Anesthesia Recovery After Rhinoplasty Operation

What Is Waiting For You During The Wake up Period After General Anesthesia?

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We usually perform rhinoplasty operations under general anesthesia and I would like to share the following details with you about waking up the patients after the procedure. As I said before, I would like to emphasize the importance of anesthesia and sterilization conditions, except that the hospital conditions are only a luxury room or a waiting room with famous paintings.

General anesthesia features and considerations during rhinoplasty operation

During the rhinoplasty operation, when the patients are completely asleep and the operation begins, many surgeons want the blood pressure to be kept as low as possible. The reason for this is to reduce blood leakage as much as possible during the operations on the nasal bone, to reduce edema in the nose and around the face, and to reduce surgical bleeding. Sometimes it may be desirable to additionally reduce carbon dioxide levels. Again, during rhinoplasty operation, additional cortisone cocktails may be used during bone cutting or bone breaking procedures, and sometimes various drugs that stop bleeding may need to be used. It is ideal for patients to wake up slowly at the end of the procedure, keeping the recovery period from general anesthesia as long and slow as possible.

Slowly wake from general anesthesia is better 

During the rhinoplasty operation, when the nasal bone is cut, it is not easy to stop the blood leaking from the incision areas. When patients wake up quickly, severe and sudden increases in blood pressure, nose bleeding, bruising and swelling due to blood leakage on the face and around the nose may be seen. Therefore, a "non-rapid" awakening under the control of an experienced anesthesiologist is ideal.

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After the rhinoplasty operation, you may wake up with the taste and smell of medicine or with a blocked nose

During rhinoplasty operations, nasal packings with various features are placed in the nose (I usually use internal nasal silicone splints), bleeding in the form of leakage in different amounts due to the surgical procedure in the nose, temporary congestion in the nose, explaining this situation to the patients before the surgery, patients sometimes It is important for reducing stress when they have to do mouth breathing. Generally, during the recovery period from general anesthesia, most of the excretion of the anesthetic gases given by the current airway from the body is through the lungs. For this reason, it is normal to have a foul-smelling drug smell to the nose and a different taste in the mouth during awakening from anesthesia. Silicone splints placed in the nose after the procedure are usually covered with antibiotic pomade. Sometimes we also wash the inside of the nose with sterile serum containing rifampicin. Patients can feel the taste of both the ointment and the antibiotic serum when they wake up. In other words, it is possible to wake up with a stuffy nose, a different chemical taste and a different smell of medicine after rhinoplasty. 

Negative things you may feel in the waking period right after the rhinoplasty operation

After the rhinoplasty operation, you may notice the following negative effects during the recovery period from general anesthesia, but you will usually get better in a few hours, don't worry.

- A feeling of congestion due to clots in the nose

- Nasal drip and blood sensation in the mouth

- Affected taste and odor due to anesthetic drugs

- Dizziness, feeling of deep sleep

- Sore throat and pain when swallowing, evident for a few hours due to the pressure of the intubation tube in the throat

- After general anesthesia, it is usually waited for 4 hours after the operation to start eating and drinking water by mouth again. During this period, some patients describe a feeling of dryness and thirst in the mouth. Don't worry, as sufficient amount of fluid is given intravenously during the operation, your body's risk of dehydration is very low. In this process, it may be recommended that patients touch their lips with a wet cloth or gargle with a small amount of water. Do not forget that those who are patient for a few hours and the swallowing reflex during the first 4 hours are at risk of aspiration due to the inability of the mouth and esophagus muscles to work adequately.

- After the rhinoplasty operation, pain relief cocktails are usually given while the general anesthesia is terminated. Therefore, the pain felt immediately after the procedure is almost non-existent.

- During the rhinoplasty operation, as in all surgical procedures, the operating room rooms are cold and patients may feel cold and cold immediately after the procedure, as the patient sleeps for 2-3 hours without movement. Again, cold serum and ice are applied on the nose during the procedure, so patients may experience chills and shivering after the operation is over. In order to prevent this situation, it is beneficial to place a special heater under the feet of the patients and to use digital operating beds with automatic back heaters in new, modern hospitals.

- After the rhinoplasty operation, involuntary tremors may be seen in the patients during the first few hours when the muscle relaxants and other drugs used during general anesthesia are destroyed (metabolized) from the body. This situation is not only caused by patients feeling cold, but can be seen during the recovery period from general anesthesia. Sometimes, relatives of patients may mistakenly see this trembling movement after the patient has taken the normal room and try to increase the room temperature. After the rhinoplasty operation, patient rooms should be kept as cool as possible, patients should sleep close to 45 degrees and ice / cold application should be applied to the face area immediately after the procedure. Please do not heat the room because patients have chills without asking your doctor!

After only 4 hours, many of the situations I wrote above disappear. In general, after the rhinoplasty operation, I want my patients to wake up gradually and stay in the resting room, which is the other part of the operating room, for about 1 hour. Unfortunately, in small and underutilized hospitals, these wake-up periods can have to be much faster. There may not be an additional section in the operating room where patients can stay for a long time. In this case, the negative effects I listed above can be seen much more clearly.

Why Can I Feel Nausea Immediately After Rhinoplasty Operation?

During the rhinoplasty operation, some of the drugs and gases given under general anesthesia leave the body by being expelled from the lungs immediately after the patient wakes up. For this reason, patients may continue to feel the smell of anesthetic drugs and taste changes from their mouths. Apart from these, nausea in the first few hours after the rhinoplasty operation can be observed for different reasons such as washing the inside of the nose with sterile serums containing antibiotics, covering the silicone splints placed in the nose with antibiotic ointments, and the flow of these pomades into the melt down the nasal cavity, the patient swallowing a small amount of blood and blood leaking into the stomach. it is natural. Some patients may vomit, and patients feel relief immediately after vomiting.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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