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Twilight Sedation Vs General Anesthesia for Septo-rhinoplasty?

asked 2 years ago by erio in WA
Latest answer by Jonathan Berman, MD
Question viewed 2,932 times
Tags: nose, anesthesia, drug, recovery, sedation

I need Septoplasty for medical reasons. I am planning to combine Rhinoplasty with it. One surgeon I consulted said that he uses general anesthesia because he can ensure my breathing continues and the breathing tube ensures that blood from my nose does not get into my lungs.

The other surgeon said that he uses IV Sedation (Twilight sedation) because it is sufficient and because recovery is easy. The anesthesia-nurse said an air-mask prevents blood from entering my lungs. Both said that the anesthetic is administered through an IV. So what's different between the two methods? The drug? The dosage?

22 answers to Twilight Sedation Vs General Anesthesia for Septo-rhinoplasty?

Twilight sedation an alternative form of general anesthesia

Twilight sedation sedation is an alternative form of general anesthesia. It is impossible to describe all of the techniques and combination of techniques in this space. Experienced surgeons and their anesthesia teams use what works best in their hands. One approach is not better than another. Recovery is similar when you select an experienced surgeon.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon

www.bevhills.com

Rhinplasty Under Sedation (twilight) versus General Anesthesia

You are correct in all the points you make in your question: 1) Anesthesia encompasses many shades of gray; the deeper the sleep, the less you breath, until, ultimately, a breathing tube and ventilator are required. While most physicians would agree that once a patient is on a ventilator it is "general anesthesia", some would argue even patients breathing for themselves in deep sleep may qualify as "general anesthesia" -- just without a breathing tube. There are some IV... more

Laxmeesh Mike Nayak, MD
Saint Louis Facial Plastic Surgeon

www.nayakplasticsurgery.com

Anesthesia for Rhinoplasty

Working on the nose is working on the airway. There is bleeding, although it is a very small amount. Protection of the airway is important-----meaning that keeping the airway patent----is essential. To perform any surgery with sedation requires depresssion of the brain---whether it be a little or a lot. Depressing the brain interferes with the breathing mechanisms: protective reflexes as well as the rythm and rate of breathing. To achieve sedation, a... more

Jonathan Berman, MD
Palm Beach Plastic Surgeon

www.drberman.com

Anesthesia choices in plastic surgery

The question of whether to use general anesthesia or sedation is common and not only with rhinoplasty but multiple other types of surgeries. What it boils down to is what type of anesthesia the physician is most comfortable with and additionally what types of anesthesia the physician may or may not be licensed to provide. You should check into the certification of the facility where the surgery is going to be performed. Many surgeons like myself to have a fully accredited operating room and... more

Adam David Lowenstein, MD
Santa Barbara Plastic Surgeon

Most modern surgeons prefer GENERAL anesthesia for septoplasty/rhinoplasty

Like many areas of medicine, anesthesia has come a long way in recent years. Better and safer drugs and more advanced monitoring technology have really made general anesthesia a much safer and more comfortable approach for patients. I perform all rhinoplasties and septoplasties under general anesthesia for these reasons. I can be assured that the patient's breathing is adequate, that they're comfortable, and that they won't move unexpectedly. Besides that, the bleeding during nasal... more

David C. Pearson, MD
Jacksonville Facial Plastic Surgeon

Twilight anesthesia is safe for Septorhinoplasty

I commonly use Twilight anesthesia or moderate sedation for all facial surgery. This is a very safe technique and reduces the risks associated with a general anesthetic. The main difference is that with a general, you would have either a breathing tube (endotracheal tube ), a mask, or what is called an LMA. LMA stands for Laryngeal mask airway, which is a tube placed at the back of your throat and blocks fluid from entering your trachea (wind pipe). Obviously, a mask wont work in nasal... more

Steven L. Ringler, MD
Grand Rapids Plastic Surgeon

Twilight Sedation Vs General Anesthesia for Septo-rhinoplasty?

The answer depends mostly on your anesthesiologist's comfort and skill level with twilight sedation during a nasal procedure which involves some bleeding in the airway. We prefer general anesthesia in septorhinoplasty, and eschew laryngeal mask airways in any case. If something goes wrong in any twilight case and/or the airway is lost, the first thing to do is to put a tube in the airway to secure it. In general anesthesia the airway is secured prior to the procedure. more

Ramtin Kassir, MD
New York Facial Plastic Surgeon

Rhinoplasty - General Anesthesia vs I.V. Sedation

I have used both of these anesthetic techniques with success. Each approach has its pros and cons and sometimes it is the patient's preference and other times it is the surgeon's preference. My personal preference is general anesthesia. The patient's airway is protected and I feel I can work more efficiently. Having said that, it is certainly acceptable to use I.V. sedation and local anesthesia if both the surgeon and patient are comfortable with this approach. Best of Luck more

Jon F. Harrell, DO
Miami Plastic Surgeon

www.westonsurgery.com

Twilight Sedation vs General Anesthesia

A twilight anesthesia can be much more dangerous due to the patient slipping into an unconscious state and not being able to breathe on their own with an unprotected airway. Under general anesthesia, the airway is completely protected from collapsing upon itself when sedated too deeply, along with being protected from the actual blood and secretions itself. It is also important to have a board-certified physician anesthesiologist present, during the surgery. In addition, at the time of... more

William Portuese, MD
Seattle Facial Plastic Surgeon

www.seattlefacial.com

Go For General Anesthesia For Septorhinoplasties

Every surgeon and anesthesiologists has their own opinions, and there is not a "right" answer to your question. Nevertheless, I would recommend general anesthesia to my patients considering nasal surgery. With a breathing tube in place, the anesthesiologist and I don't have to be quite as worried about the patient's ventilation, oxygenation, and comfort. Nowadays, general anesthesia is so safe, I would recommend it for all of my patients undergoing nasal surgery....

