If you’ve ever had a colonoscopy or a wisdom tooth removal, you may have had Monitored Anesthesia Care (MAC). MAC is a common type of sedation used in uncomplicated procedures. It is used often for outpatient procedures such as colonoscopy, vasectomy, tending to wounds, cataract removal, dental work and biopsies. “In other words, short, uncomplicated procedures are great candidates for using monitored anesthesia care,” notes Anesthesiologist Brad Stahlheber, DO. According to the US National Library of Medicine, the three main functions of MAC are: safe sedation, patient anxiety control and pain control.
Depending on the procedure, many times a local anesthetic is used in conjunction with MAC for optimal patient comfort. The purpose of this type of sedation is to keep the patient calm and pain-free during their procedure. Some patients can be a little apprehensive about a procedure even though they may not feel pain because of the local anesthetic, so monitored anesthesia care is to help the patient relax and yet still be responsive. Dr. Brad Stahlheber advises this sedation technique is not long-lasting and wears off quickly, keeping the recovery time as short as possible.
Why Monitored Anesthesia Care instead of General Anesthesia?
Monitored anesthesia care has also been referred to as conscious sedation or twilight sleep, inferring a very light sleepiness and moderate alertness. An experienced anesthesiologist such as Dr. Stahlheber has performed MAC on many patients because it is a very common and well-tolerated type of sedation. Keeping a patient comfortable and calm is an important aspect when carrying out surgical procedures, so MAC is a great choice for simple procedures.
General anesthesia refers to sedation where the patient is completely unconscious and is intubated with an endotracheal (breathing) tube. MAC is a lighter form of sedation, requiring less drugs and is considered “safer”, since it has less cardiovascular and respiratory effects. Dr. Stahlheber is able to perform both and would typically see a patient administered general anesthesia for long or complicated procedures. For tending a small fracture or wound care, Brad Stahlheber would administer MAC.
Preoperative Assessment as explained by Dr. Brad Stahlheber
Anesthesiologist Brad Stahlheber would administer MAC on a patient only after a preoperative evaluation. The purpose of this evaluation is to assess preoperative health. It is important to determine the patient’s cardiovascular and respiratory status as well as drug history and general physical status. Communication between the anesthesia team and patient is an important factor for monitoring sedation levels during the procedure. It can also help patient comfortability if they feel verbal assurance from the MAC provider, which is an important factor in carrying out the surgical procedure efficiently, resulting in less sedation time.
How is Monitored Anesthesia Care Administered?
MAC can be given to a patient through an intravenous line in a vein in a hand or arm. Drugs that provide comfort (and many times amnesia) could include benzodiazepines, propofol, dexmedetomidine and clonidine. These drugs are what create the immediate sleepy, foggy feeling. In addition, an analgesic (pain blocker) is administered either locally or in the IV. Analgesic drugs can include fentanyl, ketamine, non-steroidal and anti-inflammatory drugs (NSAIDs).