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LOCAL ANAESTHESIA

Rhinoplastic surgeons have a duty to dispel the horror stories that have become associated with nasal surgery and general anaesthesia. We were urged to apply and develop the technique of local anaesthesia with sedation, in order to reduce the patient's fear caused by general anaesthesia and to provide a more safe, comfortable and convenient procedure. The application of local anaesthesia with sedation has resulted in shorter hospitalization, shorter total operative time, shorter recovery and quicker turnover of cases, less frequent nausea and vomiting, less operative and intraoperative bleeding and it is more appropriate for patients with asthma, diabetes and hypertension. Local anaesthesia is not recommended for patients under the age of sixteen or the worried and irritable type of patients. The author currently applies local anaesthesia in over 80% of his cases.

Technique of local anaesthesia with sedation:
The local anaesthesia procedure must have been fully explained to the patient at his consultation visit. Patient selection is important, the patient should be cooperative, understanding and willing for local anaesthesia. Many patients, unfortunately, are horrified about anaesthesia. For this reason, the author's approach to local anaesthesia is based on his own experience and that of others, which is designed to provide a more safe and acceptable procedure. The patient is adequately sedated and has amnesia to much of the operating room experience, but usually is aroused easily by talking to him and alert on returning to the ward. This approach allows early mobilization and the patient is discharged home on the same day. The sedation is administered in a planned and progressive manner, premedication is given on admission one hour before surgery, then in the operating room the intravenous sedation is administered under the supervision of a trained Anaesthesiologist. Once the patient has reached his state of sedation, topical and injectable anaesthetics are delivered to the areas to be operated. (Figs. 3 -1,2,3)

  1. Preoperative medication: one hour before surgery while patient is still in his room.
    - Diazepam 5mg : oral or i.m.
    - Zofran 4mg (Ondansetron) : oral
    - Decadron 8mg (Dexametason) : Intravenous
    - Zinacef 1.5mg (Cefuroxim) : Intravenous
    - Iliadine (Oxymetazoline hydrochloride) nostril : 3 drops each
    - Emla cream (Lidocaine, Prilocaine) : on the nose and vestibular skin

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