Interview with Dr Faouzi Gloulou
Hello. Can you introduce yourself and your profession?
My name is Doctor Faouzi Gloulou, I am an intensive care anesthetist trained in multipurpose anesthesia and the care of patients in intensive care. I went to university and then trained at the hospital. I worked as a hospital practitioner for a few years in a HU (university hospital). For several years now, I have been working in the private sector and I exclusively do cosmetic and plastic surgery, in particular at the Etoile clinic.
In what setting do we see an anesthesiologist before an operation?
We see an anesthetist before an operation when it is an operation that will be done under general anesthesia. The role of the anesthesiologist is to assess the clinical condition of the patient on various levels, particularly the major neurological, respiratory and cardiac functions, since the surgical intervention has a certain impact on all of these parameters.
My role is to assess the feasibility of surgery, assess the risks and define a strategy for optimal patient care.
How long do you have to go to an anesthesiologist before an operation?
Generally we will say that the more we plan the meeting ahead the better because it allows us if there are specialized exams to do to have time. Everything is regulated by law, there is a minimum legal delay of 48 hours before the operation. But otherwise usually it is between a month and three weeks before.
What examination may be required before an anesthesia?
So all physical and clinical exams are done during the consultation. Then there are standard exams that we don’t have all the time: it depends on the age of the patient, the type of surgery as well.
The basic examinations are blood tests: blood groups, hemoglobin, platelets, coagulation … Sometimes kidney function. You may have to do an electrocardiogram and ask for advice and specialized cardiac, pulmonary examinations … but this does not happen often.
Usually the standard is hemoglobin and EKG.
In the context of WAL liposuction: what could call into question an intervention?
WAL liposuction is a technique where you still lose a lot of volume suddenly, clinically, you have to check that the patient is in good condition, especially at the cardiovascular level because it can affect everything that is blood pressure and blood pressure. This surgery is the equivalent of a stress test. Patients still take 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, which is low at 11 or 10 grams per deciliters.
So is there a strategy to deal with the anemia?
For anemia there is a whole strategy. This is why you should always see an anesthetist and a surgeon well in advance to check as soon as possible with a blood test. The first thing to do is take iron tablets two to three weeks before the procedure for it to take effect.
If the anemia is too deep, you may need to give intravenous iron injections or offer erythropoietin (EPO) to speed up the production of red blood cells. These are injections under the skin that help replenish the stock of iron and red blood cells. This will allow us to operate without taking any risks for the patients.
In WAL liposuction it is possible to do general and spinal anesthesia?
So as long as you only touch the lower limbs you can opt for spinal anesthesia which allows for earlier rehabilitation. The return to a normal diet is faster than with general anesthesia. After that there is not a big difference.
Spinal anesthesia is a technique that works very well: you only put the lower half of your body to sleep. There is a bit of apprehension because people think they will see and hear everything when not at all. They won’t see anything, they can bring their music back with their headphones and they won’t hear anything. It’s just that there is apprehension with the idea that you can’t sleep completely. During the consultation we explain all this in detail and generally when all the information is well understood and integrated it goes very well.
After general anesthesia there is always an alternative that can be done at any time and for all those who do not want spinal anesthesia. We do not have enough studies and hindsight to see the differences between general and spinal anesthesia in terms of recovery, but our feeling in relation to patients that we saw with Dr. Zwillinger is that clearly in terms of spinal anesthesia we has very few side effects with better recovery, less use of opioid painkillers, analgesics and a return to a normal diet faster than for those who opt for general anesthesia.
This is clearly how I felt and what I saw: there is less need to use opioids postoperatively with people who recover faster with less nausea and vomiting.
At the post-operative level following the intervention, what is happening at the clinic level?
Usually postoperatively, whether through the technique of general or spinal anesthesia, once the operation is finished there is a mandatory visit to the recovery room. There, generally, we take a little check-up and make sure that the patients are stable with good tension, good saturation, that they spontaneously breathe well and we also take stock of the pain. Usually during the operation we have already started to anticipate by putting painkillers and in the recovery room we readjust to see if we need more or if we add other pain medications.
Then, once everything is checked, return to the patient’s room and there he resumes his daily activity: breakfast, first wake up done with the nurse (for more information: read our interview with a nurse of the Paris Etoile clinic) etc. Afterwards, during the hospitalization in a room, during the afternoon generally, we make sure that there is no pain and no nausea and that the patient has eaten well and that he manages to get up. correctly without having repercussions on its tension.
Afterwards, the nurses are generally well established and know very well how things are going after the operation. The anesthesiologist is also always present with them to check. The exit is generally done at the end of the day after having validated all the parameters authorizing the exit.
On the big day, what to do and what not to do before a general or spinal anesthesia?
So already starting with the days preceding the surgery, it is necessary to avoid taking anti-inflammatory drugs, aspirins and aspégics because that thins the blood and increases the risk of bleeding. Paracetamol and doliprane are allowed, they are not a problem.
The day before there is the fast to be observed but, and this is an important point, you have to eat normally in the evening.
Patients also tend to fast in the evening but you should only observe 6 hours of fasting, there is no need for more and above all it is very important to hydrate yourself well before, you are allowed to drink l water up to 3 hours before because it allows better recovery and less nausea and vomiting after the operation.
Do not deprive yourself of drinking lots of water! The water passes quickly through the stomach, there is no risk if you drink three hours before an operation.
Usually, when you have chronic treatment, this has already been done with the anesthesiologist at the first consultation. There are quite a few treatments that must be stopped and all of this must be anticipated at the time of the consultation and planned. There are treatments for high blood pressure, including ACE inhibitors, which will interfere with the anesthesia and cause blood pressure to drop. Anti-diabetes medication in tablets or injections generally should not be taken the same morning. People also who have anticoagulants in their chronic treatments: there clearly it is necessary to stop these drugs for a few days.
All this must be well planned during the consultation with the anesthesiologist and why it must be done before to prevent these types of problems to avoid any postoperative complications.
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