Quick Answer
The majority of sinus surgeries are performed with the patient under general anesthesia, meaning you are put to sleep. However, some less complex procedures may use local anesthesia and intravenous sedation to numb the area without fully putting you under. Your surgeon will determine the best anesthesia option based on the type of sinus surgery you need.
Overview of Sinus Surgery
Sinus surgery is performed to treat chronic sinusitis or sinus infections that do not respond to other treatments. There are a few different types of sinus surgery:
- Functional endoscopic sinus surgery (FESS) – The most common type, involves inserting a small camera into the nose to visualize the sinuses and removing tissue or bone to improve sinus drainage.
- Balloon sinuplasty – Uses a tiny balloon catheter to open up blocked sinus passages without removing tissue.
- Endoscopic frontal sinus surgery – Opens the frontal sinuses located above the eyes.
- Maxillary antrostomy – Creates an opening in the maxillary sinus to promote drainage.
The type of anesthesia used depends on the specific procedure, its complexity, and your surgeon’s recommendation.
Why General Anesthesia is Common
There are several reasons why general anesthesia is the most common approach for sinus surgery:
- Allows the surgery team better access and visibility – Being fully asleep allows the surgeon to insert instruments more easily and maneuver delicate structures.
- Minimizes discomfort – Sinus surgery involves inserting instruments into very sensitive nasal and sinus cavities. General anesthesia prevents pain and discomfort.
- Reduces patient movement – Sinus tissues are very delicate and close to the brain. Patient movement under local anesthesia could risk damage and bleeding.
- Controls bleeding – General anesthesia lowers blood pressure and relaxes nasal tissues, allowing for better surgical control of bleeding.
- Longer, complex procedures – Many sinus procedures like FESS can take 1-3 hours to fully complete. General anesthesia is better suited for longer operations.
For these reasons, the vast majority of sinus surgeries use general anesthesia to maximize safety, surgical access, and patient comfort.
When Local Anesthesia May be Used
While general anesthesia is most common, some less complex sinus procedures may be performed under local anesthesia and IV sedation. These include:
- Minor sinus endoscopy – Quickly examining the sinuses with a scope.
- Simple sinus drainage procedures – Making a small opening to promote drainage.
- Very limited sinus surgery – Removing small polyps or debris.
- Balloon sinuplasty – This procedure is less invasive than FESS surgery.
- In patients at high risk for general anesthesia – Older patients or those with health conditions.
With local anesthesia, the nasal and sinus tissues are numbed with medication but the patient remains awake and breathing on their own. IV sedation is often used as well to help the patient relax.
General anesthesia is still preferred for most sinus procedures when possible. But less invasive surgeries may be successfully performed under local anesthesia in select cases.
What to Expect With General Anesthesia
If your sinus surgery will be performed under general anesthesia, here is an overview of what to expect:
Before Surgery
- You will change into a hospital gown and remove contacts/glasses/dentures.
- An IV line will be placed to administer medications.
- You will be attached to monitors such as a blood pressure cuff, EKG, and pulse oximeter.
- Oxygen will be administered through a mask or nasal cannula.
- You may be given a sedative through the IV to help you relax.
During Surgery
- Anesthesia providers will administer anesthesia medications through your IV.
- Within seconds, you will become unconscious and be completely asleep/unaware during surgery.
- A breathing tube may be inserted after you are asleep to control your breathing.
- Anesthesia providers monitor your vitals and adjust medications to keep you safely asleep.
- At the end of surgery, anesthesia medications are stopped and the breathing tube removed.
After Surgery
- You are transported to the recovery room still groggy from anesthesia.
- Nurses regularly monitor your vital signs as you wake up.
- You may receive oxygen and IV fluids until fully awake.
- Nausea, drowsiness, and throat irritation are common initially.
- Once stable, you are discharged home or admitted if staying overnight.
- You cannot drive or operate machinery for 24 hours after general anesthesia.
