Rhinoplasty with intravenous and local anesthesia.

Procedural sedation for a rhinoplasty, like any procedure, relies on careful patient selection and patient and surgeon compliance. Patients should have an American Society of Anesthesia (ASA) score of 1 or 2, with a possibly well-controlled 3 also acceptable, and should be devoid of certain comorbidities, including obstructive sleep apnea, gastroesophageal reflux disease, and obesity (body mass index ≥35). Before the procedure begins, clinicians must explicitly communicate to patients that they will feel no pain; however, because they are being sedated, they may know what is occurring during surgery, but they should not care. A common misconception about sedation is that it involves general anesthesia without an airway. Clinicians must reassure patients that the anesthetist will be with them the entire time, and any discomfort can be dealt with immediately and the anesthesia titrated to an acceptable level.