Twilight Sedation Vs General Anesthesia for Septo-rhinoplasty?

Like many areas of medicine, anesthesia has come a long way in recent years. Better and safer drugs and more advanced monitoring technology have really made general anesthesia a much safer and more comfortable approach for patients.
I perform all rhinoplasties and septoplasties under general anesthesia for these reasons. I can be assured that the patient's breathing is adequate, that they're comfortable, and that they won't move unexpectedly.
Besides that, the bleeding during nasal surgery tends to run into the throat. Under sedation, the patient can 1) choke on it, 2) swallow it, which is nauseating, or 3) spit it into the surgical field (and onto me!)...which is also not ideal :-)
I would bet that my anesthesia colleagues would agree with me on all of the above, too.
Hope this helps,
--DCP

I commonly use Twilight anesthesia or moderate sedation for all facial surgery. This is a very safe technique and reduces the risks associated with a general anesthetic. The main difference is that with a general, you would have either a breathing tube (endotracheal tube ), a mask, or what is called an LMA. LMA stands for Laryngeal mask airway, which is a tube placed at the back of your throat and blocks fluid from entering your trachea (wind pipe). Obviously, a mask wont work in nasal surgery, so some type of airway must be used in a general anesthetic. With this type, you are much deeper in terms of sedation and may require the tube for helping your breathing.
In contrast, with twilight sleep, you are breathing on your own, and do not require a breathing tube. It is very safe to do a septorhinoplasty under this type of sedation and I have never seen a problem with my patients using this approach. Some surgeons are less qualified or just less comfortable with this approach and may prefer using a general anesthetic.
In my experience of 25 years, I have never seen a problem with sedation for any facial surgery and it remains my first choice, except in children and younger teens who are better off under general for emotional reasons. The risks of a general can be minimized in the hands of an board certified anesthesiologist, but it still carries more risks and side effects than sedation. It also adds to the cost of surgery, and all of this should be considered when making your decision.

Either twilight sedation or general anesthesia can be safely performed, and each has advantages and disadvantages. Ask your surgeon about these for your particular case. What is more important is who is doing the anesthesia. Is it a board certified anesthesiologist? Usually they will prefer general anesthesia because of the controlled airway. If your surgeon is also doing the anesthesia or if they use a nurse to do it, then they will usually prefer IV sedation. You should consider which one seems safer to you.

Your nose is part of your airway, so I prefer to use an endotracheal tube to protect the lungs and lower airway. I perform almost all nasal-septal surgery with general anesthetic and an oro-tracheal breathing tube.This is my personal preference, although there are many experienced Rhinoplasty Surgeons that utilize "twilight" anesthesia.
You should clarify what type of "air mask" your anesthesia nurse mentioned.
I hope this is helpful for you.

The safest anesthesia is general anesthesia with endotracheal tube that goes into the wind pipe and has a cuff(balloon) filled with air to seal the wind pipe and prevent any blood of secretions from getting into the lungs.
Twilight sleep is ok as long as you don't end up having some bleeding. There is always a risk of that.
In terms of recovery, even with general anesthesia these days the medications are so good that recovery is fast.
Regards

Most plastic surgeons would prefer general anesthesia as it is easier to control. Twilight is somewhat risky when it is performed for long periods of time. So if the surgery is going to be long, we prefer it to be with general anesthesia because the anesthesiologist is controlling your breathing.
Now in both circumstances, whether you are having general anesthesia or twilight sedation, I would make sure that both are administered by a board certified anesthesiologist. Most often, corners are cut and some doctors or surgeons try to reduce the cost of the surgery by having a nurse or themselves do the sedation......very dangerous beware!

Whether you have twilight or general, I prefer that an anesthesiologist is available. Therefore you have two physicians managing your care. One is the surgeon perforimng the surgery and the other is focused on your breathing and pain relief.
The difference is the amount of medications delivered and the amount of support required to maintain your cardiopulmonary system while providing analgesia and amnesia to some degree.

I prefer twilight anesthesia for the following reasons:
No tube down your throat.
Better recovery with less nausea and malaise.
The downside is you need an anesthesiologist who is good at it. It is not worth it if the anesthesiologist is not comfortable with it because he will keep you too light or too sedated.

I greatly prefer general anesthesia for my patients undergoing rhinoplasty. It is clearly the safer way to go. If there is much bleeding in the nasal airway, this could lead to airway issues and aspiration. Performing a rhinoplasty under IV sedation could lead to an airway emergency, and I simply want to eliminate this risk. The disadvantages of general anesthesia are minor, in my experience.

Working on the nose is working on the airway.   There is bleeding, although it is a very small amount.   Protection of the airway is important-----meaning that keeping the airway patent----is essential.   To perform any surgery with sedation requires depresssion of the brain---whether it be a little or a lot.   Depressing the brain interferes with the breathing mechanisms:  protective reflexes as well as the rythm and rate of breathing.   To achieve sedation, a doctor or nurse must administer drugs.  These drugs are brain depressors.

General endotracheal anesthesia is still the SAFEST way to achieve this.  NO pain, no feeling of the surgery and absolute protection and secureness of the airway.   To compromise the airway for a cosmetic surgery is not a good idea.   No matter how talented the surgeon is nor how great the anesthesiologist or nurse anesthetist is, the airway is secure, safe with a tube in it.   There is no glitz or glamour to perform rhinoplasty or septoplasty without an endotracheal tube.   In most if not all communities there are "cowboys" who claim great successes from surgery without the "old fashioned" endotracheal tube.   

Ask your surgeon where the highest complication rate of anesthesia on cosmetic surgery is.   The answer across the US is where there was no endotracheal tube anesthesia used.   Almost all anesthesia mishaps occur from loss of the airway.   It is much more difficult to loose control of the airway if there is no tube there protecting it.  There are occasions where there is medication overdose, but more often the problems arise from trying to get away with "not using an endotracheal tube."

The best and safest surgeons use endotracheal anesthesia to perform nasal surgery.   Those surgeons that recommend not using that technique should be questioned why they are choosing not to use one.  Some surgeons claim that it is safer for the patient to breathe on their own without the endotracheal tube.   Patients can breathe on their own with an endotracheal tube.   

Surgeons need to respect the airway.   :-)