H J Clément

Hospices Civils de Lyon, Lyons, Rhône-Alpes, France

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Publications (25)19.55 Total impact

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    ABSTRACT: Epidural clonidine has been proposed as an adjunct for anaesthetic mixtures during labour. Administered as a bolus, clonidine may have side effects such as sedation and hypotension; its continuous infusion could be attractive in this respect. We, therefore, conducted a randomized, double-blind trial using patient-controlled epidural analgesia with a background infusion using a low dose of clonidine during labour. A total of 128 healthy parturients in active labour received a patient-controlled epidural analgesia solution of 0.0625% levobupivacaine and sufentanil 0.25 microg ml(-1) with or without clonidine 2 microg ml(-1). Ninety-five parturients were analysed. The pain score over time was evaluated as well as drug volume utilization; supplementation bolus and side effects were recorded. The primary endpoint was maternal satisfaction [ClinicalTrials.gov Identifier (NCT00437996)]. Three patients in the control group failed to achieve satisfactory epidural analgesia owing to a technical issue. Although the primary endpoint was not statistically significant, analgesia was more pronounced and obtained earlier in the clonidine group. The area under the curve for the visual analogue pain score was significantly lower in the clonidine group. In this group, hourly doses of levobupivacaine and sufentanil were reduced (13.9 +/- 4.3 vs. 16.3 ml +/- 4.0; P = 0.005) as well as rescue supplementation and pruritus incidence (18 vs. 46%; P = 0.004). Maternal blood pressure was significantly lower, over time, in the clonidine group but remained within the normal range. Sedation was similar in both groups (4.3 vs. 2.0%; not significant). The addition of clonidine to epidural levobupivacaine and sufentanil for patient-controlled epidural analgesia in labour improved analgesia, reduced the supplementation rate and reduced pruritus without improvement in maternal satisfaction. Blood pressure was significantly lower in the clonidine group over time but without clinical consequence.
    European Journal of Anaesthesiology 03/2010; 27(5):441-7. · 2.79 Impact Factor
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    ABSTRACT: In France obstetric haemorrhage is the leading cause of maternal death. The aim of this study was to evaluate if the management of postpartum haemorrhage at individual maternity units followed guidelines established by the Aurore Network. A descriptive study was carried out in 16 maternity units of the Aurore network between October 2004 and September 2005. Cases and data were prospectively identified and collected. Postpartum haemorrhage occurred in 1144 of 21 350 deliveries, an overall incidence of 5.4+/-0.3%. Of these, 316 cases were rated as severe. Diagnosis was clinical in 82.5% of severe cases and 77.5% of non-severe cases; the remainder were detected by postpartum laboratory tests. Uterotonic agents were given prophylactically to 46.7% of the 896 patients following vaginal delivery. In cases in which postpartum haemorrhage was due to uterine atony, 83.1% of women underwent examination of the uterine cavity and 96.3% received oxytocin, which proved therapeutic. Sulprostone was administered to 39.5% cases of persistent postpartum haemorrhage. A uterotonic was given prophylactically to 85.4% of the 247 patients at caesarean delivery. Oxytocin was therapeutic in 94.8% of cases of uterine atony. Sulprostone was administered in 84.4% of cases of persistent postpartum haemorrhage. The regional guidelines issued by the Aurore network were only partially followed. More effective guideline dissemination and implementation is required to improve the prevention and management of confirmed haemorrhage.
    International journal of obstetric anesthesia 10/2009; 18(4):320-7. · 1.85 Impact Factor
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    ABSTRACT: Objectives To assess the efficiency of a new tool designed to shorten the decision-to-delivery interval (DDI) for emergency C-sections (CS). Materials and methods DDI comparisons during three 6-month periods in a third level maternity. In stage A we evaluated the spontaneous DDI, in stage B the DDI was measured after the introduction of a color-code communication tool related to the degree of urgency for CS (amber code indicated urgent CS with an ideal DDI of 30 min and red code for very urgent CS with an ideal DDI of 15 min). In stage C we assessed the impact of the color-codes related protocols implementation. Results Two hundred and fifty-three C-sections were included (211 urgent CS and 42 very urgent CS). Mean DDI decreased significantly from 42 min to 24 min between period A and period C for amber codes (corresponding to 43,2% and 82,1% of the objectives respectively) and from 24,9 min to 10,7 min for red codes (20% et 83,3% of the objectives). Conclusion This study suggests that color-codes and their related application protocols significantly shorten the DDI during the evaluation periods.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction. 02/2009; 38(1):51–59.
