Rhinoplasty Surgery: Anesthesia Options

If you are considering rhinoplasty, you should give thought to your anesthesia options. Most rhinoplasty procedures last more than an hour and some may last several hours. During this time, you need to be kept pain-free, relaxed, and still, which is what anesthesia does.

Your surgery may be performed in a hospital, in a freestanding surgical center, or in a surgical suite in your surgeon's office. Most patients go home the same day after surgery, but if you are having very extensive surgery or have an underlying health condition, you may stay in the hospital overnight or in a recovery center.

For a rhinoplasty, anesthesia may be administered by a certified registered nurse-anesthetist (CRNA), by an anesthesiologist (a medical doctor who specializes in anesthesia), or by your plastic surgeon. You need to find out in advance what kind of anesthesia (regional or general) your surgeon will be using, who will be administering it, and what their qualifications are. 

Rhinoplasty Anesthesia: Local, Regional or General

Anesthesia can be local, regional, or general. In local anesthesia, only a small area is anesthetized, usually with an injectable local anesthetic although topical anesthetics can be used. In regional anesthesia, a region of your body is numbed, again usually with an injection of an anesthetic. In general anesthesia, you may be sedated or you may be completely unconscious.

Rhinoplasty is usually performed either with local anesthesia plus some sedation, or general anesthesia. Your surgeon may give you a choice here, but circumstance may preclude your choosing, or your surgeon may have a clear preference. As a rule of thumb, if your nose only needs a little reshaping, you can probably have local anesthesia. If you need more extensive work, you will probably need general anesthesia.

If you are having local anesthesia for your rhinoplasty surgery, you will receive sedative medications that will relax you and keep you calm. You quite possibly will fall asleep. The sedatives may be administered through an intravenous (IV) line into a vein in your arm or you may be given pills to take.  Even if you stay awake or wake up a bit during the procedure, you will be so relaxed you will not care. When you are relaxed and sedated, your surgeon will inject local anesthetics, such as lidocaine. He or she may also inject a drug called epinephrine, which will constrict the blood vessels and help reduce bleeding. The injections feel pretty much like getting any injections; you will feel a sting for a few seconds and then the area will start to go numb. Usually, you will get several injections over the area of your mid-face. 

General anesthesia can be administered by an inhaled gas or through an IV line. You will be unconscious during the whole procedure and be awakened afterward. 

Why Do I Need to Fast Before Surgery?

You are often told not to eat past midnight the night before your surgery and take nothing by mouth that morning. If you must take a medication the morning of your surgery, clear it with your surgeon first, and take it with just a few sips of water.

Your stomach needs to be empty in the event you become nauseated during or immediately after your surgery. If you have food in your stomach and vomit, you might choke or inhale food particles into your lungs. This would be a dangerous situation. Avoid this risk by following your surgeon's instructions. 

Risks and Complications of Anesthesia

Anesthesia is very safe, especially when administered by an anesthesiologist or nurse-anesthetist. But safe does not mean there is no risk. There are people who have been seriously injured or who have died during anesthesia even when everything was done properly and no underlying disease was known about in advance. 

Most serious problems associated with anesthesia are related to general anesthesia, but problems can occur with all types of anesthesia, including local anesthesia with sedation. You can have an allergic reaction to one of the medications used, even if you have had anesthesia safely in the past. You can develop a laryngospasm or bronchospasm (spasms of your windpipe and throat that could block your breathing), you could vomit a bit and aspirate some of that, or you could have an injury from the breathing tube. You could also suffer a heart attack or a disruption of your heart's normal rhythm. 

Most of these risks are very small, ones that are unlikely to happen, that is, unless you have some sort of underlying heart or respiratory problem. Other underlying problems, such as liver or kidney disease, can interfere with anesthesia and raise the chance of an adverse event. Smokers are more likely to have problems with anesthesia than are people who do not smoke. 

Still, the vast majority of people who have surgery with any type of anesthesia do fine. Don't let the fear of the small risk of something going wrong deter you. You just need to understand what the risks are. 

Special Medication Alerts

Make sure that both your surgeon and the person who administers anesthesia has a complete list of all the medications that you take, including all vitamins, herbal supplements, and even any recreational drugs you use. 

Many drugs interfere with or interact with anesthetics. They can weaken the effects of anesthesia or intensify it, and neither is a good thing to have happen. If you advise about your medications, he or she can make adjustments in the amounts being given to you. 

One class of drugs that are known to interfere with anesthesia is a type of antidepressant drug called monoamine oxidase (MAO) inhibitors. Even if you stopped taking these drugs several weeks before your surgery, they can still interact with anesthesia. Make sure your surgeon knows your medical history! 

This information is not meant to scare you but rather to inform you so that you are able to make a well-educated decision about your anesthesia. Remember, thousands of people undergo anesthesia safely every day