![]() ![]() Low-dose ketamine provides weak sedation but excellent analgesia. The patient-maintained sedation (PMS) is found to be more effective than PCS in terms of patient satisfaction and minimizing side 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). Targeting the effect-site concentration rather than blood concentration provides faster onset and better predictability of drug effect. Apart from the distribution and elimination half-life, factors like context sensitive half-time, effect-site equilibration, and potential of interaction with other drugs need to be taken into account while choosing the drugs. Fewer sedative drugs are required in geriatric population, as chances of desaturation and cardiovascular instability are more. Operation time, clinical condition, age of the patient, and the need to convert to general or regional anesthesia help to guide towards the selection of appropriate sedation technique. Due to dearth of an ideal agent, sedation techniques for MAC often utilizes a combination of agents to provide analgesia, amnesia, and hypnosis with complete and rapid recovery that suits a particular operative procedure with minimum side effects like postoperative nausea and vomiting (PONV), prolonged sedation, and cardiorespiratory depression. There is a poor correlation between BIS value and observational sedation scale scores for different sedative drugs, which emphasizes the use of both BIS and sedative scales to evaluate patient's response to sedation.Īn ideal sedative agent should be consistently effective in having rapid onset, easy titration, high clearance, and minimal side-effects particularly a lack of cardiovascular and respiratory depression. The incidence of apnea during MAC is high, and the incidence increases as BIS decreases. 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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