Awake Rhinoplasty with Tumescent Local Anesthesia

[Sleeplessbordernights]

Anyone here has any experience with that? I rather throw a tube and be done with it but some a surgeon I work with swear by this

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[UscGhost]

If you inject enough local I'm sure it would work, if the surgeon is skilled.

Just be careful about over sedation and aspiration

 

[Sleeplessbordernights]

If you inject enough local I'm sure it would work, if the surgeon is skilled.

Just be careful about over sedation and aspiration

That’s precisely why Im kinda worried, Im thinking maybe just versed plus fent, or ketamine + precedex

 

[deleted875186]

where is all this tumescent anesthesia going in the nose. Seems concerning to me.

 

[thinkorswim]

This is why I hate surgery centers. You get all kinds of shady surgeons doing stupid things in a broom closet behind their office. No thanks.

 

[Mehd School]

I'm pretty open to things but this seems pretty dumb to me. I'm open to someone changing my mind. But it's going to challenging to oxygenate and/or assess the depth of sedation on a patient who has part or most of their face draped. I would anticipate it would require a decent amount of sedation depending on the procedure, especially if they're breaking septum.

 

[TheLoneWolf]

Uhhh...what patients do you have that would sign up for this voluntarily...young healthy females are my most anxious patients.



Our surgeons wants spontaneously ventilating slabs of meat for even colonoscopies.

 

[coffeebythelake]

Heard plenty of stories about sketchy plastic surgeons doing conscious sedation with screaming patients but remember nothing afterwards because they were essentially roofied with mega doses of versed and fentanyl while being face-raped (or whatever other body part) by the surgeon.

 

[amyl]

Why? Is anesthesia really that expensive

But then people go to Mexico for bypass surgery and South America for plastics all to save a buck.

 

[nimbus]

If it’s “awake”, why even be there? I would just go home.

 

[2Fast2Des]

Anyone here has any experience with that? I rather throw a tube and be done with it but some a surgeon I work with swear by this

There is literally nothing to be gained from this. Nose stuff can bleed, and then get a pt in spasm you want to deal with while a completely covered face with no airway access, hard PASS.

 

[Sleeplessbordernights]

I was in one today, it’s awful, and yes it’s a high volume surgery center, a friend anesthesiologist asked to cover for him, it pays extremely well but it’s not worth it, I’m not returning there

 

[Onefellswoop87]

That’s precisely why Im kinda worried, Im thinking maybe just versed plus fent, or ketamine + precedex

Where is all the tumescent anesthetic fluid going? I’m sure even an Ortho bro knows the nose bones are connected to lung bones, so surely an ENT would too. What do you do when they obstruct? Nose is occupied with surgical equipment and tumescent fluid so no NPA. Put in an OPA with the head turned away from you since you tipped them into no-gag reflex after fentanyl and versed or ketamine? Get your primadonna surgeon who dictates your plan to move while you do a jaw thrust and turn off sedation?

You’re asking for aspiration on a near room air general anesthetic.

Put a tube in.

 

[POW16]

Either they're awake and I'm not involved or I'm putting a tube in. The end.

 

[Beeftenderloin]

I had a former co-resident that was a practicing anesthesiologist in their home country before re-training in the US. They were doing “awake” off-pump CABGs with a high thoracic epidural.

This seems kinda like that…