How Do You Protect Airways During Rhinoplasty?

Question

i am planning to have a rhinoplasty but i dont like general anasthesia i want to have it with local anasthesia but i am afraid of aspiration can you tell me how do you protect airways during rhinoplasty do you place anything behind of nose and does it fully protect from aspiration?

Kenneth Hughes, MD · Answer

The only way to truly protect an airway is to have a secure airway, which is only possible with general anesthesia. If you are really worried about aspiration, then local and sedation is not the best alternative. If you are doing straight local, then airway reflexes would be intact and there should not be a true risk for aspiration. However, this may not be comfortable if any bony work is undertaken. Kenneth Hughes, MD Los Angeles, CA

Andres Bustillo, MD, FACS · Answer

The rhinoplasty procedure can be performed with either general anesthesia or IV sedation. If using IV sedation, the surgeon usually places a small amount of packing in the back of the nose to prevent any blood or secretions to run down the back of the nose and into the airway.

James M. Ridgway, MD, FACS · Answer

Dear John,

The question you ask is a good one. When patients undergo entirely local procedure they are able to protect their airway. If they are under conscious sedation (twilight sleep) the will have a nasopharyngeal pack that will protect fluids from draining to the airway. If general anesthesia is performed, the tube or laryngeal mask protects the airway. Regardless, the airway is always protected.

Be healthy and be well,

James M. Ridgway, MD, FACS

William Portuese, MD · Answer

For patient safety it's always best to undergo rhinoplasty under general anesthesia. The airway is totally protected by a laryngeal mask airway, or an endotracheal tube. Placing any packing in the back of the nose while patients are awake and sedated can only lead to aspiration of the packing and blood down into the trachea. It is best to have a board certified physician anesthesiologist present in a certified ambulatory surgery center setting for the best practices of patient's safety. Having rhinoplasty performed under local anesthesia is a bad idea

Stephen Weber MD, FACS · Answer

The airway is typically protected by minimizing bleeding and ensuring that any blood does not wind up in the airway. This is achieved with meticulous technique and using pledgets to absorb any bleeding. With deeper sedation, the airway can be maintained with an oral airway or a breathing tube in the case of general anesthesia. No technique is foolproof so ensure that you undergo surgery in an accredited facility with a board certified and experienced Facial Plastic Surgeon working alongside an experienced anesthesiologist. I hope this information is helpful.Stephen Weber MD, FACSWeber Facial Plastic Surgery

Steven Wallach, MD · Answer

Rhinoplasty can be performed under sedation. Usually nasal packing will prevent blood from dripping into the airway.

Steven M. Lynch, MD · Answer

Hi,

	  I would disagree with you on the local anesthesia for a full nasoplasty.  I am assuming that you are going to have some sedation.  You will need it for any work during the procedure.

	  No matter how you are being sedated or not, we can protect the drainage into the back of the throat with a packing in the back of the nasal vault.  This mandates any blood to come out the nostrils during the procedure and we easily suction that away as the steps are being taken for the nasoplasty.

	  Make sure you choose your surgeon wisely.  Any surgeon who accepts you for a nasoplasty to be completely done under local anesthesia without sedation must have some interesting secrets. 

	  No matter how the anesthesia is done, the protection of the back of the throat is quite simply done with the packing.  If general anesthesia, then we use a throat pack and remove it at the end of the procedure.  Also with the general anesthesia approach, the anesthesiologist will use a balloon on the tube in your throat to prevent aspiration.  It works very well.

George J. Beraka, MD (retired) · Answer

Hi.

	1)  You need to do it in an accredited surgical suite with a board certified anesthesiologist,

	2)  With accurate local and topical anesthesia (which constricts the little blood vessels), there is very little bleeding.

Richard W. Fleming, MD (retired) · Answer

Regardless of the anesthetic technique used during rhinoplasty the airway is always protected. An experienced surgeon will select a competent anesthetist or anesthesiologist to work with him or her. In my clinic all of the anesthesiology staff has been working with us for at least 15 years.

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