Demetri Arnaoutakis1, Sheena Samra2, Sim Choroomi2, Andrew Frankel3. 1. Hyde Park Cosmetic Surgery Center, Tampa, FL, United States of America; Lasky Clinic, Beverly Hills, CA, United States of America. 2. Lasky Clinic, Beverly Hills, CA, United States of America. 3. Lasky Clinic, Beverly Hills, CA, United States of America. Electronic address: afrankelmd@laskyclinic.com.
Abstract
IMPORTANCE: While numerous techniques for costal cartilage harvesting have been described, one consistency in the published literature is that the procedure is performed under general anesthesia. This is the first report to offer IV sedation as a safe alternative to general inhalational anesthesia in cases involving costal cartilage harvesting. OBJECTIVE: To determine the feasibility and safety of costal cartilage harvest with IV sedation. DESIGN: A retrospective chart review was performed of 116 rhinoplasty patients who underwent harvest of costal cartilage grafts under IV sedation from 2005 to 2019. SETTING: Private practice of senior author (AF) at Lasky Clinical Surgical Center. PARTICIPANTS: Consecutive patients who underwent cosmetic and/or functional rhinoplasty. MAIN OUTCOME & MEASURES: The number of cases involving a pneumothorax, size of the pleural injury, radiographic findings, repair technique and treatment for pneumothorax were all recorded. RESULTS: There were 7 cases involving a pleural tear (size range 3-8 mm) during costal cartilage harvest and each of these was repaired intra-operatively. All 7 patients remained clinically stable in recovery room on 2 L of oxygen. Although clinically stable, one patient had radiologic evidence of a pneumothorax of 50%, and thus she was transferred to a hospital for placement of a Heimlich tube with overnight observation. CONCLUSIONS AND RELEVANCE: Although plenural tears can be attributed to surgical technique rather than the type of anesthesia, these cases do provide valuable insight to the fact that successful management of such complications can be accomplished without the need for general anesthesia.
IMPORTANCE: While numerous techniques for costal cartilage harvesting have been described, one consistency in the published literature is that the procedure is performed under general anesthesia. This is the first report to offer IV sedation as a safe alternative to general inhalational anesthesia in cases involving costal cartilage harvesting. OBJECTIVE: To determine the feasibility and safety of costal cartilage harvest with IV sedation. DESIGN: A retrospective chart review was performed of 116 rhinoplasty patients who underwent harvest of costal cartilage grafts under IV sedation from 2005 to 2019. SETTING: Private practice of senior author (AF) at Lasky Clinical Surgical Center. PARTICIPANTS: Consecutive patients who underwent cosmetic and/or functional rhinoplasty. MAIN OUTCOME & MEASURES: The number of cases involving a pneumothorax, size of the pleural injury, radiographic findings, repair technique and treatment for pneumothorax were all recorded. RESULTS: There were 7 cases involving a pleural tear (size range 3-8 mm) during costal cartilage harvest and each of these was repaired intra-operatively. All 7 patients remained clinically stable in recovery room on 2 L of oxygen. Although clinically stable, one patient had radiologic evidence of a pneumothorax of 50%, and thus she was transferred to a hospital for placement of a Heimlich tube with overnight observation. CONCLUSIONS AND RELEVANCE: Although plenural tears can be attributed to surgical technique rather than the type of anesthesia, these cases do provide valuable insight to the fact that successful management of such complications can be accomplished without the need for general anesthesia.