Anesthesia
Anesthesia is a very important consideration as you proceed with making a decision about rhinoplasty surgery. The main factor you should consider in the choice of anesthesia is safety. Although anesthesia is generally very safe, particularly with progress in techniques and medications over the years, there is nevertheless a small risk.
Many people have concerns or questions related to anesthesia. This is justified, because in the few instances when complications occur in the setting of facial plastic surgery, they are usually anesthesia complications. You should discuss with your surgeon the different options available and inquire which one would suit you best and would be safest for your case. The different anesthesia options in rhinoplasty surgery are local anesthesia, usually with sedation, and general anesthesia.
Local Anesthesia With Sedation
This type of anesthesia includes a local anesthetic to freeze the nose and a sedative to provide overall relaxation and sedation to the patient. Local anesthesia is the injection of a freezing medication similar to that used in a dentist’s office. This simply freezes the area where it is injected without any sedative effect. Sedation can be administered as an injection in a muscle (for example the thigh or buttock) or through an intravenous (iv). The sedative medication is usually a combination of a relaxing medication and a painkiller. Patients are usually in and out of sleep. The degree of sedation or "sleepiness" can be tailored by giving additional doses of sedation throughout the procedure to ensure that the patient is sedated and comfortable.
The physician administering the sedation could be an anesthesiologist or the surgeon himself/herself, if (s)he is trained and experienced in the administration of sedation. The doctor gives enough medication to ensure the patient is comfortable without over-sedating. It is therefore important the doctor be skilled and experienced at sedation to be able to continuously monitor the patient’s condition and level of comfort. If the sedation is administered optimally, patients are often not aware of their surroundings and do not remember much of what took place. The patient’s blood pressure, heart rate, and oxygen level are continuously monitored.
This type of anesthesia offers several advantages in rhinoplasty surgery. The recovery is faster, the coughing, nausea, and vomiting sometimes associated with general anesthesia are avoided, and the time necessary to complete the procedure is decreased. This approach is less invasive and allows patients to recover faster and return to daily activities sooner.
General Anesthesia
General anesthesia is when the patient is completely unconscious and a breathing tube is placed down the throat by an anesthesia specialist. The anesthesia machine is breathing for the patient who is monitored throughout the procedure by the anesthesia doctor. The anesthesia gases are given to the patient through the breathing tube in her windpipe. When the procedure is completed, the anesthesia doctor withdraws the tube and the patient is awakened.
This type of anesthesia is the most invasive option as there tends to be more of a “stress” on the system with a longer period of recovery and “hang-over” after surgery. There is generally more nausea and vomiting after surgery and more bleeding during surgery due to the effect of the anesthesia gases. This effect also translates to more bruising.
Which Type of Anesthesia is Used in Rhinoplasty Surgery?
Although no statistics are available, most surgeons in North America prefer to perform rhinoplasty surgery under general anesthesia. This is because surgical training takes place in large teaching hospitals where the overwhelming majority of procedures are performed under general anesthesia, and this is the way most surgeons are trained to perform any type of surgery. Few are the surgeons who acquire additional training, experience, and comfort in performing surgery under local anesthesia, with or without sedation. Fewer still are those who acquire the comfort in administering the sedation themselves. Most surgeons will therefore prefer general anesthesia, as this is what they feel most comfortable with.
Which Type of Anesthesia is Best Suited For Me?
This depends to a large extent on what your surgeon is most comfortable with. If your surgeon is experienced in performing rhinoplasty under local anesthesia, then you have the option of local or general anesthesia. Otherwise, general anesthesia is your only option. Certainly, the final decision rests with the patient. For some patients, the type of anesthesia a surgeon uses will influence their decision to select that surgeon to perform their rhinoplasty. A thorough discussion at the time of consultation will help select the best choice of anesthesia method. Safety is the most important factor, although comfort and preference are also vital considerations.
For more information regarding anasthesia you may contact our office with any questions you have.