IV deep sedation VS. general anesthesia for Revision Rhinoplasty? HELP! (photo)

In our practice, we commonly use an anesthetic technique called TIVA anesthesia.  This stands for Total Intravenous Anesthesia.  This technique allows patients to be sedated using only their IV line, and they can avoid a tube in their airway.  However,  rhinoplasty is the one procedure that i prefer a traditional general anesthetic.  During rhinoplasty surgery, some secretions and blood can drip from your nose into your airway.  This is much less likely if you have a secure airway via general anesthesia.  

Both general or deep sedation is reasonable with a good anesthesiologist, but like you said, the airway is controlled under general.

Type of anesthesia is chosen based on many factors, including the patient's history, location of the surgery, magnitude of the surgery, as well as the level of comfort of the anesthesiologist, the surgeon and the patient. General anesthesia and deep sedation are safe modalities of anesthesia, but is tailored to the patient and condition. General anesthesia does control airways because a tube is inserted (ET tube, or LMA) to control breathing during anesthesia. 

When performing  the rhinoplasty procedure, it is important  to control  the airway to prevent blood running down the back of the throat during  the surgical procedure. The recovery time from a deep IV sedation versus a light general anesthesia is approximately the same.  In our  office, we use board certified physician anesthesiologists for patient safety and comfort. We also perform the surgery in a state licensed and Medicare certified outpatient surgery Center

Dear JLlulish,

In general, a rhinoplasty surgery
that involves a fracturing of the nasal bones is most safely performed with a
fully certified anaesthesiologist protecting your airway and lungs from
backward flow of blood from the rhinoplasty procedure, either from the broken
bones or from work on your breathing passages and septum. Occasionally small enhancement rhinoplasty or
primary rhinoplasty procedures of the nasal tip can be performed under a light
IV sedation; even local anaesthesia and oral sedation with very little risk of
retrograde flow of blood.

However, for any kind of extensive enhancement rhinoplasty surgery, it has
generally been my approach to have an anaesthesiologist present who will
administer any IV or general anaesthesia as well as protect your airway with a
special kind of tube that has an inflatable balloon that protects you from
retrograde flow of blood. Certainly, if
you were to have some sort of medical complication or anaesthetic complication,
a fully-certified anaesthesiologist is in the best position to ensure your
safety.

The best course of action would be
to return to your operative rhinoplasty surgeon and discuss your concerns of IV
sedation versus general anaesthesia and the importance of having an
anaesthesiologist present.

I trust this advice is of some use
and best of luck.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

Deep IV sedation is just another form of general anesthesia; you are correct when you say that the airway is not controlled with sedation.  Either can be safely used if done by an expert anesthesia professional. The 3 anesthesia providers in my surgery center use both techniques.