Once the decision to have a nose job is made and the initial consultation has been completed, the risks of anesthesia are a chief concern for most people. Even though the safety of anesthesia has improved considerably over the last forty years, there is still a small risk involved. The procedure itself rarely causes major complication. There are various options available and your doctor will summarize the risk associated with each one. The location of the procedure will drive which type of anesthesia to employ: surgeon’s office, surgical center, or a hospital. We have sketched out below the types of anesthesia available and the effects, and risks, of each.
General Anesthesia
A patient under General anesthesia is completely unconscious and intubated, meaning a tube is placed into the throat and connected to the anesthesia machine. Breathing function is managed by a breathing machine and the anesthesiologist monitors heart rate, oxygen level, and blood pressure. Despite the safety record of general anesthesia, many patients opt for a local or sedation alternative. General anesthesia has advantages that other methods do not.
One of the primary benefits is complete patient comfort and protection of the airway. Bleeding is a concern with general anesthesia the inhaled gas can relax blood vessels, thereby increasing blood flow to the nose. Because the patient is intubated during the procedure, the airway remains unobstructed. Another advantage to a general is the mitigation of pain or discomfort. Because the patient is unconscious, sensory perception is a non-factor. While many rhinoplasty procedures employ a general anesthetic, either in a hospital or accredited surgical suite, there are some drawbacks.
Perhaps the most common complaint is resultant side effects. Reported nausea, vomiting, and a “hang-over” feeling have been associated with post-operative general anesthesia. Other complications include higher levels of bleeding and body aches.
Conscious Sedation
Conscious Sedation is also known as twilight anesthesia and induces the patient into a relaxed state unaware of their surroundings or any feeling of pain. The marked difference between twilight and general anesthesia is that the patient in twilight is not intubated. Additional oxygen is usually administered through a small plastic tube placed near the mouth. First, the surgeon numbs the area with a local solution such as Xylocaine or Marcaine. The anesthetist monitors vital signs and delivers the twilight medication through an intravenous or IV line. Bringing a patient out of twilight is smooth and natural. Once the IV medication is discontinued, the patient recovers consciousness within a few minutes without experiencing any nasty side-effects.
Twilight anesthesia is growing in popularity with patients as well as rhinoplasty surgeons. Issues with conscious sedation manifest in two aspects: One, the patient may be too lightly sedated and therefore uncomfortable during the procedure. Second, the patient might be sedated too deep; preventing the patient to breathe on their own, or possibly leading to blood aspiration.
The advantages of twilight sleep include less post-op nausea and vomiting, quick recovery time, and no invasive intubation, and less blood loss. Disadvantages are minimal and include aspiration of fluids.
Local Anesthesia with Oral Sedation
In the past, the local anesthetic was the preferred option. If you have ever undergone a dental procedure, then you have probably experienced the effects of local anesthetic. The outer and inner portions of the nose are numbed with a mixture of Lidocaine and epinephrine; a process that can be moderately painful. Once the nasal region is entirely numb, the procedure can then be performed painlessly. Because epinephrine constricts blood vessels, there is usually minimal oozing. Generally, patients arrive for the procedure with a bit of nervousness and apprehension. Most doctors will help the patient relax by administering light doses of Valium. Because of the invasive nature of a rhinoplasty procedure, many doctors prefer a general or twilight option.
The advantages of a local are numerous and include: a minimal administration of drugs; no post-operative nausea and vomiting; decreased blood loss; and a faster recovery. However, the major disadvantage is that it limits the procedures that can be performed on the nose. Major rhinoplasty can rarely, if ever, be accomplished.
Each rhinoplasty surgeon leverages their expertise to select the appropriate method. Discuss with your nasal specialty surgeon, which anesthesia he prefers and why. Ask, what problems or complications he has encountered in the past and how these issues where dealt with.
