Corinne Lejus

Centre Hospitalier Universitaire de Nantes | CHU Nantes · service d'anesthésie réanimation

Objective: The FRTID (Formation de Référents aux Techniques d'Intubation Difficile) is a French continuing medical education program on difficult airway management. Its objectives are to train experts in the task of training other physicians in their hospitals for better guideline compliance. Our aim was to describe the curriculum of the experts a...

Introduction De multiples travaux montrent que la simulation haute-fidélité (HF) améliore les performances techniques et comportementales sur simulateur. L’impact sur les pratiques cliniques est plus controversé. L’hypothèse de cette étude prospective était que des ateliers HF améliorent la qualité de la prise en charge réanimatoire des nouveau-nés...

Cerebral non-invasive monitoring of oxygen saturation by near-infrared spectroscopy (rSO2) during paediatric cardiac surgery is supposed to decrease the risk of neurological complications. Since haemoglobin level is one of the factors changing rSO2, we aimed to explore if rSO2 monitoring influences intra-operative RBC (red blood cell) transfusion t...

Résumé La rachianesthésie éveillée est proposée pour la cure de hernie chez le nouveau-né ancien prématuré pour diminuer le risque d’apnée postopératoire. Cependant, ce bénéfice, par rapport à une technique d’anesthésie locorégionale associée à l’inhalation de sévoflurane, est discuté. Les autres indications incluent, chez l’enfant plus grand, la c...

To evaluate whether the Script Concordance Test (SCT) can discriminate between levels of experience among anesthesiology residents and attending physicians. Multicenter (Toulouse, Nantes, Bordeaux and Limoges), prospective, observational study. A SCT made of 60 items was used to evaluate "junior residents" (n=60), "senior residents" (n=47) and expe...

Stroke is a well-described postoperative complication, after carotid and cardiac surgery. On the contrary, few studies are available concerning postoperative stroke in general non-cardiac non-carotid surgery. The high morbid-mortality of stroke justifies an extended analysis of recent literature. Systematic review. Firstly, Medline and Ovid databas...

L’accident vasculaire cérébral ischémique (AVCI) est une complication postopératoire connue après chirurgie cardiaque et carotidienne. En revanche, peu d’études sont disponibles concernant les AVCI après chirurgie générale. Son importante morbi-mortalité justifie une analyse des données épidémiologiques récentes.

Purpose Preload responsiveness parameters could be useful in the hemodynamic management of septic shock. Methods Multicentric prospective echocardiographic observational study from March 2009 to August 2011. Clinically brain-dead subjects were included. Pulse pressure variations (ΔPP) were recorded. Cardiac index (CI), variation of the maximum flo...

Background Few data are available in the literature on risk factors for postoperative vomiting (POV) in children.Objective The aim of the study was to establish independent risk factors for POV and to construct a pediatric specific risk score to predict POV in children.Methods Characteristics of 2392 children operated under general anesthesia were...

Aunque durante mucho tiempo se ha subestimado el dolor postoperatorio en pediatría, el arsenal terapéutico disponible hoy día para el niño es prácticamente tan amplio como el del adulto. La estrategia multimodal privilegia el uso de la anestesia locorregional debido a su superior eficacia y a un efecto favorable sobre la rehabilitación postoperator...

While coat contamination increases progressively with the duration of use, there are no guidelines on how frequently medical white coats should be changed. The purpose of our study was to examine the turnover of individual batch of medical white coats in a university hospital. A retrospective analysis of the white coat turnover of 826 physicians wa...

To evaluate a single-use fiberscope, the Ascope-Trainer™, for the training in the intubation under fiberscope. Prospective randomized study approved by the local ethic committee. After evaluation of their level of expertise, "experienced" or "novices" in intubation under fiberscope, the doctors attending the Training for Referents in Difficult Airw...

Major trauma remains a worldwide cause of morbi-mortality. Early mortality is the consequence of hemorrhagic shock and traumatic brain injury. During early resuscitation, anaesthesia is often mandatory to perform surgery. It is mandatory to master the hemodynamic effects of hypnotic drugs in order to anticipate their potential deleterious effects i...

This study aimed to evaluate the pupillary dilatation reflex (PDR) during a tetanic stimulation to predict insufficient analgesia before nociceptive stimulations in intensive care unit (ICU). In this prospective non-interventional study in a surgical ICU of a university hospital, PDR was assessed during a tetanic stimulation (10, 20 or 40 mA) immed...

Neonates are considered as immunologically immature. There are no specific guidelines for surgical antibiotic prophylaxis in this population since data concerning the risk factors for surgical site infection (SSI) are lacking. A 40-month retrospective single-center study that included all consecutive neonates undergoing surgery was performed. The v...

Background: A widely used physiological simulator is generally accepted to give valid predictions of oxygenation status during disturbances in breathing associated with anesthesia. We compared predicted measures with physiological measurements available in the literature, or derived from other models. Methods: Five studies were selected from the...

