I'm having nose surgery to correct a deviated septum under general anesthesia. Will my breathing be stopped during surgery?

Septoplasty can be performed while awake or asleep. Being asleep (general anesthesia) is the most common. While anesthetized patients usually stop breathing and so the anestheseologist places a plastic tube into the windpipe by way of the mouth. This then allows the anesthetic machine to breathe for the patient.

 In our practice, we perform septoplasty and rhinoplasty under general anesthesia, by a board-certified physician anesthesiologist for patient safety and comfort. In most septoplasty cases, we perform the anesthesia with an LMA( laryngeal mask airway).  This is a breathing tube that sits on top of the vocal cords and patients can undergo a light general anesthetic. In some instances, we  use an endootracheal tube which is placed below the vocal cords. This requires a slightly  deeper general anesthesia.  During the anesthetic, patients are unconscious, but are usually breathing on their own with their own bodily functions not being stopped. Patient's heart rate, blood pressure, carbon dioxide, and oxygenation are all monitored during the procedure.

General anesthesia implies that the patient needs assistance with keeping the airway open and or with breathing. Anesthetics using an endotracheal tube that goes through the vocal cords requires the patient the patient to be deeper while an LMA sits at the top of the airway and does not require the patient to be as deep.  As long as the anesthetist has control of the airway, the patient is safe.  Breathing is stopped when the patient is paralyzed.  This may be initially when the airway is inserted of for a longer period of muscles are being worked on.  For a rhinoplasty, most patients have an endotracheal tube.  Whether the patient breaths on his or her own or has assistance from a ventilator is up to the anesthetist and should not impact the patient.  I would not want to perform a septoplasty any other way.

Dear nosebleed,

In general, surgery to correct a
deviated septum and improve your breathing will involve the risk of some
bleeding during the surgery. Various
techniques are used to minimize the risk of bleeding, but general anaesthesia
with intubation – that is, a tube that goes down your throat through the vocal
cords and protects blood from flowing backwards into your lungs – is a critical
element of performing this type of surgery safely.

During the actual procedure, you
will be relaxed with medications and you will need the ventilator to breathe
for you. The ability to breathe
spontaneously would mean you would not have general anaesthesia or intubation
to protect your airway and this is generally considered an unwise or unsafe
medical decision with septal deviation surgery.

Modern anaesthesia, modern
anaesthetists and the modern medications make this a very, very safe
choice. The risk of an anaesthetic
mishap during intubation and ventilation is extremely low. There is far more risk driving on a highway in Canada than a general anaesthetic
performed for septal deviation surgery in a young, healthy individual. Sensational cases such as the recent case
with Joan Rivers is extremely rare. She
was 81 years old and may have had underlying cardiac disease. In a young, healthy individual, septal
surgery with a general anaesthetic and intubation to protect the airway from
the retrograde flow of blood is definitely the safest decision.

At this point, I would discuss
this with your septal plastic surgeon to provide some reassurance and I’m sure
your surgery will go well.

I hope this information has been
of some assistance and best of luck.

Sincerely,

R. Stephen Mulholland, M.D.

Certified plastic surgeon

Yorkville, Toronto

Dear nosebleed, We have a full time anesthesiologist that works in our private surgical center and each case is preauthorized by anesthesia for clearance. During the preoperative appointment anesthesia will come in and speak with the patient and answer any questions and concerns. During nasal procedures an LMA or (laryngeal mask airway) or an endotracheal tube is used to provide assistance with keeping the airway open and breathing. During the anesthetic most patients are breathing on their own but are provided assistance when needed. This is the safest way to perform any nasal surgery as your airway is protected, and you are fully monitored, i.e. heart rate, oxygen levels, blood pressure, carbon dioxide.  Typically your anesthesiologist will call you the evening before surgery to review questions and concerns and remind you of NPO status etc. Best regards, Michael V. Elam, M.D.