The bispectral index (BIS) is effective to measure the depth of consciousness during MAC. Assessment of the depth of sedation is of great importance as it helps in titrating drug administration to prevent awareness or excessive anesthetic depth and thereby promotes patient safety and early recovery. Sedation is a continuum, which ranges from minimal (anxiolysis), to moderate (also called conscious sedation, where the patient remain asleep but is easily arousable), to deep sedation (where the patient can be aroused only by painful stimuli). Capnography is an essential monitoring component of MAC to detect apnea at an earliest opportunity. Monitoring comprises of continuous communication with the patient, observation of parameters such as oxygenation, ventilation, circulation, temperature, as well as vigilance for local anesthesia toxicity. MAC includes support of vital functions, management of possible intraoperative problems, and provision of psychological support. An obvious difference exists between MAC and moderate sedation. The standard of care is essentially the same as that for general or regional anesthesia, and includes a proper preanesthetic checkup, standard intraoperative monitoring, and routine postoperative care. Hence, MAC is essentially an anesthesiologist led service.
Presently, MAC is the first choice in 10-30% of all surgical procedures.Ī provider of MAC has to be qualified and skilled to rescue an airway or convert to general anesthesia if the situation demands. MAC is suitable for day care procedures as it helps in fast tracking. This service (MAC) results in less physiologic disturbance and a more rapid recovery than general anesthesia. MAC essentially comprises of three basic components: A safe conscious sedation, measures to allay patient's anxiety, and effective pain control.
MAC alone or with local anesthesia accounts for a relatively high percentage of anesthesia services nationwide. Monitored anesthesia care (MAC) has been described as a specific anesthesia service for diagnostic or therapeutic procedures performed under local anesthesia along with sedation and analgesia, titrated to a level that preserves spontaneous breathing and airway reflexes, according to the latest American Society of Anesthesiologists (ASA) update in 2008.
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