Monitored Anesthesia Care
Monitored Anesthesia Care
Monitored Anesthesia Care
Care
Objectives
Terminology
Monitored Anesthesia
Care
MAC
GRAY ZONE
GENERAL ANESTHESIA
Preoperative
Assessment
MAC
GENERAL
ANESTHESI
A
Observer's Assessment of
Alertness/Sedation Scale
MAC
Consciousness
Patent Airway
Spontaneous Breathing
Safety Risk
Conscious
Factors ThatCooperative
Contribute the
Communicative
Success
of capacity
MAC
Functional
IV
difference betwe
propriate case selection & ASA PC I Knows
and GA
patient preparation Manageable anxiety
PATIENT
Manageable
pain role of sedative
ws difference between MAC
Knows
and GA
Able to follow commandsmanagement
ws role of sedative vs pain
Able to lie still / flat Cool Calm
management
Cataract extraction Bedside Manner
ANESTHESIOLOGIST
SURGEON
Cool
Calm Bone marrow biopsy
Able to manage pa
Lumpectomy
Talks vs Sedates
Cooperative
to manage pain &Pacemaker
sedation - AICD insertion
Cooperative Inguinal Hernia repairsCommunicative
arthroscopy Clinical experienc
PROCEDURE
Communicative Knee
TEE Cardioversion
Knows Dr / Patient limits
Rhinoplasty
ows how / when to convert
rd
3 Molar extraction
Context-Sensitive Halftime
Distribution of Drugs
VRGs
Plasm
a
Poorly
Perfuse
d
Tissues
Context-Sensitive HalfTime
T 1 /2 :
462min
T 1/ 2 :
111min
T 1/2 :
557min
Hypnotics
Propofol
Fospropofol
Dexmedetomidine
Opioids
Fentanyl
Alfentanil
Remifentanil
Sufentanil
Benzodiazepines
Midazolam
Diazepam
Ketamine
Fospropofol
(+) amnesia
Longer onset of
(+) effect on PONV
action than propofol
Sense of well being (4 to 13 minutes)
(-)pain at injection
Diazepam
Anxiolysis, Amnesia
Long duration
(>20h)
Pain on injection
Prolonged cognitive
function recovery
Midazolam
Anxiolysis, Amnesia,
Fast acting, low
CSHT
Prolonged cognitive
function recovery
Dexmedetomidine
Sedation +
analgesia
Minor effects on
(-)amnesia
(-)slow onset
Potential for
Diazepam
2-10 ,mg
Midazolam 1-2 mg prior to propofol or
remifentanil infusion
Reversal
NALOXONE
An initial dose of 0.4 mg to 2 mg, may be repeated
every 2-3 minutes, up to 10 mg
FLUMAZENIL
Initial recommended dose of 0.2 mg
If desired level of consciousness is not achieved in
45 s, repeat 0.2-mg dose, then every 60 s until a
maximum of 1 mg is administered
Be aware of the potential for resedation
Reversal
Thank You, Po