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During local and regional anesthesia, it is a common practice to
administer both sedative and analgesic medications to enhance patient
comfort during the operation. Use of local anesthetic infiltration and
peripheral nerve blocks (PNBs) techniques in combination with intravenous
(IV) sedative–hypnotic and analgesic drugs is commonly referred to as
monitored anesthesia care (MAC). In many centers around the world, over
50% of all ambulatory (day-surgery) procedures are performed utilizing
these techniques (Table 11–1).1 When patients
undergo surgical procedures under local anesthesia with IV
sedation—analgesia in the operating room (OR), the old terminology used to
describe the care of these patients as “conscious sedation.” As the term
implies, conscious sedation was a minimally depressed level of consciousness
that retained the patient's ability to maintain an airway independently and
continuously and to respond appropriately to physical stimulation and verbal
commands. The American Society of Anesthesiologists (ASA) avoids this term
in their Practice Guidelines for Sedation and Analgesia by Non-anesthesiologists2 because it is imprecise and instead refers to
this practice of anesthesia as MAC.
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According to the ASA,2 MAC is the term used to
describe the administration of local anesthesia alone or the use of
anesthetic drugs for a patient undergoing diagnostic or therapeutic
procedures with or without local anesthesia. The ASA defines MAC “as
instances in which an anesthesiologist has been called upon to provide
specific anesthesia services to a particular patient undergoing a planned
procedure in connection with which a patient receives local anesthesia or,
in some cases, no anesthesia at all. In such a case, the anesthesiologist is
providing specific services to the patient, is in control of his or her
vital signs, and is available to administer anesthetics or provide other
medical care as appropriate.” The standard of care for ...