Can a septorhinoplasty be performed under general anesthesia without epinephrine? Are there alternative opinions?

Question

Can rhinoplasty/septoplasty be done in general anesthesia without epinephrine or any other vasoconstrictor to the nose? I’m very sensitive to epinephrine and don’t feel comfortable having surgery with it. Is there any other option to control bleeding ?

Lucian Ion, FRCS · Answer

Thank you for your question. It is technically possible to carry out rhinoplasty and septoplasty with anesthesia without epinephrine. In general, the risk of bleeding is higher, but it is possible to control the bleeding during the undermining of the soft tissues. This process takes somewhat longer but can be relatively successful.

During the general anaesthetic, the anaesthetist controls the blood pressure to help decrease bleeding and facilitate the surgery.

At the end of the surgery, it is also possible to use fibrin glue, both for the septum and under the nasal skin, to decrease the tendency to bleed. This approach aims to ensure a successful final result and improve the experience in terms of swelling after surgery.

Eric M. Joseph, MD · Answer

As long as somebody does not have cardiovascular disease, the benefit of epinephrine and reducing bleeding during surgery outweighs any significant risk. Even if somebody is sensitive to epinephrine, that effect would be over when the patient awakens after surgery. I hope this helps. Sincerely, Dr Joseph

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Epinephrine is a very important component to the local anesthetic, which is injected into your nose during rhinoplasty because it causes less bleeding during the surgery so your surgeon can visualize all the important structures. When the surgery is performed under general anesthesia with a board-certified anesthesiologist, taking one and one care of you it is extremely safe. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Zeshaan Maan, MD · Answer

It would be helpful to clarify the nature of your sensitivity, but for the sake of this question I’ll assume you’ve had injections of local anesthetic containing epinephrine and that even this small amount injected into your skin led to unwanted effects. It’s worth considering that while you are under general anesthetic, these effects would be dampened and likely resolved by the time you wake up.
That being said, my injection solution includes TXA, which helps to control bleeding without vasoconstriction, and epinephrine. Without epinephrine, your surgery will likely take a little longer as your surgeon’s visualization will be impacted, but it’s not impossible. 
I recommend having a discussion with your rhinoplasty surgeon about your concerns.

Ronald J. Edelson, MD · Answer

Many people have rapid heart beat from epinephrine when they go to the dentist. This is less likely to occur with rhinoplasty and the anesthesiologist will be able to control your heart rate

Can a septorhinoplasty be performed under general anesthesia without epinephrine? Are there alternative opinions?

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