Rhinoplasty with intravenous and local anesthesia

Overview

Rhinoplasty can be done with the patient asleep under general anesthesia or sedated with intravenous drugs while the nose is numbed. The authors describe the patient selection, communication and anesthetic management needed for the sedation approach to work.

Sections of note

• Review article; no series, complication rates or outcomes appear in the abstract.
• Suitable patients: ASA physical status 1 or 2, possibly a well-controlled 3.
• Exclusions: obstructive sleep apnea, gastroesophageal reflux disease, obesity with body mass index 35 or above.
• Before surgery, patients must be told they will feel no pain and that, while sedated, they may be aware of events but will not care.
• The authors address the misconception that sedation is general anesthesia without an airway.
• The anesthetist stays with the patient throughout and adjusts the sedation level as needed.

What it means for a patient

• Sedation with local anesthetic is an option for healthy patients and avoids a breathing tube.
• You may have some awareness during the operation; the drugs are designed to make that untroubling.
• Patients with sleep apnea, significant reflux or high body weight are steered to general anesthesia.

Why this paper matters

Anesthetic choice affects bleeding, recovery and safety in rhinoplasty, and sedation is common in office-based surgery. This review gives selection criteria but no comparative safety data.

Terms

• Procedural sedation: intravenous drugs that relax and partly sedate a patient while they breathe on their own.
• Local anesthesia: numbing injections in the nose.
• ASA score: the American Society of Anesthesiologists scale of overall health, 1 being healthy.
• Obstructive sleep apnea: repeated airway blockage during sleep, a risk under sedation.
• Body mass index: weight relative to height; 35 and above is severe obesity.
• Titration: adjusting a drug dose step by step to the desired effect.