On the oral boards, you would have to have a discussion with the surgeon regarding risks/benefits of waiting. They want you to function like a consultant, so these discussions are important. After that and he tells you about neurovascular compromise, you would want a protected airway, so go with GA IMHO. An ISB will fail on the boards, and with sedation the patient will go apneic and aspirate. I take these things in April, so I hope that line of thinking will fly.
In the real world, I would do what military would do. Why induce, paralyze, and intubate for a 3 minute case? A lot of times these orthopods ask for paralysis, but they don't know the difference if the patient is really paralyzed or not, they just want the patient to not move. Ketamine/propofol/fentanyl/midaz cocktail, some jaw lift, O2 mask, everyone is happy.
