ANAESTHESIA IN AESTHETIC SURGERY

Advances in modern anaesthesia have enabled the progress of surgery and patient comfort. Plastic surgeons and patients are fortunate enough to have a wide range of reliable and effective techniques available, so that the anaesthesia can be tailored very precisely to the surgery and to the patient's wishes.

In general, anaesthetics can be divided into five types: topical anaesthesia, inhalation of nitrous oxide (Kalinox®), local anaesthesia, local anaesthesia with sedation (neuroleptanalgesia) and general anaesthesia.

For the procedures performed in his office, Dr. Victor Médard de Chardon uses local anaesthesia, topical anaesthesia and inhaled analgesia with nitrous oxide (Kalinox®).

The other types of anaesthesia are administered by a physician specialising in anaesthesia and resuscitation, who works exclusively in this field.

Topical anaesthesia

Cutaneous topical anaesthesia is the application of anaesthetic cream to the skin. Topical anaesthesia is used in current practice for facial rejuvenation injections (hyaluronic acid or Botox injections).

It usually contains a combination of lidocaine and another anaesthetic (e.g. prilocaine or tetracaine). The two most well-known creams are Pliaglis ® and Emla ®. Dr. Victor Médard de Chardon prefers to use Pliaglis®, as it contains three times the amount of active ingredient found in Emla®.

Emla® is usually applied at least two hours before the procedure, whereas Pliaglis® cream is applied thirty minutes before.

Inhalation of Kalinox®

Kalinox® is a medical gas composed of a mixture of nitrous oxide (50%) and oxygen (50%).

It has two properties:

  • An analgesic effect that reduces the threshold for perception of pain
  • A conscious sedation effect:  the patient is relaxed and feels removed from their environment.

Fast action and elimination:

  • Kalinox® is effective after 3 minutes of inhalation
  • After inhalation, the patient rapidly regains their initial state of consciousness, with no residual effects.

This type of anaesthesia is administered continuously by Dr. Victor Médard de Chardon's nurse.

Kalinox® is specifically indicated for short, potentially painful procedures performed in the surgeon's office: hyaluronic acid injections, Botox injections into the armpits, hands or feet to prevent excessive perspiration, and intralesional steroid injections.

Local anaesthesia

Reserved for procedures targeting a small area of the body, local anaesthesia is the in-situ injection of anaesthetic drugs (e.g. Xylocaine, lidocaine, or Naropin) used to block the sensation of pain. It acts by preventing the sensory nerves from transmitting pain information to the brain. Your brain therefore receives no such information from the anaesthetised area and you do not feel pain.

The aesthetic surgery procedures that involve this type of anaesthesia include blepharoplasties, otoplasties and surgery for skin cancers.

There are different families of local anaesthetics which have shorter or longer lasting effects. They all work by temporarily blocking the electrical current of the nerves.

Adrenalin is often added to local anaesthetics in order to block small bleeds and work in the best conditions possible.

Local anaesthetics are very safe providing that the maximum authorised doses are not exceeded (the dose is calculated based on the patient's weight) and allergic reactions are extremely rare. However, this does not mean that complications do not exist. When patients present a history of coronary syndrome or irregular heart rate, local anaesthesia, particularly adrenalin, should be used with care.

Neuroleptanalgesia (local anaesthesia with sedation)

Neuroleptanalgesia involves the intravenous injection by the anaesthetist of several analgesic (e.g. fentanyl) and sedative (e.g. midazolam) drugs, followed by local anaesthesia administered by the surgeon.

The purpose of these injections is to reduce the level of consciousness and prevent pain. The anaesthetist is present throughout the procedure and regularly administers small doses of short-acting anaesthetic medication.

Patients remain conscious and can speak to the surgeon and anaesthetist, but usually recall only little or none of the procedure afterwards. The benefits of this mode of anaesthesia are a faster recovery and lower incidence of nausea compared with a general anaesthetic.

Particularly suitable for outpatient surgery, the aesthetic surgery procedures that involve this type of anaesthesia include blepharoplasties, otoplasties, small lipoaspirations, mini-face lift and neck lifts, simple rhinoplasties and breast augmentation using implants.

General anaesthesia

General anaesthesia is normally reserved for the more major types of aesthetic surgeries), such as mastopexies, breast reductions and face lift and neck lifts. It is, of course, administered by a specialist in anaesthesia and resuscitation.

The two primary aspects of general anaesthesia are the management and control of state of consciousness and airways.

Controlling state of consciousness

Medications are administered intravenously to render the patient unconscious and suppress pain. The drugs selected, their dose and the sequence of administration allow optimal pain relief to be achieved at the start, during the procedure, and post-operatively.

Controlling respiration

Respiration is managed by a ventilator that regularly insufflates oxygen through an endotracheal tube (intubation) or via a laryngeal mask placed at the back of the throat.

Control of post-operative pain with regional anaesthesia

For surgeries of the breast (breast augmentation or reduction) or stomach (abdominoplasty), additional regional anaesthesia is administered via injections of long-acting local anaesthetics. Therefore, for several hours after the patient wakes up, the area operated on remains asleep.

Regional anaesthesia is administered under ultrasound guidance by the anaesthetist when the patient is already asleep under general anaesthetic.

PRE-OPERATIVE ANAESTHETIC CONSULTATION

The choice of anaesthesia is made based on the recommendations of your surgeon and anaesthetist, and on your own wishes. The principals and risks of each of these techniques will be explained to you at the preoperative consultation.

The anaesthetic consultation has been mandatory since 5 December 1994. It must take place at least 48 hours prior to the aesthetic surgery operation .

During the consultation, the anaesthetist compiles an individual patient anaesthesia file. The results of the clinical examination and the patient's medical and surgical history are noted, including allergies, addictions such as tobacco, alcohol or drugs, as well as any current medical treatments.

The clinical examination is to identify any pre-existing condition that could contraindicate the operation or require further tests. If in doubt, the doctor may prescribe further tests (e.g. electrocardiogram, chest x-ray, etc.) or a specialist consultation with a cardiologist or other specialist.

During this consultation, the doctor prepares the anaesthesia protocol detailing premedication, type of anaesthesia, prophylactic antibiotic treatment and thrombosis prevention.

© Dr. Médard de Chardon - Aesthetic and Reconstructive Surgery 101 rue d'Antibes, Cannes, France - Phone : +33 (0)4 93 68 86 68