Anesthesia For Rhinoplasty – Cosmetic Nose Surgery


Rhinoplasty can be done without intubation. The surgeon and the

Anesthesiologist work as a team to provide the best possible patient


Anesthesia for Rhinoplasty is a combination of intravenous propofol

given by the Anesthesiologist together with local anesthesia injected in

and around the nose by the surgeon. The intravenous use of propofol for

anesthesia is sometimes called total intravenous anesthesia or TIVA.

Propofol is a gentle, safe, non-opiate medication with rapid smooth

action, and quick offset. It is exceedingly unlikely to cause any allergic

reaction, and does not cause nausea. In the proper hands, it is easily

controlled, and can be used for mild sedation to general anesthesia. It

can be used for very short operations, lasting a few minutes, to long

procedures lasting many hours.

For cosmetic nose surgery without intubation, the patient is fully monitored for

respiratory, heart and cognitive function. The TIVA with propofol is

continuously adjusted with the aid of a computerized pump. Initially,

enough medication is given to eliminate the discomfort of the local

anesthesia injections. The local anesthetic also includes a

vasooconstrictor,epinephrine, to eliminate bleeding during the operation.

The local anesthetic used is long acting, and the pain relief lasts long

after the rhinoplasty is completed. As soon as the nose is numb, the

propofol dose is decreased to the minimum required to keep the patient

asleep. Since the nose is completely numb, the dose of propofol is usually

quite small at this point. The patient continues to breathe naturally, remaining asleep and unaware until the end of the Rhinoplasty procedure. Patients wake up shortly after the TIVA is stopped, and are fully alert, ready to eat drink and ambulate minutes after nose

surgery is done. A combination of oral and intravenous anti-inflammatory

medications are given before, during and after surgery resulting in

minimal swelling and pain after surgery.

General anesthesia with intubation typically involves the use of propofol

together with paralyzing drugs and inhaled anesthetic gases. A tube is

placed through the mouth into the windpipe. In medical terms, this is

called oral endotracheal intubation. The patient depends on the

anesthesiologist to help with breathing using a manual and/or powered

ventilator for most if not all of the duration of the surgery. Since the

patient doesn’t move (paralyzing medications are used), the nose does not

have to be as thoroughly numbed as in the TIVA technique. There is more

likely to be bleeding, and gauze packing is frequently used in the nose

and throat. When blood is swallowed patients are also more likely to wake

up nauseated. Before patients wake up, they are often given medications to

reverse the paralyzing drugs. These medications and intravenous opioid

narcotics, and inhaled gases and contribute to a significant incidence of

post operative nausea and vomiting. Even in experienced and gentle hands,

many patients complain of sore throat, and less frequently, hoarseness and

vocal irritation.

TIVA and local anesthesia for rhinoplasty require the Anesthesiologist and

the surgeon to work together as a team. The Anesthesiologist needs to

monitor the patient closely, both visually and electronically. The surgeon

needs to thoroughly and carefully numb the nose with the appropriate

propofol dose adjusted constantly by the Anesthesiologist. Once the nose

is completely numbed, a few minutes are required for the anesthetic and

vasoconstrictor (epinephrine) effect to fully work. At this point the

rhinoplasty can proceed with total sedation and minimal medication until

the surgery is completed.