Monitored Anaesthesia Care (MAC)

While MAC without sedation may not be suitable for all patients or procedures, it offers several advantages:

• Reduced risk of sedation-related complications: Avoiding or minimising sedation reduces the risk of breathing difficulties, low blood pressure, or confusion, especially in critically ill patients.
• Improved patient monitoring and interaction: Patients who remain awake during the procedure can communicate their symptoms, feelings, or discomfort, such as chest pain, shortness of breath, or dizziness, to medical staff, aiding in quicker diagnosis and treatment.
• Faster recovery: Without sedation, patients experience less grogginess and fewer delays in cognitive function, and can thus resume normal activities sooner.
• Enhanced psychological well-being: For some patients, being aware and in control during treatment provides a sense of normalcy and reduces patient anxiety.
• Shorter hospital stay: Since recovery is quicker, a shorter hospital stay is required, which is beneficial for overall patient care and cost-effectiveness.
• Lower risk of medicine side effects: Skipping sedatives means avoiding issues like dependence, withdrawal, or harmful drug interactions that can complicate other aspects of their care.

The time depends on the type of procedure—some take only a few minutes, while others may last over an hour. Recovery is usually quick since no sedation is used.

Though MAC without sedation can be beneficial in certain circumstances (e.g., when it is crucial for the patient to remain aware or to avoid sedation-related complications), it comes with its own set of risks and challenges. Careful patient selection and meticulous monitoring help reduce these risks. Risks associated with MAC without sedation are:

• Anxiety and discomfort: Being awake during a procedure, especially if it is invasive, may lead to tachycardia (increased heartbeat), hypertension (high blood pressure), and an overall feeling of discomfort.
• Inadequate pain relief: Local anaesthesia might not provide complete pain relief for some patients, leading to discomfort or pain, which can make the procedure difficult for both the patient and the medical team.
• Psychological effects: Remaining awake during surgery or medical procedures can sometimes lead to panic attacks, claustrophobia, or trauma if the patient finds the environment overwhelming.
• Difficulty managing patient movement: Being awake increases the chance of involuntary movement or jerking that can interfere with and compromise the success or safety of delicate procedures (e.g., in case of bone or eye surgeries).
• Vocal reactions: Some patients may show signs of distress by crying or shouting, which can complicate the procedure or cause discomfort for both the patient and the medical staff.
• Overlooked signs of anxiety or pain: Without sedation, subtle signs of pain or anxiety may be missed if not carefully monitored.
• Nausea or vomiting: Nausea or vomiting can occur even without sedation, particularly if they are anxious or have a sensitive stomach. In rare cases, it may lead to inhalation of vomit into the lungs (aspiration).
• Heart or breathing difficulties: Stress and anxiety can lead to increased heart rate, elevated blood pressure, and even breathing changes, which could complicate the procedure, especially in patients with underlying heart or lung conditions.