  • International Journal of Obstetric Anesthesia 05/2006; 15(2):180-1. · 1.80 Impact Factor
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    ABSTRACT: Amniotic fluid embolism occurs rarely but is a leading cause of maternal mortality. It is a difficult and somewhat intangible diagnosis that warrants a high index of suspicion by physicians. AFE is an unpredictable, unpreventable, and, for the most part, an untreatable obstetric emergency. Management of this condition includes prompt recognition of the signs and symptoms, aggressive resuscitation efforts, and supportive therapy. Any delays in diagnosis and treatment can result in increased maternal and/or foetal impairment or death. Whereas once the invariable outcome of AFE was death of the mother, today the prognosis is somewhat brighter thanks to increased awareness of the syndrome and advances in intensive care medicine. No laboratory test is specific to attest the diagnosis and autopsy must to be realised in case of maternal death. Although non-specific, the diagnosis of AFE could be supported by the observation of amniotic fluid in the central venous blood as well as in the bronchoalveolar fluid. This easy and quick test will be helpful in decision-making. Prompt and aggressive supportive treatment is required to lessen an otherwise dismal outcome, which may include death and permanent disability. This article provides an account of the protean clinical features, pathogenesis, and principles involved in treatment.
    Annales Francaises D Anesthesie Et De Reanimation - ANN FR ANESTH REANIM. 01/2006; 25(6):599-604.
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    ABSTRACT: Aim Comparison of the decision to delivery interval in cases of forceps delivery and in cases of cesarean sections. Material and method A retrospective analysis was performed on 137 cases of forceps deliver (n=63) and cesarean section (n=74) indicated for abnormal fetal heart rhythm. All cases were observed in a level 3 maternity unit between October 2003 and August 2004. Results The mean decision-to-delivery interval was significantly shorter in the forceps group (14.84min ± 6.54 versus 29.31min ± 11.79 p<0.0001). Maternal and neonatal morbidity were comparable. Conclusion This study suggest that once the fetal head is engaged, forceps delivery can significantly reduced the decision-to-delivery interval.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 12/2005; 34(8):789–794. · 0.45 Impact Factor
  • Fuel and Energy Abstracts 01/2005; 34(8):789-794.
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    ABSTRACT: Amniotic fluid embolism occurs rarely but is a leading cause of maternal mortality. A high index of clinical suspicion is necessary to make an early diagnosis to reduce morbidity and mortality. We report a non-fatal case of amniotic fluid embolism occurring during a caesarean section, with special emphasis on the mode of development and diagnosis. The initial presentation of this syndrome was a coagulopathy, followed by the usual complications of massive bleeding. Although non-specific, the diagnosis of amniotic fluid embolism was supported by the observation of amniotic fluid in the central venous blood as well as in the broncho-alveolar fluid.
    International Journal of Obstetric Anesthesia 11/2004; 13(4):271-4. · 1.80 Impact Factor
  • I Sayegh, O Dupuis, H J Clement, R C Rudigoz
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    ABSTRACT: To assess the interval between the decision to carry out an emergency caesarean section and delivery, and to determine whether this interval can be shortened. A retrospective study was performed in a French maternity hospital over a 6-month period. All caesarean sections performed during labour were included. These caesarean sections were divided into two groups according to Lucas's classification: (1) emergency and urgent caesarean sections and (2) scheduled caesarean sections. The mean decision--to--delivery interval was 39.5 min in the first group and 55.9 min in the second group. It was mainly influenced by the time taken to get the patient into theatre. The mean decision-to-operating theatre interval accounted for 45.6 and 53.8% of the mean decision-to delivery-interval, respectively. The recommended interval of 30 min is not routinely achieved. Improving communication within the perinatal team could decrease the decision--to--operating theatre interval and should be promoted.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 10/2004; 116(1):28-33. · 1.84 Impact Factor
  • I. Sayegh, O. Dupuis, H. J. Clément, R. C. Rudigoz
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    ABSTRACT: The objective of this retrospective study conducted in the Croix-Rousse maternity ward was to determine the time lapse between the decision to perform cesarian section and birth. Cesarean sections performed in the emergency setting and/or during labor over a six month period were reviewed. Two groups were defined according to the Lucas classification: emergency and urgent cesareans and scheduled cesareans. Mean time from decision to birth was 39.5 minutes in the first group and 55.9 minutes in the second. This delay was strongly influenced by the time required to install the patient in the operating room. Improved communication within the perinatal team could help shorten the time between the decision to perform cesarean section and birth.
    La Revue Sage-Femme 04/2004; 3(2):53-58.
  • I. Sayegh, O. Dupuis, H.-J. Clément, R.-C. Rudigoz
    Fuel and Energy Abstracts 01/2004; 33(4):347-348.
  • G Tramoni, H J Clément, F Lopez, J P Viale
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    ABSTRACT: We report the case of a 30-year-old woman with a post-partum haemorrhage and foetal death caused by a leptospirosis infection. This disease could induce a coagulopathy associated with foetal death and potential hazard for epidural analgesia.
    Annales Françaises d Anesthésie et de Réanimation 05/2003; 22(4):363-5. · 0.84 Impact Factor
  • G Tramoni, H. J Clément, F Lopez, J. P Viale
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    ABSTRACT: We report the case of a 30-year-old woman with a post-partum haemorrhage and foetal death caused by a leptospirosis infection. This disease could induce a coagulopathy associated with foetal death and potential hazard for epidural analgesia.
