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What is Monitored Anesthesia Care?

Mary McMahon
Updated May 17, 2024
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Monitored anesthesia care (MAC), also known as twilight anesthesia, is a type of anesthesia where sedatives are provided to keep the patient calm while allowing the patient to remain awake and responsive. It is used in conjunction with local or regional anesthesia. A trained anesthesiologist administers MAC and is present throughout the procedure to look out for the welfare of the patient. After the procedure is over, the anesthesiologist will allow the patient to regain full awareness and assess the patient for pain.

There are a number of settings where monitored anesthesia care may be desired. In some procedures, it is necessary for the patient to be awake and able to respond to commands. In others, a patient may be endangered by general anesthesia, making it an unsafe choice. For minor procedures and many dental surgeries, monitored anesthesia care can be used to keep the patient comfortable during the procedure without exposing the patient to the risks of general anesthesia.

This anesthesia technique cannot be used alone. When provided with sedatives, patients can still experience pain. The sedatives address anxiety and discomfort. Local or regional anesthesia is needed to prevent the patient from feeling pain. MAC can also include the use of drugs designed to induce amnesia so the patient will not remember the procedure after it took place. This can be desirable in cases where patients might develop nightmares or other problems after surgery.

If a patient is a good candidate for a combination of monitored anesthesia care and local or regional anesthesia, the anesthesiologist will meet with the patient before the surgery to identify any risk factors and develop an anesthesia plan. When it is time for the surgery, medications will be introduced through an intravenous line and the patient's vital signs will be monitored on hospital equipment. The anesthesiologist and surgeon may talk to the patient during the procedure and the patient will be assessed for signs of stress reactions and other complications, with medications adjusted as needed.

There are fewer risks associated with monitored anesthesia care. Because patients breathe independently during the procedure, artificial ventilation does not have to be used, reducing the risks of damage to the lungs. Complications associated with the heart and other organs are less common, and patients are less prone to adverse reactions to anesthesia. Intensive monitoring is provided throughout the procedure to identify and address any issues that develop during the surgery.

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Mary McMahon
By Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a WiseGeek researcher and writer. Mary has a liberal arts degree from Goddard College and spends her free time reading, cooking, and exploring the great outdoors.

Discussion Comments
By lovealot — On Oct 01, 2011

I have had a few minor surgeries and procedures. I must say that I was very impressed with each of the anesthesiologists. Before the surgeries, they gave a thorough explanation and were glad to answer questions.

I think I must have had a monitored anesthesia during my two cataract surgeries. It was a short procedure. I couldn't talk during the time I was under, but I felt like I was in a twilight zone, being able to hear the doctors and nurses talking.

After the surgery, it took a very short time to feel alert and ready to go home.

By B707 — On Oct 01, 2011

@Bhutan - I had a similar experience to you when I was having my first child. I was either given an epidural that was too strong or the timing was off when they gave it to me.

Anyway, when I was on the delivery table, I could not push hardly at all. The nurses had to literally push along my stomach to get the baby out. Needless to say, I was not happy about this.

But the baby was all right.

I'm thinking that the nurses just weren't paying close enough attention.

By Sinbad — On Sep 30, 2011

I recently went under general anesthesia for a quick surgery I had to remove a vocal cord polyp. And by quick I mean, ten minutes quick.

I wasn't given a choice of anesthesia between monitored anesthesia care and general anesthesia, and I must say I was glad. Even though my surgery was minor, I would not have wanted to think about weighing the pros and cons of the two different types of anesthesia, especially considering I thought anesthesia was the scariest part!

By bagley79 — On Sep 30, 2011

I was actually given an option of what type of anesthesia I preferred when I was having a colonoscopy. I went with the general anesthesia because I didn't care if I was awake or not.

Using monitored anesthesia would be a good option for my Dad. He has a history of colon cancer and has had numerous follow up colonoscopy procedures through the years.

He wants to know what they are doing and wants to be awake during the whole process. He drives himself to the appointment and doesn't take any anesthesia at all.

There is no way I could do this, but if the procedure ever gets too uncomfortable for him, this is an option he would have. It would make the procedure more comfortable, but he would still be able to be awake during the whole thing.

By andee — On Sep 29, 2011

I have received a general anesthetic a few times over the years for some major surgeries. I know there are many risks that go along with this, but I have never had any complications from it.

In most cases, I would rather be totally out so I don't know what is going on around me. One time when I was having a breast biopsy done, I had monitored anesthesia along with a local anesthesia.

I was awake during the whole process, and even though I could not feel anything, I was able to talk with the doctor and respond to him during the whole process.

I can see how this type of anesthesia would be beneficial in many situations where you lower your risk of side effects from anesthesia, but can still have procedures done without experiencing any pain or discomfort.

By indemnifyme — On Sep 29, 2011

@JessicaLynn - From what I understand, twilight anesthesia is a pretty popular choice for people who are getting their wisdom teeth out these days. Like the article said, it's much less risky than general anesthesia.

Still, I feel like if I was going to have monitored anesthesia care, I would want to make sure the anesthesiologist was very experienced. It sounds like this is kind of a two part process-one part sedation, one part actually anesthetizing the pain. It would be really horrible if they messed up one part of that!

By JaneAir — On Sep 28, 2011

One of my friend elected to have twilight anesthesia when she got her wisdom teeth taken out. It worked very well in her case, and she had no memory of the procedure after it was done.

I kind of wish I could get this just for regular dental care. I get so anxious it would probably be beneficial for me to be somewhat sedated and then have no memory of the procedure.

By Moldova — On Sep 28, 2011

@Bhutan- Anesthesia awareness is really important because many people die of anesthesia complications for elective surgeries like plastic surgeries. You really have to have your full medical history available to your doctor so that they can determine what the best course of action for the surgery is.

In some cases it might be better to delay a surgery until the health of the patient improves rather than take a risk with someone that has cardiac problems that may be at higher risk.

I have a friend that actually became a nurse anesthetist because she really wanted to work in the field of anesthesia services. She found the work challenging and really exciting. It also pays very well because the average nurse anesthetist makes well over six figures. I think that all jobs relating to anesthesia management pay well.

By Bhutan — On Sep 27, 2011

When I had both of my children I was given an epidural both times. The first time I was given a much higher dosage than the second time and when it came time to push, I could not feel my lower body so it was hard for me to determine my progress in the labor stage.

With my second child, I did not have as much anesthesia because they said that the epidural had a tendency to depress the heart rate of the baby and my son’s heart rate was a little depressed as it was. Although it was a painful delivery because I virtually had little anesthesia, my recovery was much faster with my second delivery than with my first.

I also had to have an episiotomy on the first delivery because of the excessive anesthesia which was unnecessary in the second delivery. I think that anesthesia like an epidural can be a great way to control the pain the in the delivery but if you have too much it can also lead to other problems.

There have been cases in which the anesthesia complications of the epidural has lead to paralysis because the shot is placed in your spine and some women have an adverse reaction to it.

Mary McMahon
Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a...

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