Introduction: We sought to investigate whether the use of balanced solutions reduces the incidence of hyperchloraemic acidosis without increasing the risk for intracranial hypertension in patients with severe brain injury. Methods: We conducted a single-centre, two-arm, randomised, double-blind, pilot controlled trial in Nantes, France. Patients...

Rhinopharyngitis is a very common condition in children. The presence of an infection of the upper airways increases significantly the risk of respiratory complications from induction of anaesthesia to recovery. The outcome is usually favorable, however some complications can be life-threatening. Thus, the objective of this review is to give a comp...

Background: Glycine is an excipient of remifentanil and may induce side effects. To investigate glycine and ammonia concentration with the use of remifentanil in Intensive Care Unit patients with acute kidney injury (AKI) defined by a decrease in creatinine clearance above 50%. Methods: Prospective open-label cohort study in three surgical Inten...

Recently, national French recommendations have clarified the indications for preoperative routine, including the pediatric field. Because of the low incidence of cardiorespiratory disease in children, the attention is mainly focused on the diagnosis of congenital or acquired coagulopathies. Clinical examination and personal and familial history of...

Goal of the study To evaluate a single-use fiberscope, the Ascope-Trainer™, for the training in the intubation under fiberscope. Type of study Prospective randomized study approved by the local ethic committee. Methodology After evaluation of their level of expertise, “experienced” or “novices” in intubation under fiberscope, the doctors attendin...

The transfusion of blood and blood products is a complex, multi-professional task which is liable to errors from donor to recipient. Simulation is a new training tool in medicine which may result with an improvement for safety and quality of care without any risk for the patient. Different simulators are available: haptic system and low fidelity ma...

In pediatric elective surgery, the main indications of blood transfusion are cardiac surgery, neurosurgery and abdominal tumors. Blood saving techniques are also available. The transfusion threshold has to take into account the physiological age-related particularities. Underestimation of blood loss and delayed transfusion are associated with a sev...

The transfusion of blood and blood products is a complex, multi-professional task which is liable to errors from donor to recipient. Simulation is a new training tool in medicine which may result with an improvement for safety and quality of care without any risk for the patient. Different simulators are available: haptic system and low fidelity ma...

To investigate the impact of etomidate on the rate of hospital-acquired pneumonia (HAP) in trauma patients and the effects of hydrocortisone in etomidate-treated patients. This was a sub-study of the HYPOLYTE multi-centre, randomized, double-blind, placebo-controlled trial of hydrocortisone in trauma patients (NCT00563303). Inclusion criterion was...

Infections are a major cause of death and morbidity after acute injury of the central nervous system (CNS). Acute lesions of the CNS alter immune homeostasis contributing to the development of immunosuppression (IS), and making the bed of the infection. IS results in a decreased phagocytic functions of neutrophils and macrophages as well as monocyt...

Infections are a major cause of death and morbidity after acute injury of the central nervous system (CNS). Acute lesions of the CNS alter immune homeostasis contributing to the development of immunosuppression (IS), and making the bed of the infection. IS results in a decreased phagocytic functions of neutrophils and macrophages as well as monocyt...

To define the risk factors of allogeneic erythrocyte transfusion in patients older than 65 years of age who underwent hip fracture surgery. Retrospective, single-center study. Orthopedic unit of a university hospital. The records of 413 consecutive patients undergoing hip fracture surgery over a 12-month period and receiving low-molecular-weight he...

Existen dos clases principales de soluciones macromoleculares de reposición vascular (RV) o coloides: los hidroxietilalmidones (HEA) y las gelatinas fluidas modificadas (GFM). Las propiedades fisicoquímicas, farmacocinéticas y farmacodinámicas, así como los efectos indeseables, son motivo de una actualización que pone de relieve varios conceptos es...

Las urgencias quirúrgicas neonatales son poco frecuentes; sin embargo, el procedimiento anestésico debe tener en cuenta muchas particularidades fisiológicas del recién nacido y la fisiopatología de la malformación congénita subyacente. El comportamiento farmacocinético de la mayoría de los agentes anestésicos es diferente. La inmadurez hepática es...

Le soluzioni macromolecolari di riempimento vascolare (RV), o colloidi, sono rappresentate in Francia da due classi: idrossietilamidi (HEA) e gelatine fluide modificate (GFM). Le loro proprietà fisicochimiche, farmacocinetiche e farmacodinamiche e i loro effetti indesiderati sono oggetto di un aggiornamento che evidenzia diverse nozioni importanti...

Le urgenze chirurgiche neonatali sono poco frequenti, ma la loro gestione anestesiologica deve prendere in considerazione molteplici caratteristiche fisiologiche del neonato e la fisiopatologia della malformazione congenita sottostante. Il comportamento farmacocinetico della maggior parte degli agenti anestetici è modificato. L’immaturità epatica è...

