In the early days of rhinoplasty all of the operations were done under local anesthesia. This was because general anesthesia was not felt to be safe enough to warrant using it for a relatively short case that did not require entry into a major body cavity such as abdominal or chest surgery. That was before the era of computerized monitoring of patients under anesthesia. Such automated monitoring of pulse, blood pressure, oxygen saturation and carbon dioxide content of the blood was made available in 1985. Interestingly, it was a child of the space program whereby all the same key bodily functions of astronauts thousands of miles from earth were tracked electronically.
Today it is unusual to have the operation done under strictly local anesthesia because we have such excellent and safe anesthetics available such that the patient need not be awake during the operation. Incidentally, one can have a type of anesthesia whereby they are not totally unconscious as in the case of general anesthesia, yet have no awareness of what is happening. When that type of anesthetic, as administered by a certified registered nurse anesthetist or a physician anesthesiologist, the patient is in a trance-like state which detaches them from what is happening. They are breathing on their own and technically they are not unconscious. That technique relies on the surgeon anesthetizing the nose with local anesthesia satisfactorily. For some procedures, that is the ideal technique. The type of procedure which is appropriate for that would be a simple rhinoplasty without any surgery upon the airway to correct a deviated septum, reduce enlarged turbinates, or create additional openings into the sinuses.
Such local anesthesia with sedation is also ideal when one is having only the tip of the nose refined; or if the patient is only having an implant placed to raise the bridge. Remember, you are not awake, you are not aware, you have no pain. You would not know you are not under the effect of a general anesthetic. The advantages are very rapid wake-up, less chance of nausea and vomiting and less grogginess for the rest of the day.
General anesthetic is generally used when one is having a combined procedure whereby nasal cosmetic surgery and functional, internal reconstructive surgery is being done to improve the airway, reduce the incidence of sinus infection and improve snoring for example. In that case, it is important that the anesthesiologist have complete control of the airway so that no blood or mucous can drip down into the throat, and he does this by protecting the windpipe with an inflatable tube that is placed into the upper windpipe.
For revision rhinoplasty with or without correction of deviated septum or turbinate reduction or opening of the sinuses, the length and complexity of the operation may be uncertain. Also, it is possible that because of previous surgery or surgeries, there is scarring and this can lead to more bleeding. If such is the case, the anesthesia specialist may opt for a light general anesthestic.
I want to emphasize the importance of having an anesthesia specialist regardless of the type of anesthetic that you are going to have. There is no reason to be without an anesthesia specialist in this modern era. They are trained to provide comfort and safety in the operating room and make an excellent partner for your surgeon. Be sure to ask about the type of anesthesia that your surgeon recommends and feel free to discuss it with the anesthesia specialist prior to your procedure. The decision to have either a nurse or MD “at the controls” should be yours. Be sure to inquire about which type of specialist will be at your service.
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