Emergency room doctors often use moderates sedation to help them with procedures such as fracture reduction or correction of a dislocated joint. To make the whole subject more confusing, most practitioners understand the phrase "conscious sedation" to mean moderate sedation. Deep sedation can be thought of as being on "just this side of consciousness.
The acronym "MAC" stands for monitored anesthesia care. MAC means that an anesthesiologist or nurse anesthetist, anesthesia resident, anesthesiology assistant is present and responsible for the sedation, care, and monitoring of the patient during the procedure. Any level of sedation can be a MAC anesthetic, but it usually implies a deeper level of sedation. Alternatively, anesthesiologists may be requested to administer sedation to very sick or high-risk patients.
For a MAC anesthetic, the anesthesiologist will assess the patient preop, monitor and medicate intraop, and direct the recovery postoperatively. Their statement includes the following:. The decision of whether or not to do a procedure under sedation vs. Your surgeon and anesthesiologist will be able to let you know of your choices or options for your particular situation and may have a recommendation based on their experience.
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The ABCs of MAC Anesthesia
You made me laugh! But I actually do understand so thank you. I believe you are absolutely correct in that I know propofol and versed among many others were on board for the cocktail, at least initially. I think I've just been fortunate in the past to maintain more of a constant state thanks to the team and haven't ever dealt with the wearing off of the drugs so to speak, at least not that I remember. This was certainly not intended to be general and I do understand it was not intraoperative awareness, my curiosity was more around why I knew I was in that OR to start with ;-. You are also correct in that I had no pain just intense pressure and the movement wasn't purposeful.
I knew I was doing it, but I couldn't do anything about it either. Thankfully surgeon and rest of OR team were fab and all was well and thank you again for going above and beyond with your clarification. It really does help, prob more than you know! The levels of anesthesia really exist on a continuum. During any given procedure, the level of anesthesia may change expectedly or unexpectedly, based on surgical, surgeon, anesthesiologist and patient factors.
When those agents were less prominent or wore off to some degree, you were able to be 'more conscious' if that makes sense and form and retain memories. It doesn't sound like you were under general anesthesia since you remember, and were making sounds and moving. It gets a little more confusing since general anesthesia can occur from time to time when deep sedation is being used. But a patient can go into and out of general to vacillate between different levels of sedation.
In any case, your overall anesthetic would seem to qualify as a sedation. In this case, having some memories is not really considered 'coming to' or of having intraoperative awareness as it would be if you were intended to be unconscious with general anesthesia. I hope that makes a tiny bit of sense. So, the short er answer is that yes, it is within normal limits to have some memories of being in the operating room.
The local anesthetic used by the surgeon should prevent you from feeling pain, but not pressure. When your level of sedation lightens, it is common to be confused and 'pull away' from a stimulus, even if its just pressure until you are able to understand what is going on OR be sedated deeper again to prevent the movement or memories. Hi Dr. I have a question regarding MAC anesthesia. I recently had a procedure requiring several biopsies under my arm and it was agreed upon to use MAC anesthesia.
During pre-op, the anesthesiologist prepared me that we may transition more into general vs just MAC which was fine obviously however when the nurse anesthetist came and took me, she informed me we would only be doing a lighter MAC and that would be sufficient. I was fine with that as long as I would be out of it and she said I would be. Problem was, I came to during the middle of the procedure.
Could hear everything, began moving, couldn't talk but could make noise. Couldn't feel pain, but def pressure. My surgeon is the one who noticed I was pulling away and requested more meds be administered. I'm just curious if this is common or expected with MAC for future reference. I'm not upset about what happened I would just like to be prepared for the next time.
I was a little confused as during pre-op I was prepared for general and it ended up being less You were the first place I thought to come to and sure enough you had a hub posting : Thank you!! I would love to have had this information when I had surgery a few years ago - I had questions and of course was anxious.
