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The majority of septoplasties and rhinoplasties are performed on healthy patients in the outpatient setting; however, occasionally patients present with medical comorbidities or obstructive sleep apnea (OSA). These surgeries can be performed with local anesthesia and sedation or general anesthesia with an LMA or endotracheal tube. The indication for surgery may be purely cosmetic, post trauma, reconstructive after tumor resection or to improve nasal breathing. Many nasal procedures can successfully be performed under local anesthesia with sedation. Operative and recovery times have been shown to be shorter for patients undergoing surgery with local anesthesia with sedation compared with general anesthesia. Bleeding is one of the biggest complications of nasal surgery. Minimization of intraoperative blood loss allows the surgeon to have an operative field which he can visualize well. The main intraoperative concern includes the minimization of bleeding with use of vasoconstrictors and submucosal epinephrine, controlled hypotension and a smooth emergence.