Intubation during rhynoplasty. Is it necessary?

Question

Why am I told some doctors like to intubate for rhynoplasty, and some don't? I hear it's easier for the doctor, but isn't it harder on the patient???

Thomas Buonassisi, MD · Answer

Rhinoplasty can be performed with local anesthetic supplemented by IV sedation. This does not require intubation. In those patients who prefer to be "put to sleep" with General Anesthetic then some form of airway needs to be used be it and endotracheal tube or laryngeal mask.In my practice most patients choose IV sedation which does not require any intubation as patients are relaxed and breathing on their own. For me this is preferable as there are no tubes coming out of the mouth and getting in the way of this fairly delicate procedure.Some surgeons prefer general anesthetic for this surgery but its just a preference.

Ronald J. Edelson, MD · Answer

Anesthesia for rhinoplasty can be done in a variety of ways. It can even be done under sedation and local anesthesia.  Intubation is usually the best way to protect the airway during the surgery and prevents blood from draining down your throat as well.  I use intubation on almost all rhinoplasties.

Kenneth Hughes, MD · Answer

Most of the time I use general anesthesia, and most patients are intubated.  Find a board certified plastic surgeon who has performed hundreds of rhinoplasties.  Look for great reviews and great before 
and after pictures.Kenneth Hughes, MDLos Angeles, CA

Toby Mayer, MD · Answer

This depends on the anesthetist and the surgeon and if the surgery is minor or not. Most surgeons intubate or block the throat to prevent blood from entering the lungs.

Sean Younai, MD, FACS · Answer

Is it better to have General Anesthesia for Rhinoplasty or just sedation? General Anesthesia could be done with either Intubation when a tube is placed into the airway or without one. It is always much safer to protect a patient airway and prevent airway collapse during surgery, therefore I recommend intubation.

Gerald Minniti, MD, FACS · Answer

Hello,Being intubated can lead to a sore throat for a day or so, but that's really the extent of it.  When you say intubation, you may be referring to general anesthesia which usually accompanies intubation.  Today's general anesthesia is safe or safer than 'sedation' medication in many instances, and in the case of most rhinoplasties, this is true. It is important to sedate the patient enough so that the stimulation of rhinoplasty surgery does not wake them or cause pain, and this amount of sedation is typically beyond their ability to protect their airway, or even to breath on their own.From the perspective of the patient and how they experience their surgery day, general anesthesia with intubation, is pleasant and brief.  When fully awake and ready to go home, which is about the time you start forming memory of your experience, most people are only minimally aware of their stuffy nose, and not pain or a sore throat. Best of luck!

Ashkan Ghavami, MD · Answer

I prefer full general anesthesia and intubation in 95% of rhinoplasties.  I have been able to do exactly the nasal shaping I wanted in situations where sedation was used, however and there was no intubation. This was usually in someone who needed a minor revision or a male patient who only needed their hump taken down with no tip shaping or a septoplasty needed. In many parts of the worked that is actually the norm.  However, when wanting to focus on multiple maneuvers during a comprehensive rhinoplasty. Rhinoplasty is the most complex plastic surgery we do, and you want your surgeon to be focused on the delicate work at hand. In the old days when closed rhinoplasty in under 40 minutes was the norm, oral sedation without intubation was common place. Times have changed, techniques have advanced and more often that not, your expert rhinoplasty surgeon will prefer you to be completely asleep, intubated, with your airway fully protected, and no chance of blood entering your lungs or stomach. The below video shows a typical experience of a young patient undergoing rhinoplasty with full anesthesia and intubation.

Richard J. Brown, MD · Answer

This varies from surgeon to surgeon and patient to patient. I like all m patients asleep for Rhinoplasty surgery. It just makes me more comfortable knowing patients are asleep and I think overall it is a better experience for the patient. You will find many answers that differ form this one but I do my Rhinoplasties under general anesthesia.

Stephen Weber MD, FACS · Answer

This depends upon both the plastic surgeon and the anesthesiologist experience and comfort zone. The key is safety. In the vast majority of practices rhinoplasty is performed under general anesthesia with an endotracheal tube to protect your airway. If your chosen surgeon performs rhinoplasty under sedation without intubation and has a skilled anesthesiologist that provides the anesthesia you are likely in good hands. The other important safety indicator is that your procedure (regardless of tube or no tube) is performed in an accredited surgical facility which has the most up to date and extensive equipment to keep you safe during surgery. I hope this information is helpful.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

William Portuese, MD · Answer

There are 2 ways to enable breathing during general anesthesia for a rhinoplasty. The first method is  called laryngeal mask airway(LMA), which is a breathing tube/ diaphragm  placed on top of the vocal cords and does not require intubation. It  prevents blood going down the back of the throat and maintains a stable airway at the same time. We use this type of breathing tube for  most rhinoplasty procedures under general anesthesia by a board-certified physician anesthesiologist The second method is when patients are intubated with an endotracheal tube(ET Tube) placed through the vocal cords.   This intubation accomplishes protecting the airway from blood and allows patients to breathe, but patients do have more of a sore throat afterwards. For patient's safety and comfort we do not recommend  rhinoplasty be done under local or IV sedation for the above reasons.  With sedation anesthesia, most patients do not want to have conscious awareness of the osteotomies of the nasal bones. For more information and our rhinoplasty Photo  Gallery, please see the link below

Intubation during rhynoplasty. Is it necessary?

Answers (16)

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