    Annales Françaises d Anesthésie et de Réanimation 04/2003; 22(4):363-365. · 0.84 Impact Factor
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    ABSTRACT: Ropivacaine has been claimed to produce less motor block than bupivacaine during epidural analgesia. However, this advantage has not been clearly confirmed in obstetric studies using low analgesic concentrations in a ratio close to that suggested to be equianalgesic. This double-blind, randomized, prospective study was performed in 140 parturients who requested epidural analgesia. After a lumbar epidural catheter had been placed, patients received either 0.10% bupivacaine plus sufentanil 0.5 microgram ml-1 or 0.15% ropivacaine plus sufentanil 0.5 microgram ml-1 followed by a continuous infusion. Additional boluses were used for inadequate levels of analgesia. Visual analogue pain scores, motor block, level of sensory block, supplementary boluses and main characteristics of labour were recorded. No differences were observed between the two groups for pain scores, total volume of anaesthetic solution used [59 (23) and 57 (24) ml in the bupivacaine and ropivacaine groups respectively], duration of labour, mode of delivery, side-effects or satisfaction score. The incidence of motor block was not statistically different between the groups (54 and 69% in the bupivacaine and ropivacaine groups respectively, P = 0.07). However, when motor block occurred, survival analysis showed that it occurred sooner in the course of labour with ropivacaine compared with bupivacaine (log rank test, P = 0.012). Combined with sufentanil 0.5 microgram ml-1, 0.10% bupivacaine and 0.15% ropivacaine produce effective and equivalent analgesia during labour, with similar incidences of motor block.
    BJA British Journal of Anaesthesia 07/2002; 88(6):809-13. · 4.24 Impact Factor
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    ABSTRACT: Obstetrical management of women known to have a cerebral vascular malformation is controversial. The risk of cerebral hemorrhage during pregnancy is difficult to assess. We report thirteen cases of pregnancy in women with known cerebral vascular malformations who had or had not undergone surgical treatment. The effect of pregnancy on these malformations and corresponding obstetrical care described in the literature were studied. Our conclusion is that the risk of bleeding from cerebral arteriovenous malformations is not significantly increased during pregnancy whereas the risk of cerebral hemorrhage is slightly increased at the end of pregnancy, but unchanged during labor and delivery, in women with arterial aneurysms. There is no reason to advise against pregnancy in most cases and vaginal delivery is often possible unless there is a risk of dystocia.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 07/2002; 31(4):379-86. · 0.45 Impact Factor
  • Annales Francaises D Anesthesie Et De Reanimation - ANN FR ANESTH REANIM. 01/1998; 17(8):824-824.
  • R C Rudigoz, L Marchal, M Gallien, H J Clément
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 02/1994; 23(5):503-10. · 0.45 Impact Factor
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    ABSTRACT: Laparoscopy without an important surgical act was executed in twenty patients. Anaesthetic protocol associated propofol, alfentanil and vecuronium. This protocol meet conditions for ambulatory patients. Only three were not suited to leave hospital six hours after coelioscopy.
    Agressologie: revue internationale de physio-biologie et de pharmacologie appliquées aux effets de l'agression 02/1991; 32(2):131-3.
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    ABSTRACT: The authors report a case of pregnancy in a patient suffering from moderately severe cystic fibrosis (the syndrome consisted of diffused obstruction in respiratory function with a vital capacity of 79% and the lowered blood oxygen level with arterial blood gas estimations; oxygen saturation was 94%). The condition was marked by temporary worsening during the pregnancy in which infective bronchitis supervened). She also threatened to go into early labour and did in fact deliver at 36 1/2 weeks of an infant which was normal for the duration of the maturity. The authors review previous known facts about cystic fibrosis. A study of the literature has made it possible to be more accurate in describing methods of ante natal diagnosis of the condition and ways of following the pregnancy and the illness as well as the woman's fertility and her ability to breast feed.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 02/1990; 19(6):745-50. · 0.45 Impact Factor
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    ABSTRACT: Protein C is a protein found in the serum, dependent on vitamin K. It is a strong protection against venous thrombosis. Deficiency in protein C, whether constitutional or acquired, can give rise to thrombo-embolic accidents in young patients without any obvious triggering factor. The authors start by describing the physiological features of protein C. Deficiencies of this protein are transferred through a dominant autosome. Two cases are described where protein C deficiency occurred in pregnancy. This association has not been previously described. They then discuss the kinetics of protein C in pregnancy, at delivery and in the newborn. They then point out how important it is to treat with anticoagulants in prophylactic doses during the pregnancy. They use repeated doses of Heparin as an anticoagulant and for its antivitamin K action following the delivery. They give a list of precautions that have to be observed in this relay system which should be slow and carefully worked out later. Obstetrical observation has to look for the onset of pre-eclampsia and intra-uterine growth retardation due to placental microthrombi. The authors conclude, after pointing out the frequency and the seriousness of this condition, by proposing that it should systematically be looked for in families where there have been cases of thrombo-embolic accidents.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 02/1989; 18(7):899-904. · 0.45 Impact Factor