Anesthesia is one aspect of plastic surgery that makes many patients feel uneasy. While no one wants to be alert and awake during rhinoplasty, many people are also concerned about the risks of "going under." Fortunately, a number of considerations considerably reduce the risks of receiving an anesthetic. A patient can receive a number of different types of anesthetics, depending on the preference of the surgeon and the type of procedure he or she is undergoing.
Some types of anesthesia numb only the area being operated on, meaning the patient is awake for the surgery. This is called local anesthesia. Others put a patient fully under, so that he or she needs assistance breathing during the surgery. The option used by Dr. Epstein during rhinoplasty is twilight sedation, which is somewhere between a local anesthetic and general anesthesia.
Typically the drugs used during twilight sedation are delivered to a patient intravenously, or through an IV. Twilight sedation has three major goals. It eliminates any pain or discomfort felt during the surgery when combined with a local anesthetic, lowers anxiety, and causes a patient to forget what is going on during the surgery. If you receive twilight sedation during rhinoplasty, you’ll still be "awake" for the most part, but you won’t be aware of what is going on and you won’t remember anything after the procedure is over. You will sleep during the surgery, while feeling nothing.
Twilight sedation is usually combined with a local anesthetic, so that the area around the nose is completely numb. Combining sedation with local anesthetic assures you will feel nothing during surgery.
Benefits of Twilight Sedation
Twilight sedation offers a few benefits compared to general anesthesia or a local anesthetic. Since you will still be breathing on your own, no intubation of a breathing tube is required. The anesthesiologist who works with the surgeon won’t need to ventilate you, for example. Usually, the recovery time after twilight sedation is shorter than the amount of recovery needed after general anesthesia is given.
You’re also less likely to experience unpleasant side effects after twilight sedation, such as nausea, than you would be if you received general anesthesia. Twilight sedation also usually has fewer complications compared to general anesthesia, one in particular being a lower risk of bleeding.
Getting Ready for Sedation
Usually you’ll need to do a few things to prepare for twilight sedation. Some changes should be made before any type of surgery, whether you’re receiving twilight sedation, general anesthesia or a local anesthetic. Quitting smoking is essential, not only because doing so improves your healing time and reduces your risk for complications from the surgery, but also because it reduces the risks of receiving twilight sedation.
Your surgeon might provide you with specific instructions to get ready before your sedation and surgery. The surgeon will instruct you no to eat or drink anything after a certain time the night before your procedure. It’s also usually recommended that you avoid drinking alcohol for three days before surgery.
Even though you aren’t going fully under with twilight sedation, you won’t feel up-to-snuff immediately after you wake up from surgery. Since you’ll most likely feel groggy and a bit tired, it’s required that you find someone to take you home after your procedure and stay with you. In many cases, patients are ready to be driven home about two hours after their rhinoplasty.
Safety and Concerns
While twilight sedation has fewer risks than general anesthesia, complications are possible in some cases. Complications are more likely to occur if the sedative is given by a person without much experience. It takes a lot of training and experience to know just how much to administer to a patient to keep him or her sufficiently sedated without going overboard. The anesthetist Dr. Epstein works with has been administering twilight sedation in his office for more than 15 years.
The anesthesiologist or anesthetist will keep a close eye on you- called monitoring you- during the rhinoplasty to make sure you are doing all right. Your blood pressure is taken every so often during surgery and your blood oxygen levels are measured with a pulse oximeter to make sure they remain at an appropriate level.
You might feel a bit queasy after the sedative wears off. Drowsiness is common, which is why going home and resting up is recommended after the surgery. If you feel that you can stomach it, it’s usually a good idea to eat a light, healthy meal when you get home, so that you can regain your strength.
Your surgeon will give you more specific advice about what is and isn’t safe to do in the first 24 hours after your surgery. Usually, driving a car or making important decisions are not advised during those first 24 hours.
If you’ve been putting off nasal surgery because you are concerned about anesthesia, learning as much as you can about your options beforehand can help put your mind at ease. Dr. Jeffrey Epstein specializes in rhinoplasty, performing between four and five surgeries each week. He uses twilight sedation at his practice and is able to address any concerns you might have about it.
Dr. Epstein sees patients at two locations, in Miami, Fl, and in New York City. To schedule a consultation in Miami, call (305) 666-1774. For an appointment in Manhattan, call (212) 759-3484 today.