By Doctor Richard Daury, Anaesthetist
Former President and Founder of the Clinique Esthétique de Paris Spontini

Patients are often apprehensive about anaesthesia, regardless of the surgical intervention undertaken.

Clearly, a small number of accidents over the last twenty years, extensively covered by the media, have increased public awareness of the importance of these procedures practiced by highly qualified specialist physicians.

However, under the initiative of the anaesthetists themselves, their professional organisations and guiding bodies: SFAR (French society of anaesthetic reanimation); SNARF (trade union of French Anaesthetists).


The public authorities instigated a certain number regulations, decrees and recommendations to rigorously ensure the safe utilisation of anaesthesia :

• Expert personnel and the latest technology must be used in the operation theatres where the interventions take place, as well as in the post-operation recovery rooms.

• A protocol of procedures must be followed prior operations :
   - consultation
   - patient information
   - complementary tests if necessary.

• Guidelines for the preparation and verification of the operation theatres and equipment (check-lists controlled before each utilisation of the operation theatre et and for each patient) quality controls by official organisations :
   - Police headquarters
   - Fire brigade
   - Véritas – or Apave – standards agencies
   - Systems maintenance (worthy of modern aviation standards),
     committee against faecal infections
   - safeguards for the use of blood and other materials, etc...

• Progress in the use of anaesthesia linked, notably, to progress in pharmacology, which make these types of anaesthesia interventions more agreeable, even pleasant… and less dangerous than certain pure local anaesthesias performed without a complementary anaesthetic.


Thus, after twenty years of progress, risks linked to anaesthesia have, according to national statistics, considerably diminished from one accident per 20,000 administrations in 1982 to one per 400,000 in 2002. These accidents arise most often in patients with high risk pathologies and during complex procedures,
which is practically never the case in cosmetic surgery.

It should be stressed that – in general – the risk is tolerable if one takes into account the benefits of surgical interventions for life-threatening cases (serious accidents and diseases).

It is unacceptable to take risks for interventions, no matter how useful and desirable, which are non-vital.

Which is why :

The team of founding practitioners, adopted for its activities three labels of quality standards:

• Professionalism

• Security

• Peace of Mind

The group is particularly proud of the achievements made at the Clinique Esthétique de Paris Spontini, thanks to their association with Générale de Santé.

The Générale de Santé: European leader in the global context of private healthcare in France, invested all its logistical expertise in the creation of clinics, in partnership with experienced practitioners to create :

• La Clinique Esthétique de Paris Spontini

The establishment combines all security criteria at the highest standards, in accordance with law of 4 March, 2002, and considers as fundamentally important, the qualification attributed by the council of the association of practitioners which overseas anaesthetic security issues.

Anaesthesia consists of a number of techniques which allow the undertaking of surgical procedures by suppressing pain. There are two main types of anaesthesia: general and local anaesthesia.
Anaesthesia is always practiced by a doctor qualified as a specialist in anaesthesia resuscitation. Highly qualified, the practitioner allows the patient to benefit from the comfort and security even further enhanced by recent technological advancements.

Anaesthesia and cosmetic surgery

The type of anaesthesia is selected according to the nature and length of the intervention planned, the health condition and preferences of the patient, the results of the related prescribed tests, as well as the preferences of the surgeon. Nonetheless, the final choice and responsibility lies with the anaesthetist, who conducts the anaesthesia and with whom the patient will have consulted before the intervention during the pre-anaesthetic appointment. Only local anaesthesia can be practiced by a surgeon in the absence of a qualified anaesthetist.

Local anaesthesia

Used only for minor interventions, local anaesthesia consists of administering an appropriate anaesthetic to the area to be operated on.
A local anaesthetic can also be combined with sedatives of various strengths, selected in order to relieve the patient's anxiety. The administration of a local anaesthesia can also be preceded by the application of an anaesthetic gel which makes it more comfortable. The duration of the effects of a local anaesthesia is from 2 to 3 hours.
An extensive or prolonged local anaesthesia requires the presence of an anaesthetist who can compensate for discomfort linked to stress, the medical specificities of the patient and the toxicity of local anaesthetics.

