Risk of airway fire with iv sedation during facelift surgery vs general anesthesia risk?

OR fires from oxygen and cautery are quite rare. In facelift surgery this risk is negligible with proper precautions: use of a nasopharyngeal airway so oxygen is not delivered near site of cautery, stopping oxygen when cautery is being used, moist sponge over cannula. With proper care, IV sedation during facelift surgery is extremely safe and less of a risk when compared to general anesthesia.

The risk of airway fire is exceedingly low with either type of anesthesia. I perform nearly all my deep plane facelifts under IV sedation with an anesthesiologist and we are able to perform this safely without any supplemental oxygen in most patients. With this approach there is no supplemental oxygen and therefore no oxygen source to ignite a fire. If the surgeon is using supplemental oxygen, as a precaution the oxygen should be turned off before the use of cautery around the cannula.

General anesthesia is often preferred over IV sedation for facelift surgeries involving electrocautery tools due to the higher risk of airway fire with IV sedation. This risk arises from the use of supplemental oxygen in an open system near the surgical site, which can accumulate and ignite. General anesthesia uses a closed system with an endotracheal tube, better controlling oxygen delivery and significantly reducing the risk of fire, outweighing the potential complications associated with general anesthesia.

If you are in good overall health, the comprehensive risk of general anesthesia is very low. However, when performed correctly, the risk of airway fire or other issues from IV sedation is also very low. Both are safe and acceptable ways of performing a facelift in the appropriate candidate, it really boils down to surgeon preference and patient preference. If you are otherwise comfortable with your surgeon and surgical team, I would not hesitate to pursue a face and neck lift just because of the requirement of general anesthesia.

This is an interesting question, because there should never be a "high risk" of airway fire; this is a very serious and rare intraoperative complication. When oxygen is free flowing or tented in the presence of a spark or elevated temperature, there is theoretically a risk. For example, when we are performing laser resurfacing, we turn off the flow of Oxygen to mitigate this risk. Both anesthesia techniques are actually very safe in healthy patients and controlled settings. I prefer deeper sedation with airway control during facelifts because I am extensively tightening the neck. Airway control with an LMA or ET tube helps to keep the patient safe and comfortable, and allows the Surgeon to perform the tasks at hand. The key in intraoperative safety is patient selection: elective aesthetic procedures are not for patients at high medical risk.