What Is The Best Anesthesia Option for Rhinoplasty?
A common question is what is the best anesthesia option for rhinoplasty. There are several types of anesthesia.
Local anesthesia is when the nose (local area) is numbed, with either an injection or a topical agent. In rhinoplasty, the topical anesthesia is often placed on either cotton or a pledget (absorbable cotton rectangle) which is soaked in an anesthetic solution.
Some surgeon use cocaine as a topical anesthetic. While this has been in use for many years, it does have some distinct disadvantages. First of all, cocaine, while an excellent topical anesthetic and decongestant (numbs nose up extremely well and shrinks up the inside of the nose), can lead to arrhythmias, which is an abnormal heartbeat.
While this does not sound particularly scary, it can in very rare cases lead to some more significant issues. For this reason, I do not find that the benefit of cocaine justifies its added risk. I prefer the use of Afrin topical spray as a decongestant OR use lidocaine on pledgets in small amounts for cases that need both numbing and decongestion.
IV sedation is where the patient is relaxed chemically during the case by an anesthesiologist. The anesthesiologist makes the patient just asleep enough to not feel anything or be awake during the case, but not so sleepy that they can not control their airway. Obviously, an experienced anesthesiologist is helpful here because there is a very fine line between just right and too much. One of the issues here is that the airway must be protected during the case so any small amount of bleeding, liquid or any other fluid during the case can lead to problems.
General anesthesia is where the anesthesiologist controls the airway with an ET tube. A tube is placed in the airway. While this sounds scary, it is often the best way for most patients to have a rhinoplasty. The tube serves to protect the patient from bleeding during the case. The downside of general anesthesia is that patients can sometimes experience discomfort in their throats after the procedure which typically subsides in 24 hours or less if it does occur.
What to Consider
The following are some factors which are important to consider which anesthesia is used:
Type of Rhinoplasty– Every nose is different and therefore the surgeon should vary his approach based on anatomy. A complex revision requiring rib harvest is best performed with general anesthesia, while a minor procedure such as a small dorsal edge or alar base resection can be performed under local anesthesia.
Surgeon Experience– Some surgeons may have a positive experience with either IV sedation, local, or general anesthesia. Ideally, the choice of anesthesia will be dictated by the patient’s anatomy with the surgeon being comfortable with a variety of techniques if necessary.
Anesthesia Experience– An experienced anesthesiologist will be able to perform a variety of techniques
Individual Patient Characteristics and Preference– Some patients do not want to even see the inside of an operating room. Others do not like the idea of being “knocked out”. More anxious personalities will often be treated better with general anesthesia.
Overall, general anesthesia protects the airway and is useful in cases which are longer than 2 hours; its distinct advantage. IV sedation can be applicable for some patients in cases lasting less than 2 hours. Local anesthesia can be an option for patients with minimally invasive work needed and a calm disposition.