Otoplasty Anesthesia

Anesthesia for Otoplasty

When considering otoplasty, most patients have anesthesia related questions and concerns. Anesthesia options and techniques enjoyed a great deal of development over the last 15 years but it still carries risks. And because almost all chief complications with facial plastic surgery in general are in one way or the other related to anesthesia, it is important to discuss this before otoplasty surgery. Luckily, the ear is relatively easy to anesthetize with local anesthesia. Once the ear is numbed up, no more pain should be felt. Having said that, otoplasty can be performed in the plastic surgeon’s office, a surgical center or in a hospital. Usually, the place where cosmetic ear surgery is performed will also determine the anesthesia preferences.

We discuss anesthesia options as they apply to otoplasty with special attention to pros and cons. We will also outline rough comparisons of prices for anesthesia and facility. Although cost-effective medical care is important, finances should probably take a back seat when deciding on your ear reshaping procedure.

Local Anesthesia with Sedative

Local anesthesia with a sedative is our preferred method for all adult patients. Teenagers do routinely very well with this technique as well. Unfortunately, the very young (4 to 6 years of age) are not good candidates due to the lack of reliable compliance in this age group. Patients compare otoplasty under sedative local anesthesia as a trip to the dentist with “mind altering drugs” on board. The plastic surgeon can effectively anesthetize the auricles (outer ears) with a mixture of lidocaine and epinephrine (adrenalin). Lidocaine serves as the anesthetic and lasts about 90 minutes or so within the ears. Epinephrine is an important additive as it prolongs the effect of lidocaine and leads to constriction of the blood vessels allowing a virtually bloodless procedure. Some people describe “heart racing” and agitation with these medications (often at the dentist office).

These reactions are absolutely normal and expected but can be more profound in some patients. Even these extra-sensitive patients do routinely very well: the sedative decreases the anxious response to a point where it is barely or not at all noticeable. After the ears have been numbed up, otoplasty is performed without further pain to the patient. Vital signs (heart rate, blood pressure, blood oxygen levels) should still be monitored during the ear pinning procedure as a routine precautionary measure. Although most patients find themselves nodding off for parts of the procedure, some may sleep through everything. Not all plastic surgeons recommend otoplasty under local anesthesia with sedation but prefer performing the surgery under general anesthesia.

Location: Surgeon’s procedure room, free-standing surgical center.

Advantages: Minimum of medications; nausea / vomiting is extremely rare; anesthesia-related recovery close to nil; minimal blood loss; decreased surgical time.

Disadvantages: Surgeon needs to be comfortable with this technique; Patient will feel local anesthesia injections.

Price: $; facility charges only.

IV Sedation (Twilight Anesthesia; Conscious Sedation)

In twilight anesthesia, all the medications are administered directly into the blood stream via the IV. But in contrast to general anesthesia, the patient is breathing by themselves without the help of a ventilator or breathing tube. Routinely, the patient is not aware of the procedure and experiences no pain. The anesthesiologist uses short-acting medications making quick and effective adjustments in the level of sedation possible. For instance, for injections, a more medications are administered. Once the procedure is completed, the anesthetist stops the IV sedatives and the patient regains consciousness very quickly. IV sedation anesthesia is a popular choice in modern day facial plastic surgery.

Location: Accredited surgical suites in doctor offices; free-standing surgical center, hospitals.

Advantages: No intubation; nausea / vomiting is rare; short wake-up period.

Disadvantages: Requires experienced anesthesiologist.

Price: $$$; facility and anesthesia charges apply.

General Anesthesia

Most anesthetics used for general anesthesia are gases with are administered by the anesthesiologist through the airway tube. The patient is routinely asleep and not aware of any surroundings. The endotracheal tube is placed in the patient’s windpipe and connected to a breathing machine. The anesthesiologist uses vital sign data to determine, how much medication gases and fluids are necessary to be both, safe and effective. Because this appears to be the most intrusive form of anesthesia, many patients and cosmetic surgeons try to avoid general anesthesia. The plastic surgeon’s beliefs, practice, teaching and experience with otoplasty surgery determine his or her anesthesia choice.

Location: Office-based surgical centers accredited for general anesthesia; free-standing surgical centers; hospitals.

Advantages: No recollection of pain or the procedure; complete control by anesthesiologist.

Disadvantages: most invasive anesthesia technique with most stress on cardio-vascular system; nausea / vomiting are more common; increase bleeding possible; sometimes long hang-over effect; longer procedure time.

Price: $$$; facility and anesthesia charges apply.

Best Anesthesia Choice for Otoplasty

The preferred anesthesia option is the one that the patient and the plastic surgeons feel most comfortable with. We encourage all patients to have an honest discussion about anesthesia which should include the doctor’s practice with each mode and his/her preferences. Although there is not a true “best”, there is usually a preferred anesthesia technique considering all factors. Only a thorough understanding of anesthesia-related advantages and disadvantages can help the patient making a truly informed decision.

Are you ready to book your consultation?
Call 888-575-6673