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

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.

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.