What Are the Three Options for Anesthesia During Septoplasty?

I have performed over 1500 septoplasty procedures (most in combination with cosmetic rhinoplasties).  Almost all of these were performed under twilight (deep IV sedation) without any difficulty what so ever.  If performed by an experienced surgeon, there is very little bleeding associated with a septoplasty.  In addition, if the patient is positioned correctly, almost all bleeding will pool behind the nose in the highest part of the throat and never gets anywhere near the larynx or trachea.  This blood can easily be suctioned away from this area through the nose. Of course, general anesthesia is a completely acceptable option but absolutely not necessary.  I would not recommend having a septoplasty performed under local anesthesia for obvious comfort reasons, but it is possible to do it this way as well.

The 3 options are local anesthesia, twilight anesthesia, and general anesthesia.  We only recommend general anesthesia for this procedure.  It is important to have a protected airway during surgery so that patients do not swallow and aspirate blood, which can cause pneumonitis.  In addition, any blood swallowed during the procedure will cause significant nausea and vomiting after the surgery.  Unlike local and twilight anesthesia, another benefit of general anesthesia is that patients will not have conscious awareness when their nose is being broke.  

I have found that while many patients initially ask for local or twilight anesthesia for these procedures that as they get closer to the event they prefer to be completely asleep under general anesthesia. As long as your surgery is being done in an accredited facility with MD anesthesia supervising you are safe with any choice.

Most surgeons use general anesthesia for septoplasty because of the possibility of unexpected conditions which may prolong the procedure or need more invasive manuevers.

IMHO there is really only one best option for your safety which should be the number one priority and that's a protected airway using an ET tube or LMA which requires a general anesthetic.  This also eliminates the risk of blood aspiration during the Septoplasty.  While the Septoplasty could be performed using IV sedation, that does not employ the airway protection mentioned above, this is far less safe and as such should not be considered in this day and age IMO.

Because of the propensity for the septum to bleed down the back of the throat, I would personally recommend that you have the airway protected by a general anesthesia.  Just my opinion, but a septoplasty is not the easiest thing to do and I don't think you'd be very happy awake during it or even under just a twilight.  Mine was done by Dr. Gunter in Dallas under GA and the result was perfect and the experience was easy.