Hello. Could you introduce yourself and tell us about your job?
My name is Dr Faouzi Gloulou, and I’m an anesthesiologist trained in general anesthesia and the management of patients in surgical intensive care. I trained at university and then in a hospital. I worked as a hospital practitioner for several years in a HU (university hospital). For several years now, I’ve been working in the private sector, exclusively in aesthetic and plastic surgery, notably at the Clinique de l’Etoile.
When do you see an anesthetist before a procedure?
We see an anesthetist before a procedure when it’s going to be performed under general anesthesia. The anaesthetist’s role is to assess the patient’s clinical condition on a number of levels, in particular the major neurological, respiratory and cardiac functions, as the surgical procedure has an impact on all these parameters.
My role is to assess the feasibility of surgery, evaluate the risks and define a strategy for optimal patient care.
How long do I have to see an anesthesiologist before a procedure?
Generally speaking, the earlier you schedule an appointment, the better, because it gives you more time if you need to carry out specialized tests. There’s a legal minimum of 48 hours before the operation. Otherwise, it’s usually between one month and three weeks beforehand.
What tests can be performed before an anesthetic?
All physical and clinical examinations are carried out during the consultation. After that, there are standard examinations that are not always carried out: it depends on the patient’s age and the type of surgery.
The basic tests are blood tests: blood groups, hemoglobin, platelet count, coagulation…
Sometimes renal function. We may need to do an electrocardiogram and ask for specialized cardiac and pulmonary opinions and tests…
But that doesn’t happen very often.
Generally, hemoglobin and electrocardiogram are standard.
In the context of W.A.L. liposuction: what could jeopardize a procedure?
W.A.L. liposuction is a technique in which quite a lot of volume is lost, so from a clinical point of view, we need to check that the patient is in good condition, particularly in terms of cardiovascular health, because it can have an impact on blood pressure and blood pressure. This surgery is the equivalent of a stress test. It takes patients two to three days to recover properly, so they really need to be in good shape, especially in terms of their cardiovascular system.
Clinically and biologically, it is anemia that can jeopardize the operation, with hemoglobin low at 11 or 10 grams per deciliter.
So is there a strategy to overcome the anemia?
For anemia, there’s a whole strategy. That’s why you should always see an anaesthetist and a surgeon well in advance, to check as early as possible with a blood test. The first thing to do is to take iron tablets two or three weeks before the operation, so that it takes effect.
If the anemia is too severe, intravenous iron injections may be required, or erythropoietin (EPO) may be offered to accelerate the production of red blood cells. These are subcutaneous injections that replenish the iron and red blood cell reserves. This will enable us to operate without risk to patients.
Is it possible to use general and spinal anesthesia for WAL liposuction?
So, as long as only the lower limbs are affected, we can opt for spinal anesthesia, which enables earlier rehabilitation. The return to a normal diet is quicker than with a general anaesthetic. After that, there’s not much difference.
Spinal anesthesia is a technique that works very well: only the lower half of the body is put to sleep. There’s a bit of apprehension because people think they’re going to see and hear everything, when in fact they won’t. They won’t see anything. They won’t see anything; they can bring in their music with their headphones and they won’t hear a thing.
One of our spinal anaesthesia patients listening to music.
It’s just that there’s some apprehension about the idea that you’re not sleeping completely. During the consultation, we explain everything in detail, and generally when all the information is well understood and integrated, things go very well.
Afterwards, general anaesthesia remains an alternative that can be used at any time and for all those who do not wish to undergo spinal anaesthesia. We don’t have enough studies and hindsight to see the differences between general and spinal anesthesia in terms of recovery. Our experience with patients we’ve seen with Dr. Zwillinger is that spinal anaesthesia clearly has very few side effects, with better recovery, less recourse to morphine painkillers and analgesics, and a quicker return to normal eating than those who opt for general anaesthesia.
That’s clearly what I feel and what I’ve seen: there’s less need for morphine in post-op, and people recover faster with less nausea and vomiting.
What happens in the clinic after the operation?
Generally speaking, in the post-operative phase, whether using general or spinal anaesthesia, once the operation is over there’s a compulsory visit to the recovery room. Here, we generally do a quick check-up to ensure that patients are stable, with good blood pressure and saturation, and that they are breathing well spontaneously. Generally, during the operation, we’ve already started to anticipate pain by putting in painkillers, and in the recovery room we readjust to see if we need more or if we need to add other painkillers.
Once everything has been checked, the patient returns to his room, where he resumes his daily routine: breakfast, getting up for the first time with the nurse (for more information, see our interview with a nurse from the Paris Etoile clinic), etc. Afterwards, during hospitalization in the room, usually in the afternoon, we make sure that there is no pain or nausea, and that the patient has eaten well and is able to get up properly without any repercussions on blood pressure.
Afterwards, the nurses are generally well versed in post-operative care. The anaesthetist is also always on hand to check. The patient is generally discharged at the end of the day, once all the parameters for discharge have been validated.
On the big day, what are the dos and don’ts before a general or spinal anaesthetic?
So, starting with the days leading up to surgery, you should avoid taking anti-inflammatories, aspirins and aspirinics, as these thin the blood and increase the risk of bleeding. Paracetamol and Doliprane are authorized and pose no problem.
The day before, you have to fast, but – and this is an important point – you have to eat normally in the evening.
Patients tend to fast in the evenings too, but you only need to fast for 6 hours, there’s no need for any more than that. Above all, it’s very important to keep well hydrated beforehand; you’re allowed to drink water up to 3 hours beforehand, because this allows for better recovery and less nausea and vomiting after the operation.
Don’t deprive yourself of drinking plenty of water! Water passes quickly through the stomach, so there’s no risk if you drink three hours before an operation.
Generally speaking, when you have a chronic treatment, it’s already discussed with the anaesthetist at the first consultation. There are quite a few treatments that need to be stopped, and all this needs to be anticipated and planned for at the time of the consultation. There are treatments for hypertension, in particular conversion enzyme inhibitors, which can interfere with anesthesia and cause a drop in blood pressure. Anti-diabetes drugs in tablet or injection form should generally not be taken in the morning. People also taking anticoagulants as part of their chronic treatment: it’s clear that these drugs must be stopped for a few days.
All this needs to be well planned during the consultation with the anaesthetist, and why it needs to be done well in advance to prevent this kind of problem from arising and avoid any post-operative complications.
To complete the information given by Doctor Gloulou or to prepare for your planned surgery at Clinique Étoile, we invite you to book an appointment online.
Thank you Dr Faouzi Gloulou for this interview.
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