Michael C. Pickart, MD
Ventura Plastic Surgeon

There are considerations when choosing sedation vs general anesthesia

As you see there are many opinions, however there are certain things to consider 1: comfort of the surgeon and anesthesia person 2: What level the facility is CERTIFIED, can they do general and sedation 3: Safety of patient. Doing a Rhinoplasty with sedation and giving the patient supplemental oxygen can be a source of fire

Samir Shureih, MD
Baltimore Plastic Surgeon

Anesthesia concerns

Either twilight sedation or general anesthesia can be safely performed, and each has advantages and disadvantages. Ask your surgeon about these for your particular case. What is more important is who is doing the anesthesia. Is it a board certified anesthesiologist? Usually they will prefer general anesthesia because of the controlled airway. If your surgeon is also doing the anesthesia or if they use a nurse to do it, then they will usually prefer IV sedation. You should consider which one... more

Dean Fardo, MD
Atlanta Plastic Surgeon

Twilight Sedation for Rhinoplasty

Hi Erio, General anaesthesia usually implies that you will have a breathing tube in your lungs which is attached to a ventilator and breathes for you. As you can imagine you have to be well sedated so you don't gag on the tube. It also means that probably you will be given inhalation anesthesia to keep you sleeping. Inhalational gases tend to get absorbed into the fat cells of your body and dissipate over several days. This may cause a longer recovery as far as anesthesia goes. Twilight... more

Oleh Slupchynskyj, MD
New York Facial Plastic Surgeon

www.facechange.org

Different techniques of anesthesia

Generally, general anesthesia uses the same sedatives as with the twilight, but higher doses and more meds. General also controls/carefully monitors respiration, oxygen, etc. The tube in your trachea protects against aspiration. I like general better because I feel it is safer, it is more comfortable for the patient. Twilight is ok for patients who want it, and doctors who feel comfortable with it. sek

Scott E. Kasden, MD
Dallas Plastic Surgeon

I prefer general anesthetic for Rhinoplasty Surgery.

Your nose is part of your airway, so I prefer to use an endotracheal tube to protect the lungs and lower airway. I perform almost all nasal-septal surgery with general anesthetic and an oro-tracheal breathing tube.This is my personal preference, although there are many experienced Rhinoplasty Surgeons that utilize "twilight" anesthesia. You should clarify what type of "air mask" your anesthesia nurse mentioned. I hope this is helpful for you.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon

www.ericmjoseph.com

Anesthesia for rhinoplasty

Either deep sedation or general anesthesia is safe. I prefer general anesthesia because I think it is safer. The airway is controlled better, and the patient is maintained at an even state with their blood pressure usually not fluctuating and the patient not moving around. A calm controlled patient always allows the surgeon to focus better on what he/she is doing for the patient.

Steven Wallach, MD
Manhattan Plastic Surgeon

What Anesthesia to Use for Septorhinoplasty

The safest anesthesia is general anesthesia with endotracheal tube that goes into the wind pipe and has a cuff(balloon) filled with air to seal the wind pipe and prevent any blood of secretions from getting into the lungs. Twilight sleep is ok as long as you don't end up having some bleeding. There is always a risk of that. In terms of recovery, even with general anesthesia these days the medications are so good that recovery is fast. Regards

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon

Anesthesia Type for Rhinoplasty

Most plastic surgeons would prefer general anesthesia as it is easier to control. Twilight is somewhat risky when it is performed for long periods of time. So if the surgery is going to be long, we prefer it to be with general anesthesia because the anesthesiologist is controlling your breathing. Now in both circumstances, whether you are having general anesthesia or twilight sedation, I would make sure that both are administered by a board certified anesthesiologist. Most often, corners... more

Farbod Esmailian, MD
Orange County Plastic Surgeon

Twilight vs General Anesthesia for Septo-Rhinoplasty

Both "twilight" and general anesthesia work well. However, in my estimation, especially for septo-rhinoplasty, general anesthesia is the ideal. The airway is more controlled and oxygenation is assured by the anesthesiologist. There is also less chance of getting blood in the airway of swallowing it (which can lead to nausea). Also, I have had less problem with post-operative nausea with general anesthesia since the anesthetic agent is a gas that is almost immediately breathed out... more

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Twilight versus general anesthesia

Whether you have twilight or general, I prefer that an anesthesiologist is available. Therefore you have two physicians managing your care. One is the surgeon perforimng the surgery and the other is focused on your breathing and pain relief. The difference is the amount of medications delivered and the amount of support required to maintain your cardiopulmonary system while providing analgesia and amnesia to some degree.

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Twilight sedation for septo-rhinoplasty

I prefer twilight anesthesia for the following reasons: No tube down your throat. Better recovery with less nausea and malaise. The downside is you need an anesthesiologist who is good at it. It is not worth it if the anesthesiologist is not comfortable with it because he will keep you too light or too sedated. see video

Ricardo Rodriguez, MD
Baltimore Plastic Surgeon

Leave anesthesia method for Septo-rhinoplasty to your trusted surgeon

The difference is that in twilight anesthesia, YOU do the breathing. the rate and depth of breathing is determined by you. If you slow down, the amount of oxygen will go down, an alarm goes off and the nurse charged with monitoring you will remind you to take a few deep breaths. In general anesthesia, a machine puts a mixture of anesthetic gas and oxygen through a cuffed tube into your lungs. Your blood oxygen is kept constant by the machine. Once you are asleep, your mouth is opened and a... more