Hi every one, in our hospital Rhinoplasty cases anesthetized with general anesthesia &intubation & awake ext. anesthesia always done with pofol inf. And midazolam+ fentanyl premedication. Recently, I use another method in some cases:
I give 1mg midazolam +Remifentanil infusion; start with 0.1mg/kg/min,and titrate until patient sedation, and in 5-10 min, allow surgeon to check the patient and start the surgery.During surgery we ask the patient to swallow secretions, and when needed surgeon suction the nasopharynx.
We use supportive oxygen via a nelaton sond that lye between patient teeth and we establish additional holes on it's surface.
This method need to good surgeon and good patient.
Complications and worries:
Hypoxemia closed monitoring and oxygen supplying is mandatory.
Aspiration: probable, but blood aspiration is benign in nature.
I'm not advising you to perform this method,
But if you have any experience about it, please explain our.
I emphasize: in this method we need doses of Remifentanil that higher than safe dose for spontaneous breathing, and may be isn't a safe method!
Why, oh why, oh why?
You seem to have listed all the disadvantages yourself, with no advantages.
Why not just do a simple, safe, well-established technique called general anaesthesia????
Where is the advantage?
thanks 4 ur notes and ideas,yes i agree with u.But in our hospital a surgeon himself want this method and encourage it for some patient that afraid of G. anesthesia,and i agree with u,and for this reason i wrote all dissadvantages and emphasized that i dont offer to you.
I want only understand that in other centers anyone do it ?
and thank again for u.
0.1mg/kg/min of remifentanil is not the higher doses, it will not suppress respiration.