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Twilight Sedation Vs General Anesthesia for Rhinoplasty?

asked 2 years ago by harlie kay in illinois
Latest answer by Laxmeesh Mike Nayak, MD
Question viewed 2,830 times
Tags: anesthesia, sedation, twilight sedation

Is Twilight sedation a better choice than general for Rhinoplasty?

21 answers to Twilight Sedation Vs General Anesthesia for Rhinoplasty?

+3

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.
S. Randolph Waldman, MD

Lexington Facial Plastic Surgeon
+2

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. more
Laxmeesh Mike Nayak, MD

Saint Louis Facial Plastic Surgeon

www.nayakplasticsurgery.com

+2

Personal anesthesia preference for Rhinoplasty

Hello, 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.
Catherine Winslow, MD

Indianapolis Facial Plastic Surgeon

www.indyface.com

+2

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... more
Frank P. Fechner, MD

Worcester Facial Plastic Surgeon

www.drfechner.com

+2

Both are good choices

Harley, 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!
Kenneth R. Francis, MD

Manhattan Plastic Surgeon
+2

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... more
Kent V. Hasen, MD

Naples Plastic Surgeon
+1

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... more
Corey S. Maas, MD

San Francisco Facial Plastic Surgeon
+1

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.
William Portuese, MD

Seattle Facial Plastic Surgeon

www.seattlefacial.com

+1

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.
D.J. Verret, MD

Dallas Facial Plastic Surgeon
+1

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.
Otto Joseph Placik, MD

Chicago Plastic Surgeon
+1

Anesthesia options for rhinoplasty

Choosing the right anesthesia for you is a discussion you have with your surgeon and anesthesiologist.  One or the other form is ok.  Some surgeons prefer twilight because a tube is not in their way while operating. I prefer general using an LMA  because it is safer than twilight.
Steven Wallach, MD

Manhattan Plastic Surgeon
+1

Rhinoplasty Anesthesia options

 Either general anesthesia or twilight (monitored IV sedation) will work well for a rhinoplasty.  Make sure the anesthesia is administered wither by a Board-Certified Anesthesiologist or a experienced Nurse Anesthetist-- both are capable of providing a safe anesthetic.
Shahram Salemy, MD

Seattle Plastic Surgeon

www.drsalemy.com

+1

Rhinoplasty; Twilight Sedation or General Anesthesia?

Hi Harley, We prefer to use IV sedation with diprivan with the placement of a LMA (Laryngeal Airway Mask, to prevent secretions from going into the stomach or airway) followed by local anesthestic injections. This type of anesthesia is very safe as the patient is able to breathe on their own without assisted ventilation, and they do not require inhalational general anesthestics. For many years we used "twilight" anesthesia with great success, but having used both we have found... more
Michael A. Persky, MD

Los Angeles Facial Plastic Surgeon
+1

Sedation vs. General Anesthesia for Rhinoplasty

My preference for rhinoplasty is general anesthesia. Some physicians push using "twilight" anesthesia as they can administer it themselves, and thus be more cost competitive as you do not have to pay the anesthesiologist a fee. I like to have an anesthesiologist watching your breathing and blood pressure, so I don't have to be distracted by those issues, and can solely concentrate on the cosmetic outcome of our surgery. Since you are already paying for an anesthesiologist, then... more
Michael A. Bogdan, MD

Dallas Plastic Surgeon
+1

Anesthesia for rhinoplasty

There really is not a one-size-fits-all answer to which type of anesthesia is best. In general, for quicker or smaller procedures conscious sedation is okay. For more extensive procedures, general anesthesia may be preferred. It really has to be a decision between you, your surgeon and your anesthesiologist. Good luck with your procedure.
David Shafer, MD

New York Plastic Surgeon
+1

I prefer general aneathesia when I perform Rhinoplasty Surgery.

If you require Rhinoplasty with septoplasty or cartilage grafting, then I think general anesthesia is preferred. Your nose is part of your airway, and if you're under "twilight" sedation, you may begin to cough as some blood drips into your throat. I perform all of my Rhinoplasty Surgeries in either an accredited surgi-center or hospital with an experienced, board-certified anesthsiologist. I feel that having your airway secure, and having you asleep (general anesthetic) is my... more
Eric M. Joseph, MD

West Orange Facial Plastic Surgeon

www.ericmjoseph.com

+1

Rhinoplasty surgery with local, twilight, or general anesthesia

Harlie kay, Rhinoplasty surgery is not one operation, but rather a million potential operations. The procedure may be performed under local, twilight (IV sedation), or general anesthesia. Based on multiple factors, including but not limited to the exact rhinoplasty procedure, patient preference, or co-existing medical conditions, any of these anesthesia methods may be utilized. There isn't a best answer, and it's a very personalized approach. Best of luck.
Houtan Chaboki, MD

Washington DC Facial Plastic Surgeon
+1

Anesthesia for Rhinoplasty

As long as you're comfortable with your plastic surgeon, either form of anesthesia can be given for a rhinoplasty. However, if you're anticipating major work on the inside of your nose general anesthesia may offer a safer mode of anesthesia as your airway will be better protected. Also, less blood will get into your stomach which may help with the post-operative nausea. Good luck!
Jeffrey E. Schreiber, MD

Baltimore Plastic Surgeon
+1

Each doctor is different

I have been doing noses under twilight for over 30 years. The anesthesiologist I work with is great at it. This is an individual preference and each doctor will be different. There is no one correct answer.
William B. Rosenblatt, MD

New York Plastic Surgeon
+1

Twilight sleep vs General Anesthesia for Rhinoplasty

General anesthesia is a better choice for rhinoplasty. During the procedure you can have some bleeding in the nose which then trickles down the throat. It can go into your lungs while you are under twilight sleep and cause a penumonia. With general anesthesia you have a breathing tube that prevents that hazard. Regards
Tanveer Janjua, MD

Bedminster Facial Plastic Surgeon
+1

Anesthesia for rhinoplasty

Dear Harlie Having done rhinoplasties both ways I prefer general anesthetic for several reasons. Patients don't swallow any blood which minimizes the risk of nausea and vomiting after surgery. I find it is better for my anesthesiologist to control the airway and keep the patient safe and comfortable at the same time. If I am doing only a tip rhinoplasty very often I will do this under local with sedation. I hope this helps you but instead of worrying about the anesthesia (unless you have a... more
Steven Schuster, MD

Boca Raton Plastic Surgeon

www.schusterplasticsurgery.com

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