Is Twilight sedation a better choice than general for Rhinoplasty?
Twilight Sedation Vs General Anesthesia for Rhinoplasty?
Doctor Answers 21
Twilight is Safer!
I respecfully disagree with my colleagues who state that general anesthesia is necessary for performing a Rhinoplasty. I have now done over 2000 procedures under twilight anesthesia and strongly prefer it over general. In my opinion there is less bleeding, no discomfort when done by someone with experience, and much less post-operative nausea. There is no risk of Malignant Hyperthermia and obviously no potential risks associated with use of an endotracheal tube.
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Rhinoplasty is safe and comfortable under sedation or general anesthesia
Rhinoplasty may be performed under general anesthesia with relative ease for the surgeon and anesthesia provider. Sedation is also an excellent choice for rhinoplasty, but I'd much more demanding for both the surgical and anesthesia teams.
In my opinion, an experienced surgeon/anesthetist team can provide an excellent result and experience with sedation or general. Due to less bleeding and easier recovery, my personal preference is sedation.
Personal anesthesia preference for Rhinoplasty
Either general or sedation would be appropriate for rhinoplasty. I personally use sedation/twilight for most of my cases, to include septoplasty and cartilage grafting. Only endoscopic sinus surgery cases in my hands require general. Most patients feel better after a twilight, with less nausea and "ick" feeling. Less vomiting means less bruising and swelling. Overall, though, either is appropriate. It is up to what you are comfortable with.
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Anesthesia Options for Rhinoplasty
As a result of our own experience, training and philosophy, we all have our preferences when it comes to anesthesia for facial plastic surgery.
Most rhinoplasties today are performed under general anesthesia but this was not always the case.
Personally, I prefer IV sedation, because:
1. I feel that there is less bleeding during the procedure;
2. I feel that it is safer;
3. Patients experience a quicker recovery;
4. There is less nausea and vomiting.
You will certainly find plastic surgeons and anesthesiologists who will disagree with these notions based on their own experiences.
At the end, all involved need to be comfortable with the anesthetic choice: the patient, anesthesiologist and rhinoplasty surgeon!
Both are good choices
Both twilight sedation and general anesthesia can be a good choice for rhinoplasty surgery. The choice depends on your preferences as a patient, the amount of work that needs to be done, and the practices of the anesthesiologist. I use only board certified anesthesiologists for my patients in either case and leave the choice between them and the patient. Good luck!
Type of Anesthesia for Rhinoplasty
Etiher twilight or general anesthesia can be used for rhinoplasty surgery. Most importantly, is how comfortable and confident your anesthetist is with either form of anesthesia with rhinoplasty. I do almost all of my cosmetic surgery under a twilight IV sedation and/or epidural anesthesia. In the setting of a major rhinoplasty, I feel that you have better control of the airway with general anesthesia. Thus, for my rhinoplasties, we tend to prefer using general anesthesia for the safety of the airway.
Monitored anesthesia care preferred for Rhinoplasty
Sedation occurs on a continuum, from mild sedation to general anesthesia-- where one is no longer breathing and requires a ventilator to assist the breathing. We prefer monitored anesthesia care where the patient is deeply sedated but still breathing on his/her own. A laryngeal mask airway is used to protect the airway. In this method, the surgeon is not competing for the airway and can focus on the rhinoplasty while being confident the patient's airway is protected as he/she is breathing on their own. While conscious sedation is a reasonable option preferred by some surgeons, we find monitored anesthesia care to provide the best combination of patient safety, comfort, and optimizing the surgeon's ability to concentrate on performing the rhinoplasty.
General anesthesia is preferred and more comfortable for patients
Rhinoplasty is always best performed under general anesthesia since there is control of a secure airway. With twilight sedation there is a high likelihood that you may remember having your nose broken, and you may be more apt to get into respiratory issues because of swallowing blood down the back of your throat when you are half awake or half asleep.
Either will work
As some of the other physicians have pointed out, this is best to discuss with your surgeon and anesthesiologist. One of the challenges of rhinoplasty surgery is that you can get bleeding which will pool in the back of the throat. This can sometimes irritate the voice box and cause coughing or difficulty breathing. For this reason, in my experience, some type of airway protection is needed either with an endotracheal tube or an LMA.
There is no one anesthesia technique for all seasons
There are many factors that go into this decision making process and there is no right or wrong answer but many options depending on the situation. For example a simple rhinoplasty with no septal work can be performed under twilight. However, a reconstructive rhinoplasty with cartilage grafting from the ribs is usually performed under general anesthesia. Surgeon and anesthesiologist preferences and experience will alos play a role.