Does intubation during rhinoplasty put you at risk?

Intubation during rhinoplasty is the safest way to protect your airway. IV sedation or twilight can actually put you at great risk of anesthesia complications. Since you trust your surgeon, I would also trust their advice on the best and safest type of anesthesia for your procedure. Best of luck to you.Stephen Weber MD, FACS

Thank you for your question.  Most, but not all surgeons perform rhinoplasty (beyond very simple cases or touch-ups) under general anesthesia.  The breathing tube (endotracheal tube) has a balloon cuff on it that prevents blood that may go down the back of your nose and into your throat from entering your airway, lungs and causing pneumonitis.  This can happen if you are sedated and not protecting your airway as you normally would while fully conscious.  Physicians that perform rhinoplasty under sedation, place cotton balls in the back of the nose to keep the blood from going down the back of the throat, but these can become saturated or dislodged.  You also will likely need supplemental oxygen during surgery and this would have to be provided through the mouth.  Oxygen near the working field is a fire risk if any type of cautery is needed.  Being fully asleep obviously avoids discomfort during the surgery that you may experience with sedation.  The benefits of sedation are a quicker wake-up, less post operative nausea, no sore throat after surgery and a few others.  I certainly haven't covered everything.  There are quite a few more pro/cons of each, but I hope you get a general sense of what goes into the decision making.  Chances are your surgeon has a preference.  I would discuss your concerns with him/her.  All the best!

Thank you for your question.It is normal to be anxious or nervous about surgery.  I often tell my patients that there is no reason to be scared, but nervousness is human and to be expected.  If they're not a little nervous, then I am - and I say that because if the patient is a little nervous, that tells me that the patient has some understanding of the fact that surgery is not a zero-risk procedure.Having said that, general anesthesia is my preferred method of anesthesia during rhinoplasty, and this requires an endotracheal tube (intubation).  General anesthesia has the advantage of keeping the patient comfortable and immobile.  In that way, it is less likely that a patient's unintended movement would cause harm during the procedure.  The intubation is required to assist the patient's breathing and to avoid inhalation of blood or other fluids - this is called aspiration.  It is not unreasonable to undergo these procedures under sedation or local anesthesia, but that approach introduces other variables, such as the consistency of the anesthetic agent being used, the skill of the anesthesia team in balancing comfort and breathing, as well as the patient's ability to tolerate the procedure under those circumstances.  I find that I get more predictable results with less risk under general anesthesia, which is why I prefer that approach.One of the primary (potential) advantages of avoiding general anesthesia is the wake-up time, as well as nausea.  Patients who undergo general anesthesia have a higher likelihood of postoperative nausea, and many wake up more slowly.  This is somewhat variable, but when looking at a large group of people, more of them who undergo general anesthesia will have a slow wake up and nausea than those who undergo sedation.Ultimately, you would be best-served by a detailed conversation with your surgeon and your anesthesia team - you should be comfortable with the surgical plan you've chosen, as well as the team that you've selected to carry out that plan.Best wishes.

 In our practice, we place all rhinoplasty patients under a general anesthetic with a laryngeal mask airway, also known as a LMA. Patient's still have a breathing tube in the throat, but are technically not intubated through the vocal cords, the LMA protects the airway and prevents  blood from going down the back of the throat. All anesthesia is performed by Board certified physician anesthesiologist in our Medicare certified outpatient surgery center for patient safety and comfort. We do not recommend IV sedation  since you will have conscious awareness and recollection of the procedure  and  an unprotected airway.

Preop anxiety is entirely normal. The general anesthesia is very safe in a healthy patient and is far and away the most common way rhinoplasty is done in this country. The tube totally protects your airway and ability to breathe.