How Do You Protect Airways During Rhinoplasty?

     The only way to truly protect an airway is to have a secure airway, which is only possible with general anesthesia.  If you are really worried about aspiration, then local and sedation is not the best alternative.  If you are doing straight local, then airway reflexes would be intact and there should not be a true risk for aspiration.  However, this may not be comfortable if any bony work is undertaken.  Kenneth Hughes, MD Los Angeles, CA

  For patient safety it's always best to undergo rhinoplasty under general anesthesia. The airway is totally protected  by a laryngeal mask airway, or an endotracheal tube. Placing any packing in the back of the nose while patients are awake and sedated can only lead to aspiration of the packing and blood down into the trachea. It is best to have a board certified physician anesthesiologist present in a certified ambulatory surgery center setting for the best practices of patient's safety. Having rhinoplasty performed under local anesthesia is a bad idea

The airway is typically protected by minimizing bleeding and ensuring that any blood does not wind up in the airway. This is achieved with meticulous technique and using pledgets to absorb any bleeding. With deeper sedation, the airway can be maintained with an oral airway or a breathing tube in the case of general anesthesia. No technique is foolproof so ensure that you undergo surgery in an accredited facility with a board certified and experienced Facial Plastic Surgeon working alongside an experienced anesthesiologist. I hope this information is helpful.Stephen Weber MD, FACSWeber Facial Plastic Surgery