Nous rapportons le cas d’une jeune patiente de 25 ans qui présentait un tableau de choc septique lié à une pyélonéphrite sur obstacle urinaire lithiasique. Après dérivation en urgence des urines, un tableau d’insuffisance rénale aiguë associée à une anémie hémolytique et à une thrombopénie périphérique apparaissait, portant le diagnostic de microan...

Description of a continuous hypertonic saline solution (HSS) infusion using a dose-adaptation of natremia in traumatic brain injured (TBI) patients with refractory intracranial hypertension (ICH). We performed a single-center retrospective study in a surgical intensive care unit of a tertiary hospital. Fifty consecutive TBI patients with refractory...

Risk factors of postoperative vomiting (POV) have been less extensively explored in children compared to adults. We analyzed the risk factors of POV in children receiving continuous intravenous (i.v.) morphine in a standardized manner without POV prophylaxis after major surgery. This observational retrospective study included 235 children aged from...

The role of stress-dose hydrocortisone in the management of trauma patients is currently unknown. To test the efficacy of hydrocortisone therapy in trauma patients. Multicenter, randomized, double-blind, placebo-controlled HYPOLYTE (Hydrocortisone Polytraumatise) study. From November 2006 to August 2009, 150 patients with severe trauma were include...

microbiologic data are lacking regarding pediatric community-acquired peritonitis (CAP). we conducted a 2-year retrospective single center study. Consecutive children undergoing CAP surgery were included. Microbiology and antimicrobial susceptibility of peritoneal isolates were analyzed. a total of 70 children from 3 months to 14 years of age were...

ObjectivesTo assess the procedures considered as the most painful by health personnel of two adult critical care units.MethodsIndividual written survey with a questionnaire about 46 potentially painful procedures. Each individual has to estimate the pain intensity as well as the frequency of performance for each painful procedures.ResultsOne hundre...

to assess the procedures considered as the most painful by health personnel of two adult critical care units. individual written survey with a questionnaire about 46 potentially painful procedures. Each individual has to estimate the pain intensity as well as the frequency of performance for each painful procedures. one hundred questionnaires were...

Diagrammatic representation of the six experimental groups in the main study. In the sham group (S), cardiac puncture was performed without blood collection or resuscitation. Volume-controlled hemorrhage was performed by cardiac puncture (0.3 ml/10 g body weight) and resuscitation with shed blood was performed after 60 min (groups Hemorrhage [H] an...

Time-dependent cytokine mRNA expression in spleen dendritic cells (DC) following sepsis onset. Mice in which pneumonia was induced by methicillin-susceptible S. aureus (P group). Mice were sacrificed 1, 6, or 12 hours after Meticillin Susceptible Staphylococcus aureus injection. Then mRNA was extracted from CD11c+ cells positively selected in splee...

Effects of hemorrhage on inoculum-based mortality. Two groups of mice were studied: HP group (animals hemorrhaged before methicillin-susceptible S. aureus (MSSA)-induced pneumonia; n = 15) and P group (MSSA-induced pneumonia only; n = 15). Survival rates are expressed as percentage and are representative of three independent experiments. Twenty-fou...

Evolution of histological findings following sepsis onset. Four groups of mice were studied (each group, n = 3): naive, sham-treated (S), methicillin-susceptible S. aureus (MSSA)-induced pneumonia only (P), and hemorrhage before MSSA-induced pneumonia (HP). Formalin-fixed tissues were processed, stained with hematoxylin and eosin, and analyzed by m...

Phenotypic characterization of mouse spleen dendritic cell (DC) subsets. Spleen cells from sham-treated mice (S group), methicillin-susceptible S. aureus (MSSA)-infected mice (P group), hemorrhage-shocked and MSSA-infected mice (HP group) were labelled with antibodies against lineage antigens (CD3e, CD19, TCRb, Ter119, NK1.1) after DAPI staining. C...

Equation used to calculate endothelial permeability to albumin FITC. (0.03 MB DOC)

Primers for quantitative reverse-transcription polymerase chain reaction. TNF, tumor necrosis factor-α; IFN, interferon; IL, interleukin; GAPDH, glyceraldehyde-3-phosphate dehydrogenase. (0.07 MB DOC)

Infections are the most frequent cause of complications in trauma patients. Post-traumatic immune suppression (IS) exposes patients to pneumonia (PN). The main pathogen involved in PN is Methicillin Susceptible Staphylococcus aureus (MSSA). Dendritic cells () may be centrally involved in the IS. We assessed the consequences of hemorrhage on pneumon...