While being fully asleep, you experience no pain, awareness, or memory of the procedure. Risks are minimal with modern general anesthesia when administered by qualified anesthesia professionals.
What to Expect With Local Anesthesia
If having your sinus surgery with local anesthesia, here is how it will go:
Before Surgery
- The surgery team prepares the room and monitors.
- You are given a local anesthetic spray or cotton balls for your nose to numb the area.
- An IV is started and sedative medication administered.
- Oxygen nasal cannula placed for your comfort.
During Surgery
- The surgeon injects additional numbing medication in the operative area.
- As the sedative takes effect, you feel relaxed and comfortable.
- You may feel some pressure or touch, but no pain as the surgery proceeds.
- Your surgeon talks with you during surgery and you can respond.
- Vital signs remain stable since you are breathing on your own.
After Surgery
- The sedative medications wear off quickly after surgery.
- You are awake and able to drink fluids and eat light foods shortly after.
- The numbing lasts for several hours before normal sensation returns.
- You can go home once stable and the numbing starts wearing off.
- You may have nasal congestion and tenderness for a few days.
With proper numbing and sedation, local anesthesia can work well for less complex sinus procedures. Your ENT surgeon will discuss the best option for your individual case.
Key Points
- Most sinus surgeries like FESS are performed under general anesthesia to maximize surgical access and patient comfort.
- You are fully asleep and unaware during general anesthesia.
- Less complex sinus procedures may be done under local anesthesia plus IV sedation.
- You remain awake but comfortable during local anesthesia.
- Your ENT surgeon chooses the anesthesia based on the procedure, your health, and their own clinical judgment.
- Talk to your doctor about which type of anesthesia is right for your upcoming sinus operation.
Frequently Asked Questions
Do you always have to be put to sleep for sinus surgery?
No, it is not always necessary to have general anesthesia for sinus surgery. Less complex procedures such as minor endoscopy, balloon sinuplasty, or limited polyp removal may be successfully performed under local anesthesia and IV sedation. However, most ENT surgeons prefer general anesthesia when possible.
Can you be awake for sinus surgery?
Yes, it is possible to have sinus surgery while awake under local anesthesia, commonly with additional IV sedation. You remain conscious but very comfortable. This allows the surgeon to perform less invasive operations without putting you fully under. However, the majority of sinus surgeries are still performed under general anesthesia.
Is sinus surgery painful with local anesthesia?
No, with proper administration of local numbing medication, you should not experience pain during the sinus procedure. You may feel some mild pressure or pushing, but the area is fully anesthetized. IV sedation also helps you relax further and avoid any discomfort. While general anesthesia often provides the highest level of patient comfort, local anesthesia can still make sinus surgery pain-free when done correctly.
What are the risks of general anesthesia?
Major risks are uncommon with modern general anesthesia. Possible risks include:
- Breathing problems
- Blood pressure changes
- Heart arrhythmias
- Nausea and vomiting
- Disorientation and confusion upon waking
Your anesthesia team monitors you closely throughout surgery and takes steps to minimize any risks. Serious complications are very rare when general anesthesia is administered appropriately by trained providers.
What are the advantages of local anesthesia?
Benefits of local anesthesia for sinus procedures include:
- Avoiding risks of general anesthesia
- Quicker recovery time
- Reduced costs from not needing a full operating room
- Patients can provide feedback during surgery
- May be preferred in high-risk patients who should avoid general anesthesia
While general anesthesia is very safe, local anesthesia does avoid those risks entirely. It provides options for certain less invasive sinus surgeries.
Conclusion
Most sinus surgeries like functional endoscopic sinus surgery require general anesthesia where you are fully asleep. However, some less complex procedures may be successfully performed under local anesthesia with IV sedation. This allows you to remain awake but comfortable.
Your ENT surgeon will recommend the best anesthesia choice depending on the exact sinus surgery needed and your health status. There are advantages to both approaches. Understanding the differences in general anesthesia versus local anesthesia allows you to be informed and participate in decisions about your upcoming sinus procedure.
