Monitored Anesthesia Care (MAC)

          Monitored Anaesthesia Care

Introduction:

     Monitored Anaesthesia Care is a planned anesthetic procedure during which the patient undergoes local anesthesia together with sedation.

     Patient may be drowsy during the surgery or the procedure, and will not feel pain.

    Anesthetic medications are given through an IV line. A local anesthetic may also be injected around the surgical site to numb it.

      The anesthetic monitors the patient through out the procedure and will allow the patient to regain full awareness after the complication of the procedure.

      The heart rate and rhythm, blood pressure and oxygen saturation i,s continuously monitored.

The patient will have a 

• Pulse oximeter to measure O2 saturation
• Electrocardiography leads to record heart rate and rhythm
• Face mask to give oxygen if needed

Indications:

   Used in procedures such as 

1. Gastrointestinal endoscopy
2. Endoscopic Retrograde Cholangio Pancreatography(ERCP)
3. Stent placement in the upper gastrointestinal tract
4. Bronchoscopy
5. Dental procedures

Used in patients with some risk factors such as 

• Respiratory problem
• Cardiac problem

Anesthetics used in MAC:

• Propofol: Associated with a rapid onset of action and fast recovery from sedation.
• Benzodiazepines: To induce sedation

Side effects of  MAC:

• Breathing problems
• Nausea 
• Allergic reaction to the anesthetic

Nurse's Interventions 

  pre-procedure:

1. Monitor vital signs
2. Assess the patient's ability to remain motionless and actively co-operate
3. Take the details of the medications patient is taking and inform the physician
4. Obtain informed consent
5. Explain the procedure and reassure the patient
6. Monitor cardiorespiratory status of the patient
7. Administer medications and IV fluids as prescribed 

Post procedure:

• Monitor vital signs including cardiorespiratory status of the patient
• Monitor for any possible complication or side effects
• Once the patient recovers from anesthesia he/she can be discharged or can be shifted to room. 
• Advise: 

1. Not to drive
2. Avoid alcohol
3. Do not make any important decisions for the first 24 hours after the procedure