Your Rhinoplasty Procedure

Undergoing Anesthesia

Before your rhinoplasty surgery begins, some form of anesthesia will be administered to keep you pain-free during the procedure. If you feel somewhat nervous about being "put under" with anesthesia, you're not alone. It's common to experience some anxiety about undergoing anesthesia. However, you should know that anesthesia is safer than ever
before. In fact, a 1999 report from the Institute of Medicine states that anesthesia is fifty times safer today than it was in the early 1980s. What makes it so much safer today? It's due to improvements in the drugs used in anesthesia, in the education of anesthesia providers, in technology, and in the techniques used for monitoring patients during surgery.

For rhinoplasty surgery, sedation anesthesia combined with local anesthetics is commonly used. However, general anesthesia may be recommended depending on the complexity of your procedure, your physical condition, your reactions to medications, and whether you smoke. The anesthesiologist or surgeon makes the final decision about
the type and level of anesthesia you receive.

Sedation Anesthesia

Sedation anesthesia, delivered by IV, uses pain relievers and sedatives to minimize discomfort and to induce relaxation and drowsiness. Sedation anesthesia is often combined with local anesthetics to provide additional pain relief. With sedation anesthesia, you can breathe on your own, so there is no need for a breathing tube down your throat. Sedation anesthesia agents do not remain in the body long, and you can expect to feel normal within a few hours after surgery. Sedation anesthesia is also referred to as monitored anesthesia care (MAC), twilight sedation, or conscious sedation.

Sedation anesthesia may be administered in varying levels: minimal, moderate, or deep. The anesthesiologist makes the decision about which level of sedation to administer.

Minimal sedation: With this level of sedation, you remain awake but relaxed during your procedure, and you don't feel pain or discomfort. Your memory of the procedure isn't affected.

Moderate sedation: You'll feel drowsy and may sleep through portions of or all of your procedure with moderate sedation. However, you can be awakened if touched or spoken to. You may or may not remember what happens during your procedure.

Deep sedation: You'll sleep through your procedure and most likely won't remember much, if anything, about it. This is often referred to as TIVA—total intravenous anesthesia. A laryngeal mask airway (LMA) may be used with TIVA as a way to keep your airways open during your procedure. The LMA consists of an inflatable silicone mask and a rubber
connecting tube.

Local Anesthesia

Local anesthesia numbs a small portion of your body, preventing you from feeling any pain in that area. Local anesthesia, when used alone, leaves you fully alert and allows you to breathe on your own. For rhinoplasty procedures, local anesthetics aren't used alone, but are often combined with sedation anesthesia. Local anesthetics remain in the body for a very short time and don't cause any feelings of sleepiness or grogginess.

General Anesthesia

The deepest form of general anesthesia produces a loss of sensation throughout your entire body and blocks your memory of the procedure. Basically, you won't see, hear, or feel anything during your procedure. Because general anesthesia renders you unconscious, you may or may not be able to breathe on your own. For this reason, the anesthesiologist may place a breathing tube down your windpipe (trachea). General anesthesia agents remain in the body for up to twenty-four hours, so you won't feel like you're back to normal until these agents have been completely eliminated from your system.

Monitoring During Surgery

To ensure your safety, the anesthesia professional will monitor your body's vital functions the entire time that anesthesia is being administered. While the facial plastic surgeon concentrates on making refinements to your nose, the anesthesiologist will focus on equipment that monitors your heart activity, breathing, circulation, and oxygen levels.
EKG: The monitors that were attached to your chest, arms, and back during surgery prep are connected to an EKG (also known as an ECG) machine that monitors your heart activity. The EKG machine alerts the anesthesiologist to any changes in your heartbeat.

Blood pressure cuff: A common blood pressure cuff is used throughout surgery to inform the anesthesiologist of any change in your blood pressure.

Pulse oximeter: The pulse oximeter is clipped to the tip of your finger during surgery prep to monitor the amount of oxygen in your blood. The device is linked to a computerized unit, which sounds an alarm if there's a drop in your oxygen levels.

Ventilator monitor: If general anesthesia is used during your procedure, the breathing tube that is placed down your windpipe is connected to a ventilator, or artificial breathing machine. The ventilator breathes for you while you are under the effects of the anesthesia. To ensure that the breathing tube is placed correctly and that your ventilation
levels are normal, the anesthesiologist will check the ventilator monitor.

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