Neuroleptanalgesy

This type of anaesthesia consists of administering sedatives and anaesthetics. The neuroleptanalgesy is then completed by a local anaesthesia practiced by the surgeon.
The advantage of this sophisticated method is that it completely eliminates anxiety and pain perception during delicate phases of surgery and, notably, during the practice of a complementary local anaesthesia by the surgeon. The patient neither feels nor remembers any pain; generally, he does not lose consciousness and superficially dozes like during natural sleep, but with all the effects of a usual anaesthetic. The patient's breathing remains spontaneous, without any need of respiratory assistance.

This rapidly reversible anaesthesia allows the patient to recuperate very quickly, in a few minutes, to have a snack and return accompanied home. It is therefore referred to as out-patient anaesthesia or surgery.
After a lapse of time determined by the anaesthetist, classic orally-administered pain relievers such as Paracetamol will be given.
Recommendations by the anaesthetist will be made before the patient leaves, notably the proscription to drive or make important decisions.
The consumption of alcohol is also forbidden.

It is essential to plan for someone to accompany the patient upon departing the clinic and during the following night at home.
If necessary, you can reach the medical team by telephone.

Neuroleptanalgesy thus now allows the practice of several cosmetic surgery procedures, but is not appropriate for more complex interventions.

General anaesthesia

General anaesthesia is comparable to a deep sleep, inhibiting all pain perception and reflexes. Anaesthesia is produced by the administration of drugs, and/or the inhalation of anaesthetic vapours implemented with appropriate devices. Modern products rapidly metabolised by the organism now provide more pleasant waking than before, with post-operation pain remarkably curbed by increasingly efficient products which are more precisely administered and better tolerated.

Products used in association and at appropriate doses are generally :

• narcotics or gas

• a morphine-type analgesic, to suppress pain, with certain products considerably stronger than morphine.

Local-regional anaesthesia

Local-regional anaesthesia consists of anaesthetising the area of the body where the operation will take place. The principle is to block the nerves in this region through the administration of an anaesthetic. Rachis anaesthesia and the epidural – anaesthesia of the lower part of the body – are two particular kinds of local-regional anaesthesia, rarely used in plastic surgery.
It is theoretically possible to use them for thigh and lower abdomen liposculpture.

Surveillance during anaesthesia and waking

Anaesthesia, whatever the type, is practiced in a properly equipped operating theatre, adapted to each patient and verified before each utilisation. Everything that comes in contact with the body of the patient is either disposable, or disinfected and sterilised following a protocol rigorously controlled. The continuous monitoring includes, other than blood pressure, an electrocardiogram and an oxygen metre controlling the quality of the patient's oxygen. A respirator allows, thanks to the remarkable reliability of modern equipment, continuous surveillance of the patient's respiration, air mixture analysis and the quality of all the circulating gases which are automatically adjusted.

At the end of the procedure, the patient is taken to the post-operation room where surveillance is continued by the aforementioned monitoring equipment and specialised personnel, before returning to her room or to check-out in the case of out-patient interventions.

Pre-operation anaesthesia consultation

Following a 1994 decree, an anaesthesia consultation is required before the operation. It is a thorough clinical exam.
This consultation, scheduled before the intervention, allows the anaesthetist to determine the medical profile of the patient. The entire medical and surgical background is evaluated including risk factors concerning cardiovascular–hypertension, cardiac–and respiratory–asthma, tobacco use, chronic bronchitis–as well as allergies and other pathologies such as diabetes, kidney and bloods ailments, stomach ulcers, neurological, dental, and other problems. The anaesthetist will prescribe the necessary tests according to the type of procedure and the health of the patient. In certain cases, only a blood test is required to verify coagulation.

