Suprazygomatic Maxillary Nerve Block with Intravenous Dexmedetomidine Sedation for Endoscopic Septoplasty in a Patient with Coronary Artery Disease and Left Ventricular Systolic Dysfunction: A Case Report

Endoscopic nasal procedures are traditionally performed under general anaesthesia (GA), which may increase the risk of perioperative major adverse cardiac events in patients with underlying cardiac disease. We report the successful use of ultrasound-guided supra-zygomatic maxillary nerve block (SZMNB) combined with intravenous dexmedetomidine sedation as the sole anaesthetic technique in a 38-year-old male with moderate left ventricular systolic dysfunction undergoing endoscopic septoplasty. Supplemental buccal oxygenation via a size 4 oral RAE tube ensured optimal oxygen delivery without obstructing the surgical field. The patient remained comfortable and hemodynamically stable throughout, with no requirement for airway instrumentation or postoperative opioids. This case demonstrates that SZMNB with dexmedetomidine sedation can serve as a safe and effective alternative to GA in selected high-risk cardiac patients undergoing nasal endoscopic surgery, ensuring perioperative cardiopulmonary stability and enhancing recovery.