur consistently with laparoscopic surgery in humans. These haemodynamic changes have never been reproduced in an animal model without additional potentiating factors. As these alterations may be deleterious in some patients and as the cause is only partly understood, we have used an animal model to study these changes. Pneumoperitoneum with intraperitoneal pressures of up to 15 mm Hg were produced in pigs, in the same way as for laparoscopic surgery in humans. Arterial pressure, cardiac output, pulmonary arterial pressure and systemic arterial resistance were assessed at baseline and after pneumoperitoneum had been produced. Intraperitoneal pressures of up to 15 mm Hg were not associated with consistent circulatory changes and we conclude that haemodynamic changes associated with laparoscopic surgery are dependent on species.
    BJA British Journal of Anaesthesia 06/1997; 78(5):576-8. · 4.24 Impact Factor
  • Annales Françaises d Anesthésie et de Réanimation 01/1996; 15(6):980-980. · 0.84 Impact Factor
  • Annales Francaises D Anesthesie Et De Reanimation - ANN FR ANESTH REANIM. 01/1996; 15(6):981-981.

Publication Stats

204 Citations
157.36 Total Impact Points

Institutions

  • 2007
    • Hôpital Ambroise Paré – Hôpitaux universitaires Paris Ile-de-France Ouest
      Billancourt, Île-de-France, France
  • 1997
    • Hôpital Antoine-Béclère – Hôpitaux universitaires Paris-Sud
      Clamart, Île-de-France, France
  • 1991–1997
    • Centre Médico Chirurgical Paris V
      Lutetia Parisorum, Île-de-France, France