Podiatric surgery is the surgical treatment of the bones, soft tissues, and joints of the foot and its associated structure. In the United States, the number of annual podiatric surgical procedures continues to increase steadily 1. Such procedures can be carried out either by an orthopedic surgeon or by a podiatrist 2,3 and performed either under general anesthesia or conscious sedation. The choice between general anesthesia and sedation for podiatric surgery depends on several factors, including the type and length of the surgery and a patient’s health and personal preferences.
General anesthesia involves administering medications that make the patient entirely unconscious and unable to feel pain. This type of anesthesia is either used if a patient refuses a regional block or for longer, more complex procedures as it allows the surgeon to work without interruption and ensures that the patient remains completely unaware 4.
General anesthesia tends to be associated with a higher risk of complications, such as breathing issues, and requires careful monitoring by an experienced anesthesiologist. Different states have different regulations for podiatry and associated depth of anesthesia, but in general regulations tend to be stricter in requirements for anesthesia when it is general anesthesia being administered. For example, podiatric surgical procedures carried out in an office-based setting in New York allow only authorized licensed physicians with an anesthesiology certification are allowed to administer general anesthesia 3.
Interestingly, some researchers suggest that regional anesthesia should be favored over general anesthesia for podiatric surgical procedures 5. Compared to general anesthesia, regional anesthesia may be linked to a lower rate of morbidity and complications, including stroke, while being one of the most affordable forms of anesthesia 6. Performance of a peripheral nerve block, however, requires proper training, equipment, and support personnel in order to handle potential complications.
Conscious sedation, in contrast, involves administering medications that relax a patient and minimize pain3 without rendering a patient completely unconscious, and is preferred over general anesthesia in some types of podiatric surgery. Conscious sedation results in a minimally depressed level of consciousness whereby a patient can independently and continuously maintain an airway and respond to verbal and physical input. However, a patient may not remember the procedure afterwards.
This type of anesthesia is often used for short procedures. If the procedure does not require anesthesia, sedation can also be optionally used for individuals who would rather remain minimally conscious, such as if they are nervous about the procedure 6. However, conscious sedation may cause nausea and headaches in some patients.
It is essential that appropriate oral and written instructions be delivered to the patient or the patient’s guardian based on a patient’s state and the chosen anesthesia method. Both general anesthesia and conscious sedation present their own suite of unique benefits and risks, and which is more suitable for podiatric surgery depends on a number of factors. A patient’s podiatrist and anesthesiologist will work with the patient to select the best option, ensuring that the choice of technique is well-tailored to the nature of the procedure, patient comorbidities, intensity of anticipated postoperative pain, anesthesiologist skill level, and surgeon preference 7.
References
1. Burton A, Aynardi MC, Aydogan U. Demographic Distribution of Foot and Ankle Surgeries Among Orthopaedic Surgeons and Podiatrists: A 10-Year Database Retrospective Study. Foot Ankle Spec. 2021; DOI: 10.1177/1938640020910951
2. Hoch CP, Scott DJ, Brinton DL, Maldonado L, Gross CE. Increased Complication Rate Associated with Podiatric Surgery. Foot Ankle Orthop. 2022; doi: 10.1177/2473011421S00245
3. NYS Podiatry:Practice Guidelines:Office-Based Surgery and Conscious Sedation [Internet]. [cited 2023 Mar 31]. Available from: https://www.op.nysed.gov/professions/podiatry/professional-practice/office-based-surgery-and-conscious-sedation
4. Anesthesia Protocol for Ankle and Foot Surgery – Ether – Resources for Anesthesia Research and Education – Stanford University School of Medicine [Internet]. [cited 2023 Mar 31]. Available from: https://ether.stanford.edu/policies/AFS.html
5. Reilley TE, Gerhardt MA. Anesthesia for foot and ankle surgery. Clin Podiatr Med Surg. 2002;19(1):125–47. DOI: 10.1016/S0891-8422(03)00084-3
6. What Podiatry Patients Should Know About Anesthesia [Internet]. [cited 2023 Mar 31]. Available from: https://www.advancedfootdocs.com/blog/2016/12/what-podiatry-patients-should-know-about-anesthesia/
7. Sharrow CM, Elmore B. Anesthesia for the Patient Undergoing Foot and Ankle Surgery. Clin Sports Med. 2022 Apr 1;41(2):263–80. DOI: 10.1016/j.csm.2021.11.010