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.

Technically speaking, your surgeon is correct that having an open source of oxygen (for example, the nasal airway used during sedation) increases the risk of an operating room fire compared to the use of an endotracheal tube, which is sealed off.
Oxygen is one of the three factors needed for an operating room fire, which also includes a fuel source and a source of ignition.
Any operation in the head and neck carries an increased fire risk. Avoiding the use of alcohol and other accelerants when cleaning the surgical site in preparation for surgery can help to reduce this risk.

Any time a patient is under iv sedation, most anesthesia providers put them on supplemental oxygen. That oxygen is not only in the tube going to the patients nose or mouth but also around the facial area of the patient where surgery is being performed. Any cautery then greatly increases the risk of a fire with that supplemental oxygen. If the oxygen is at a very low setting, the risk is also much lower. With general anesthesia, the breathing tube does not allow for oxygen to accumulate around the patient's face so the fire risk is minimized. With today's anesthetics and monitoring equipment, if a patient is overall relatively healthy, general anesthesia is extraordinarily safe. Both general and iv sedation are completely normal and safe options, but those are the facts.

Andrew Campbell, M.D.
Facial Rejuvenation Specialist
Quintessa

The risk of an airway fire is very low, but it is certainly possible with IV sedation. More important is the fact that the surgery is gonna take 2 1/2 to 3 hours, and you're simply not gonna be able to tolerate being sedated for that length of time, especially if there's , deep neck work required. In our practice, we perform all facelift procedures under General anesthesia for patient safety and comfort.

Thank you for your inquiry. The performance of facelift surgery under local anesthesia w IV sedation is absolutely safe and there is no risk of an airway fire as long as supplemental oxygen is not being administered. As long as proper levels of sedation are maintained there is no need to administer oxygen and thereby there is no risk of an airway fire.
There are many surgeons, probably a majority today, who have never performed facelift surgery under local anesthesia and are not willing to offer this to their patients. The first question to ask, after Board certification, is the surgeon's experience with this technique. Performing the surgery under general anesthesia is easier and possibly quicker for the surgeon.