Room air general

I was just wandering exactly this term implied-my instructor mentioned it when talking about titrating drugs to effect in a MAC case. I'm guessing meaning you don't want the patient to the point of a general sedation if their airway is not properly protected.

R.A.G. is a semi-facetious term, similar to saying, "There is no such thing as Inadequate Regional Anesthesia, but there is Inadequate Sedation...."

Of course sedation without oxygen supplementation would rarely be a good idea. Ergo, ROOM AIR general is a misnomer also.

d

It is kind of a joking terminology, means you are giving sedation, but so much the patient is totally asleep like a general anesthetic. Just no anesthetic gas, hence the name. Not always a bad thing, as long as the patient is breathing and keeping his sat up. Having to pull out the ambu bag is bad form.

Room air General is frequently synonymous with a Big MAC which is essentially General anesthesia with a natural airway and intravenous "sedation."

Of course sedation without oxygen supplementation would rarely be a good idea. Ergo, ROOM AIR general is a misnomer also.

d

There's a small group of proponents (Downs et al) of doing sedation cases without supplemental O2, reasoning that providing supplemental O2 gives a false sense of security and masks signs of hypoventilation. I don't buy it, but it's being done in a few places.

There's a small group of proponents (Downs et al) of doing sedation cases without supplemental O2, reasoning that providing supplemental O2 gives a false sense of security and masks signs of hypoventilation. I don't buy it, but it's being done in a few places.

Fine and good at sea level elevation, not so good an idea at a mile high.

Seems like cheap insurance to me in either circumstance. Come one, how expensive is a little O2?

Not only that, but hypoventilation is being monitored with an ETCO2. You can see the respirations. When you do a Big MAC, you are titrating your drugs to effect. It doesnt matter how many years you have been practicing, you will get that patient that goes completely apneic on 50mcg of fentanyl with or without versed. If they have had preO2, or at least NC 2L, then they have sometime to come back before you have to bag them. (remembering that your pulse ox is delayed). Yes, you could do no supplemental O2 on a healthy Marine, but never on the average Joe. All in all, it sounds like lazy anesthesia and poor practice. Come on. I agree with deepz, how much does O2 cost?

while i typically administer supplemental O2 during most MAC cases, nothing is absolute in my practice. face cases (bcca, ect) get nice and comfortable with a bit of alfenta, versed, and propofol for example to get the patient through local infiltration, but from that point on i let them lighten up and they get O2 from me (if i can safely avoid it) after the local has set up. airway fires in this setting are a real threat. point of post - everything is patient, surgeon, and case specific.