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Some minor surgical procedures can be done with the combination of local anesthesia plus intravenous sedation. This type of anesthetic care is known as Monitored Anesthetic Care, or MAC. Prior to beginning anesthesia, the anesthesiologist places monitors for blood pressure, electrocardiogram, pulse and oxygen saturation of the blood. Your anesthesiologist is present for the entire surgery, and administers intravenous sedatives and pain medication as required for patient comfort, safety and to facilitate the surgeon’s needs. The level of consciousness can be controlled from awake but relaxed, to light sleep with minimal chance of awareness. While the patient is sedated, the surgeon usually injects local anesthetics into the surgical site to block both surgical and post operative pain.
Typically a local anesthetic injection is performed by the surgeon for operations involving relatively small areas. Breast biopsies, cataract operations, and small hernia repairs are common examples of operations that can often be successfully accomplished with MAC. During MAC sedation, immediate access to general anesthesia is assured should it become necessary during the operation and if it is appropriate for that patient’s condition.
It should be noted that not every operation is feasible under local anesthesia with MAC sedation. This is because local anesthetic drugs, like most drugs, have limitations with respect to their safe administration. Each drug has a recommended maximum dosage, and if adequate numbness cannot be achieved within these guidelines then an alternative anesthetic plan such as general or regional anesthesia should be considered.
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