People are often more nervous about the anaesthesia used during the surgery than the surgery itself. It can be quite confusing when trying to understand what anaesthesia is used for what procedures. Rhinoplasty can be performed under many levels of anaesthesia. Each option includes differences in cost, safety, side effects and level of awareness thus both having some advantages and disadvantages.
Generally your surgeon and anaesthetist will guide you towards the appropriate type of anaesthesia for the particular procedure you are having. A full rhinoplasty is always done under general anaesthesia.
In the United States admission fees to full services hospitals tend to be very high and there is tendency for a significant amount of cosmetic procedures to be done in outpatient care facilities. In these centres local anaesthesia with sedation is preferred over general anaesthesia due to lower costs. There is a tendency for similar centres to appear in Australia as private health insurance companies restrict coverage for plastic surgery procedures.
Local anaesthesia is always used with or without general anaesthesia or sedation. Local anaesthesia when applied to the nose assists with reducing the amount of bleeding during surgery. Typically this will be topical adrenaline (previously cocaine) and injected lignocaine mixed with adrenaline.
Intravenous Sedation (twilight anaesthesia, conscious sedation)
Intravenous sedation involves the careful delivery of anaesthetic agents through an intravenous cannula. The patient is unconscious and motionless but is still breathing by themselves. A fine balance is maintained throughout the procedure.
During a rhinoplasty and particularly during a turbinoplasty there may be some bleeding occurring. This blood can drain back and may be inhaled into the lungs when the airway is not protected by a breathing tube such as is used in general anaesthesia. For this reason intravenous sedation is never recommended if significantly bleeding is expected.
When surgery lasts several hours it can sometimes become difficult to keep patients comfortable with this technique. They may develop muscle soreness, a full bladder or restlessness.
General anaesthesia is the most safe way to have rhinoplasty surgery. A breathing tube is inserted which protects your windpipe from any blood that may drip down from surgery. A deeper level of anaesthesia is also possible which allows the blood pressure to be lowered to minimise bleeding, bruising and swelling. Local anaesthesia is still used with general anaesthesia and overall compared levels of anaesthetic agents are used compared with intravenous sedation techniques.
Continue reading – Recovery after rhinoplasty