Everything went well, but I would have benefitted from understanding it a bit more! I will refer back to this hub if I ever need a procedure again! Great explanations about sedation. I love the way you write, it makes medical procedures and effects much easier to understand. Other product and company names shown may be trademarks of their respective owners. HubPages and Hubbers authors may earn revenue on this page based on affiliate relationships and advertisements with partners including Amazon, Google, and others. HubPages Inc, a part of Maven Inc. As a user in the EEA, your approval is needed on a few things.
To provide a better website experience, healthproadvice. Please choose which areas of our service you consent to our doing so. Updated on May 13, TahoeDoc more. The continuum of consciousness, as relates to anesthesia, proceeds as follows: awake no sedation lightly sedated moderately sedated deeply sedated unconscious under general anesthesia It is not always possible to predict the level of sedation that will be needed by a specific patient for a specific procedure.
So, what exactly do each of these terms mean? Twilight Sleep The phrase, "twilight sleep", is often used when speaking to patients because it seems to describe a state of semi-consciousness. Light Sedation or Minimal Sedation Minor surgeries and procedures may be done with light sedation. You can hold a conversation and are able to answer questions.
You will not require support of cardiac or respiratory function. Minimal or no supplemental oxygen will be used. It is normal to remember most of your experience.
You will need minimal recovery time. Side effects and complications are very, very rare. Moderate Sedation Moderate sedation is used when some discomfort that's doctor-speak for pain is expected. You will respond to speech prompts or light touch. For us, conscious sedation is just that- sedation without full loss of consciousness, and may be given by certified sedation nurses without the presence of an anesthesia provider.
MAC is deeper, but the patient is able to usually maintain their own airway, and requires the presence of an anesthesia provider. Propofol can be used for induction of general anesthesia; however, after the patient is asleep they are generally kept that way using inhalational anesthetics, such as sevoflurane or desflurane.
Twilight vs. MAC Anesthesia | Medical Billing and Coding Forum - AAPC
Our conscious sedation patients do not go to PACU; they go to our post-op discharge unit. Please please please new RN do not be afraid to ask questions. It is the "art" of medicine that different clinics, anesthesiologist etc. It is not written in stone or even in policy exactly what drug equals what anesthetic method used equals what "category" if falls under.
Is the patient able to maintain their protective reflexes? FWIW many facilities use propofol for concious sedation procedures. My hospital does and it's fantastic. I'm not sure if procedure is still considered conscious sedation when Diprivan is added into the mix - that's the line where I would be calling it MAC.
I'm probably splitting hairs, and I am sure it differs by facility and state. I know in my state as an RN I can administer conscious sedation, but cannot push Diprivan. I do, however, disagree with the sentiment of PACU not being a place for new grads. As long as training is adequate, new grads can and have succeeded in PACU. I've worked with many of them, and the environment at my facility's PACU is very nurturing of new grads. That may be what makes the difference. A MAC is anesthesia involvement. No drugs have to be given, it can be wide awake or almost a general.
Propofol in low dosages can be "conscious sedation".
I find if you give enough propofol to cause slurred speech then the patient will not remember most local injections. Versed alone might prevent a patient from remembering the pain but it is not a guarantee. It is a pet peeve of mine when non-anesthesia providers tell the patient they wont remember anything in a MAC.
Types of Anesthesia
It can not be guaranteed and results in the patient claiming "anesthesia awareness" when it never actually occurred. Not to mention it can be interpreted as breech of contract in some examples. If you tell a person they will remember nothing, and they do then they can sue for breech of contract. PACU Nursing. World Leaders. Or sign in with one of these services Sign in with Google. Sign in with Facebook. Sign in with LinkedIn. Prev 1 2 Next.
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Mar 2, by Syhuggins. Mar 3, by brownbook. Mar 3, by meandragonbrett. A MAC can be anything from 2 of Midaz all the way to propofol and ketamine infusions. Mar 4, by ffliper