The great thing about this website is that a prospective patient can ask a question and receive educated opinions. My opinion is that local anesthesia with sedation provides the best compromise of pain control, relaxation, and safety while allowing the surgeon to work efficiently. I use this technique for most cases (using a CRNA or Anesthesiologist), with the exception of rhinoplasty, where general anesthesia is employed. Can general anesthesia be performed safely? Absolutely. However, the downsides are as follows:
1) Intubation (placing an airway past the larynx into the trachea). The body will try intensely to protect the airway; placing a tube past this point causes a great deal of stimulation, and potential stress on the heart.
2) Pooling of blood in the legs or vasodilation. General anesthesia causes profound vasodilation, especially during induction, which increases risk of deep venous thrombosis (DVT), and possibly pulmonary embolus. It is the standard of care for use of compression hose and/or sequential compression devices to minimize risk of DVT during general anesthesia. All patients undergoing local anesthesia with sedation or general anesthesia in my facility have both devices placed prior to induction of anesthesia.
3) Drug hangover. Inhalational anesthetics are stored in body fat and there can be some drug after effect for several days. An exception to this is Sevoflurane, which has a relatively short half life. Inhalational anesthetics have a relatively higher incidence of postoperative nausea, which impedes recovery.
In summary, it is best to follow a path that you and your surgeon are most comfoprtable with. For the majority of my cases, local anesthesia with sedation is employed. However, there are circumstances (abdominoplasty, rhinoplasty, etc) where general anesthesia is more ideal for patient comfort and airway control.