The Manujet™ and the ENK Oxygen Flow Modulator™ (ENK) deliver oxygen during transtracheal oxygenation. We sought to describe the ventilation characteristics of these 2 devices. The study was conducted in an artificial lung model consisting of a 15-cm ringed tube, simulating the trachea, connected via a flow analyzer and an artificial lung. A 15-gau...

The most recommended technique for the management of patients with a difficult airway is fiberoptic intubation (FOI). The aim of this study was to compare propofol and sevoflurane for FOI performance in patients who were difficult to intubate. Seventy-eight patients scheduled for maxillo-facial surgery were included in this prospective, randomized...

During the recent years a new debate occurred because of the introduction of a new generation of hydroxyethyl starches (HES) and of balanced cristalloids, for the composition of the priming for cardiopulmonary bypass in cardiac surgery. Colloids used for fluid therapy belong to two groups: gelatin (modified fluid gelatine – MFG – in France) and hyd...

During the recent years a new debate occurred because of the introduction of a new generation of hydroxyethyl starches (HES) and of balanced cristalloids, for the composition of the priming for cardiopulmonary bypass in cardiac surgery: Colloids used for fluid therapy belong to two groups: gelatin (modified fluid gelatine - MFG - in France) and hyd...

Objectives One objective is to state more accurately the difficulties met by the anaesthesiologists in an emergency context in case of withholding or withdrawing life sustaining therapies.

One objective is to state more accurately the difficulties met by the anaesthesiologists in an emergency context in case of withholding or withdrawing life sustaining therapies. A questionnaire addressed to anaesthesiologists of nine hospitals in the extreme West part of France. The questionnaires were sent and returned by mail in order to guarante...

Background: Little is known about the influence of anaesthesia for caesarean section on outcome in very preterm infants. Methods: A prospective, population-based, cohort study (the EPIPAGE cohort) included all births before 33 weeks in nine French regions in 1997. Of 2360 infants live-born between 27 and 32 weeks, 1338 were delivered by caesarean s...

The aim of this prospective randomized study was to evaluate the quality of analgesia, postoperative comfort and subsequent duration of hospitalization after distal hand surgery and peripheral nerve block at the wrist for paediatric outpatients. Sixty consecutive ASA I or II children were randomly assigned to the following groups: in group B (block...

Early-onset ventilator associated pneumonia (EOVAP) are frequent in head-trauma patients, but specific risk factors are poorly studied in this population. We conducted a retrospective cohort study in a surgical intensive care unit. Consecutive severe head-trauma patients admitted from January 2000 to December 2002 were studied. Microorganisms, and...

Algunas intervenciones quirúrgicas implican exigencias técnicas y posturales que pueden modificar la función circulatoria o exponer a complicaciones cardiovasculares significativas. El conocimiento de los mecanismos fisiopatológicos permite limitar la magnitud de los cambios hemodinámicos. El hecho de que la presión arterial no varíe no basta para...

Alcune procedure operatorie impongono vincoli tecnici e posturali suscettibili di modificare la funzione circolatoria o che espongono a complicanze cardiovascolari significative. La conoscenza dei meccanismi fisiopatogenetici permette di limitare l’ampiezza delle variazioni emodinamiche. L’assenza di variazioni della pressione arteriosa non è una g...

We clinically assessed the electrophysiologic effect of dextrose 5% in water (D5W) and of normal saline (NS) used for expansion of the perineural space before placing a stimulating catheter. We questioned if higher current was required with NS but not with D5W, as has been observed experimentally. This was a prospective randomized double-blind stud...

In continuous femoral nerve blocks, the various perineural positions of the tip of a conventional catheter and their clinical implication are not completely known.We used stimulating catheters to explore the relationship of catheter tip to nerve. American Society of Anesthesiologists physical status IYII patients scheduled for total knee arthroplas...

Low dose of ketamine reduces postoperative pain and opioid consumption in adult studies. However, there are only a few data with controversial results in the paediatric population. The aim of this randomized controlled trial was to evaluate the use of low doses of intravenous ketamine on postoperative pain in children after surgery on the lower par...

Little is known about the influence of anaesthesia for caesarean section on outcome in very preterm infants. A prospective, population-based, cohort study (the EPIPAGE cohort) included all births before 33 weeks in nine French regions in 1997. Of 2360 infants live-born between 27 and 32 weeks, 1338 were delivered by caesarean section with general a...

Because of the lack of controlled studies, there is no consensus regarding the practice of routine haemostasis tests before neuraxial blockade in children. The purpose of this study was to describe the French surgical practice about the preoperative evaluation of coagulation in children who were scheduled for paediatric neuraxial anaesthesia. Descr...

Several authors have reported on laparoscopic pyloromyotomy (LP) since the technique was originally described in 1990, but its benefits remain unproven. We performed a randomized controlled trial comparing LP to open circumumbilical pyloromyotomy (OP) for hypertrophic pyloric stenosis. In a prospective study, 102 infants with pyloric stenosis were...