What is monitored anesthesia care

Targeting the effect-site concentration rather than blood concentration provides faster onset and better predictability of drug effect. Drug titratability can be achieved with the use of a wide variety of drug delivery techniques including intermittent boluses, target-controlled infusion, variable-rate infusion, and patient-controlled sedation PCS. The patient-maintained sedation PMS is found to be more effective than PCS in terms of patient satisfaction and minimizing side effect.

Low-dose ketamine provides weak sedation but excellent analgesia. It has a positive effect on hemodynamic stability and can counteract the propofol-induced respiratory depression.

Emergence delirium is usually not reported at lower doses. It causes a higher incidence of PONV and the offset is prolonged with higher dosage. Combining midazolam or propofol with ketamine reduces PONV, but increases the respiratory adverse events.

Fortunately, most of the adverse events are self-limiting or easily controlled, indicating reasonable level of safety. Moreover, propofol reduces the chance of PONV, but it does not reliably produce amnesia in lower doses. Midazolam has a short elimination half-time and produces adequate amnesia. However it causes prolonged psychomotor impairment when used alone.

The midazolam-opioid combination displays synergism not only in providing hypnosis but also to produce severe respiratory as well as cardiac depression. A study evaluating the respiratory effects of midazolam 0. The recovery of patients who were administered propofol was better and faster.

The safety profile was same in either of the techniques. Dexmedetomidine, a novel alpha-2 adrenergic receptor agonist, provides adequate sedation and analgesia with minimal respiratory depression. It acts primarily on the sleep pathway and does not inhibit the activity of the orexinergic neurons, which is the basis of its arousable sedation.

The hypnotic sedative effects of dexmedetomidine can be easily reversed with alpha-2 adrenergic receptor antagonist atipamezole which may help to produce a titratable form of sedation. Parikh DA and colleagues studied the effect of the newer drug dexmedetomidine against the tradional midazolam-fentanyl combination for providing adequate sedation and analgesia in tympanoplasty operation under MAC.

They found a higher patient and surgeon satisfaction with dexmedetomidine indicating a qualitatively better sedation profile but there were significant falls in heart rate and blood pressure warranting close monitoring.

The recovery pattern for both the drugs was not observed in this study. Dexmedetomidine showed no significant advantage over midazolam-fentany in terms of respiratory depression, there being no incidence of bradypnea in either of the groups. A multicentric trial on patients undergoing a broad range of surgical or diagnostic procedures under MAC revealed that dexmedetomidine provides greater patient satisfaction, less opioid requirements, and less respiratory depression than placebo rescue with midazolam and fentanyl.

Dexmedetomidine with fentanyl has been used safely and effectively for sedation and analgesia during extracorporeal shockwave lithotripsy. There is further scope of research to evaluate the minimal necessary dose requirement in different age groups, sex, and races. Contrary to the popular belief, intravenous sedatives may actually increase the pain perception during procedural sedation.

There is a growing attention worldwide on health reforms and allocation of limited healthcare resources in all aspects of medical practice. MAC is no exception to that.

This includes checking your breathing, blood pressure, and heart rate. This may help you avoid problems from anesthesia. Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take. Author: Healthwise Staff. Medical Review: E. Freedman MD - Anesthesiology. Care instructions adapted under license by your healthcare professional.

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What happens before surgery? What are the risks of anesthesia? What can you expect after having MAC? Where can you learn more? Top of the page. What is monitored anesthesia care? You may get: A sedative or anxiety medicine to help you relax. Pain medicine. It can prevent pain during the surgery. Right after the surgery, you will be in the recovery room. Nurses will make sure you are safe and comfortable.

You may feel some of the effects of sedation with MAC for several hours. Last but not least, another purpose of any MAC is to get the patient appropriately satisfied, allowing him to get his discharge as faster as possible.

There are many surgical procedures which can be performed using a MAC. The patient consciousness evaluation is of extreme importance during the surgical procedure performed with MAC: to this purpose the clinical and electroencephalographic evaluations such as Bispectral Index are very useful.