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, there is nevertheless a small risk.
In the few instances when complications occur in the setting of facial plastic surgery, they are usually related to general anesthesia. For this reason, 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 “sleepiness” 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 sleeping. The degree of sedation or “sleepiness” can be tailored by giving additional doses throughout the procedure to ensure that the patient is well sedated and comfortable. 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 with less swelling and bruising, the coughing, nausea, and vomiting sometimes associated with general anesthesia are avoided, and the time necessary to complete the procedure is decreased. In addition, this approach is less invasive and allows patients to recover faster and return to daily activities sooner. Unfortunately, nowadays few are the surgeons who acquire additional training and experience in performing surgery under local anesthesia, with sedation and therefore prefer to use general anesthesia. Dr. Samaha possesses this experience and performs all his surgeries under local anesthesia.
General anesthesia is when the patient is completely unconscious and an anesthesia specialist places a breathing tube down the throat. A machine is breathing for the patient who is monitored throughout the procedure. 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. 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.
Our Method of Anesthesia
Dr. Samaha performs all procedures using “conscious sedation” or “twilight anesthesia” (local anesthesia with sedation, mentioned above). This type of anesthesia allows the patient to be unaware of his/her surroundings, comfortable, and pain-free, while avoiding a more invasive general anesthesia. Other added benefits are decreased coughing, nausea swelling, and bruising. Dr. Samaha has extensive experience using this type of anesthesia as he performs the majority of his rhinoplasties this way. Occasionally, patients require a general anesthetic, which is also an option. However, most patient favor the lesser invasive anesthesia which allows for a faster recovery.