Today, the practice of anaesthesia allows rapid diagnosis and treatment any anomalies.

These include, among others, precise rules for the anaesthesia consultation – during which each case is evaluated – and for the monitoring of the anaesthesia itself and the waking period.

While rare accidents, often extensively publicised by the media, do happen, hundreds of anaesthesias of all kinds are undertaken each year without incident.

Precautions and recommendations

• Do not smoke for 15 days prior the anaesthesia. Tobacco weakens the organism.

• Do not drink for 48 hours prior the anaesthesia. Alcohol can interfere with anaesthetics.

• Do not eat or drink for at least 6 hours before a general anaesthesia.

• After an out-patient intervention, it is necessary to be accompanied to return home and during the 24 hours following the intervention.

• After a general anaesthesia, drink water as soon as possible. Eating should be resumed progressively.

• Do not take any medicine other than those already prescribed.

Tests required before undergoing anaesthesia
(Some or all)

• Blood platelet count

• Prothrombin level (INR)

• TCK (blood coagulation)

• Rhesus blood type

• Urea

• Glycaemia

• Blood Na K levels

• HIV

• Serology screen for hepatitis A, B and C

• Electrocardiogram or lung X-ray, depending on age

In other cases, it will be necessary to undertake more elaborate medical tests, to have an electrocardiogram or other appropriate tests. Depending on the case, treatments in progress will be continued, stopped or completed. Recommendations will be made to the patient who will also receive a medical file and questionnaire.

The final choice of the techniques used will be made under the responsibility of the anaesthetist administering the anaesthesia in consultation with the patient prior the intervention.

Anaesthesia risks

All medical acts, even though carried out with expertise and respect for scientific knowledge, entail a risk.

Aesthetic surgery and autotransfusions

Aesthetic surgery is never practiced in an emergency. It is scheduled. This means that blood transfusions can be avoided. Thus, for all interventions during which significant bleeding can take place important – major liposculpture and abdominal plastic surgery – an auto-transfusion is programmed. This applies to about less than 1% of aesthetic surgery.

In plastic surgery, blood transfusions are rare. If they are predictable, for a major liposuction for example, an auto-transfusion will be undertaken – the transfusion of the patient's own blood. A few weeks before the intervention, the patient gives blood like a simple donor, two or three times in a row at weekly intervals. This quantity is small enough to avoid side effects. Only an iron supplement is administered to prevent any deficiency. The patient, thus, has the time to replenish globules before the intervention. The blood stored at the transfusion centre is used during the operation, thereby preventing contamination, notably viral, from other blood.

Cosmetic surgery and pain

The pain experienced during aesthetic surgery is generally diminished, providing that it has been accurately anticipated with the patient during the pre-operation consultations, both with the surgeon and anaesthetist, and carefully monitored by the nursing team.

In any case, a more or less painful period is short, a few days maximum, variable according to the type of intervention and the sensitivity of the patient. Follow-up procedures after the operation are totally painless.

Therefore, the approach, the prevention and the treatment of pain in aesthetic surgery are very different compared with those of major interventions or chronic illnesses.

Post-operative pain from the anaesthetist's perspective :

• Anaesthetists, who are accustomed to managing patient discomfort, evaluate pain levels according to the type of intervention.
Example : on a scale of 10 (delivery without an epidural and renal pains are evaluated at 9 ; localised burns at 5, etc…)

• Modern plastic surgery is evaluated between 2 to 5.

Post operative pain as perceived by the patient :

• Some, from the start, do not want to suffer at all.

• Others say they can « handle the pain ».

• Others have never experienced pain and are assumed to be more susceptible.

• Still others, finally, have experienced intense pain and will be less sensitive.

Therefore, after a successful anaesthesia consultation, the selection of the appropriate pain prevention protocol, if necessary at the request of the patient, generally results in very acceptable pain limitation during aesthetic surgery interventions.