From the Guidelines
Monitored anesthesia care (MAC) is a type of anesthesia service where an anesthesia provider closely monitors a patient during a procedure while administering sedatives and analgesics as needed, as defined by the most recent guidelines 1.
Definition and Purpose of MAC
MAC is typically used for less invasive procedures where general anesthesia isn't necessary. According to the guidelines, MAC results in deep sedation, and the normal airway protective reflexes may be lost 1.
Key Considerations for MAC
Key considerations for MAC include:
- Careful patient selection (avoid in patients with severe comorbidities or difficult airways)
- Thorough pre-procedure assessment
- Availability of equipment for airway management and conversion to general anesthesia if needed
- Clear communication with the surgical team about the level of sedation required
Monitoring and Equipment
The anesthesia provider continuously monitors vital signs, oxygenation, and depth of sedation, adjusting medications as needed, with a focus on maintaining patient safety and comfort 1.
Ideal Procedures for MAC
MAC is ideal for procedures like endoscopies, minor surgeries, or interventional radiology procedures, allowing for a rapid recovery and fewer side effects compared to general anesthesia 1.
Patient Response and Airway Management
The patient remains responsive to verbal commands, maintaining their own airway and spontaneous breathing, although deep sedation may result in loss of responsiveness 1.
Importance of Anesthesia Provider Presence
The continuous presence of an appropriately trained and suitably experienced anaesthetist is crucial for patient safety during MAC, ensuring that the patient receives the necessary care and attention throughout the procedure 1.
From the FDA Drug Label
Monitored Anesthesia Care (MAC) Sedation Adult Patients When propofol injectable emulsion is administered for MAC sedation, rates of administration should be individualized and titrated to clinical response In most patients, the rates of propofol injectable emulsion administration will be in the range of 25 mcg/kg/min to 75 mcg/kg/min.
Monitored Anesthesia Care (MAC) is a type of sedation where the rates of administration of propofol injectable emulsion are individualized and titrated to clinical response, typically in the range of 25 mcg/kg/min to 75 mcg/kg/min 2.
From the Research
Definition of Monitored Anesthesia Care (MAC)
- Monitored anesthesia care (MAC) is an anesthesia technique that combines local anesthesia with parenteral drugs for sedation and analgesia 3, 4.
- The purpose of MAC is to provide patients with safe sedation, comfort, pain control, and satisfaction 3, 4.
Key Elements of MAC
- MAC involves the use of local anesthesia by operators or anesthesiologists, along with systemic sedatives and analgesics to provide patients with comfort during procedures 3.
- The discretion and judgment of an experienced anesthesiologist are required for the safety and efficacy profiles of MAC, as the airway of the patients is not secured 3.
- Patient cooperation and comprehension of the procedure are essential components during MAC 3.
Procedures Performed with MAC
- Many procedures, including eye surgery, otolaryngologic surgery, cardiovascular procedures, pain procedures, and endoscopy, can be performed with MAC to increase patient and operator satisfaction 3, 5.
- MAC can be used for procedures such as chemoport insertion, tympanoplasty, septoplasty, lip repair, dacrocystectomy, and cataract surgery 6, 7.
Comparison with General Anesthesia
- MAC has been compared to general anesthesia (GA) in terms of efficacy, hemodynamic changes, and post-procedural outcomes, with some studies suggesting that MAC is a safe and effective alternative to GA for certain procedures 5.
- MAC may offer advantages over GA, such as reduced turnover time and faster recovery, although the choice of anesthesia technique ultimately depends on the specific procedure and patient needs 5.