MAC anesthesia versed / propofol - page 2

I have a question. For starters, I'm a fairly new RN, thus seeking some knowledge on anesthetics. I recently started a job at an eye surgery center doing PACU. When I receive pts from the OR, I see the anesthesia sheet and see... Read More

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    Quote from meandragonbrett
    The particular drugs used don't determine whether its a MAC or a GA. Also, being intubated or having an LMA placed doesn't determine whether the case is a MAC or GA. Is the patient able to maintain their protective reflexes?

    A MAC can be anything from 2 of Midaz all the way to propofol and ketamine infusions.
    I would certainly hope if you are putting in an ETT or LMA in for a procedure that the patient is getting GA.

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    A MAC is anesthesia involvement. No drugs have to be given, it can be wide awake or almost a general. All ETTs and LMAs are generals, otherwise the patient gets upset, lol. An LMA used in a MAC is usually due to loss of airway (unintentional 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. 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.
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    If the pt is unable to protect their airway, then they have crossed to a general anesthetic. Many MACs are truly generals. There are guidelines to the definitions. I have performed many generals without an LMA or ETT. I had a TIVA with an airway and a non rebreather mask. During a MAC the patient should be able to respond to stimuli.

    Never have been in the room without actually giving any meds at all. Not sure how you can bill for that and why you stand in an OR not doing anything at all.

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