Question about wisdom tooth removal

So I’m 24 years old, I had 4 wisdom teeth that came in that were never removed and 2 of them where causing me problems so I went to the dentist. Of course they suggested I have all 4 removed, but I had some reservations because of some other health problems I was dealing with related to blood pressure, tachycardia, and some other things. My concern was with being under general anesthesia and so I opted to have the top 2 taken out with just numbing (which went perfectly fine). About 1 1/2 months after this though, one of my bottom teeth is starting to have a noticeable amount of pain (about my luck to have this happen immediately after the other 2 where removed). My problem with the bottom 2 teeth is that they are partially impacted and will have to be surgically cut out. Do I absolutely have to be under general anesthesia for this? Do I have safer options if I have potential health problems that could cause problems? If I can do just numbing without a significant amount of pain, then I would be fine with doing that, but I’m not sure how much different this would be than just having teeth pulled out. Has anyone had experience with just using numbing or know if this is even a possibility with surgical removal? Any feedback is appreciated.