Twilight Sedation Vs General Anesthesia for Rhinoplasty?

As a result of our own experience, training and philosophy, we all have our preferences when it comes to anesthesia for facial plastic surgery.
Most rhinoplasties today are performed under general anesthesia but this was not always the case.
Personally, I prefer IV sedation, because:
1. I feel that there is less bleeding during the procedure;
2. I feel that it is safer;
3. Patients experience a quicker recovery;
4. There is less nausea and vomiting.
You will certainly find plastic surgeons and anesthesiologists who will disagree with these notions based on their own experiences.
At the end, all involved need to be comfortable with the anesthetic choice: the patient, anesthesiologist and rhinoplasty surgeon!

Sedation occurs on a continuum, from mild sedation to general anesthesia-- where one is no longer breathing and requires a ventilator to assist the breathing. We prefer monitored anesthesia care where the patient is deeply sedated but still breathing on his/her own. A laryngeal mask airway is used to protect the airway. In this method, the surgeon is not competing for the airway and can focus on the rhinoplasty while being confident the patient's airway is protected as he/she is breathing on their own. While conscious sedation is a reasonable option preferred by some surgeons, we find monitored anesthesia care to provide the best combination of patient safety, comfort, and optimizing the surgeon's ability to concentrate on performing the rhinoplasty.

Rhinoplasty is always best performed under general anesthesia since there is control of a secure airway. With twilight sedation there is a high likelihood that you may remember having your nose broken, and you may be more apt to get into respiratory issues because of swallowing blood down the back of your throat when you are half awake or half asleep.

Hello,
Either general or sedation would be appropriate for rhinoplasty. I personally use sedation/twilight for most of my cases, to include septoplasty and cartilage grafting. Only endoscopic sinus surgery cases in my hands require general. Most patients feel better after a twilight, with less nausea and "ick" feeling. Less vomiting means less bruising and swelling. Overall, though, either is appropriate. It is up to what you are comfortable with.

There are many factors that go into this decision making process and there is no right or wrong answer but many options depending on the situation. For example a simple rhinoplasty with no septal work can be performed under twilight. However, a reconstructive rhinoplasty with cartilage grafting from the ribs is usually performed under general anesthesia. Surgeon and anesthesiologist preferences and experience will alos play a role.

 Either general anesthesia or twilight (monitored IV sedation) will work well for a rhinoplasty.  Make sure the anesthesia is administered wither by a Board-Certified Anesthesiologist or a experienced Nurse Anesthetist-- both are capable of providing a safe anesthetic.

Hi Harley,
We prefer to use IV sedation with diprivan with the placement of a LMA (Laryngeal Airway Mask, to prevent secretions from going into the stomach or airway) followed by local anesthestic injections. This type of anesthesia is very safe as the patient is able to breathe on their own without assisted ventilation, and they do not require inhalational general anesthestics.
For many years we used "twilight" anesthesia with great success, but having used both we have found that most patients prefer "not seeing, or hearing anything".
Most importantly choose your rhinoplasty surgeon carefully. Good luck and be well.
Dr. P

There really is not a one-size-fits-all answer to which type of anesthesia is best. In general, for quicker or smaller procedures conscious sedation is okay. For more extensive procedures, general anesthesia may be preferred. It really has to be a decision between you, your surgeon and your anesthesiologist. Good luck with your procedure.

If you require Rhinoplasty with septoplasty or cartilage grafting, general anesthesia may be preferred. Your nose is part of your airway, and if you're under "twilight" sedation, you may begin to cough as some blood drips into your throat.

We perform nearly all Rhinoplasty Surgeries in either an accredited surgi-center or hospital with an experienced, board-certified anesthsiologist. We feel that having your airway secure, and having you asleep (general anesthetic) may be best.



I hope this helps, and best regards.

Etiher twilight or general anesthesia can be used for rhinoplasty surgery. Most importantly, is how comfortable and confident your anesthetist is with either form of anesthesia with rhinoplasty. I do almost all of my cosmetic surgery under a twilight IV sedation and/or epidural anesthesia. In the setting of a major rhinoplasty, I feel that you have better control of the airway with general anesthesia. Thus, for my rhinoplasties, we tend to prefer using general anesthesia for the safety of the airway.