Monitored anesthesia care.

According to the American Society of Anesthe-siologists (ASA), a monitored anesthesia care (MAC) is a planned procedure during which the patient undergoes local anesthesia together with sedation and analgesia. Actually MAC is the first choice in 10-30% of all the surgical procedures. The 3 fundamental elements and purposes of a conscious sedation during a MAC are: a safe sedation, the control of the patient anxiety and the pain control. The patients undergoing conscious sedation are able to answer to orders appropriately and to protect airways. Last but not least, another purpose of any MAC is to get the patient appropriately satisfied, allowing him to get his discharge as faster as possible. There are many surgical procedures which can be performed using a MAC. The patient consciousness evaluation is of extreme importance during the surgical procedure performed with MAC: to this purpose the clinical and electroencephalographic evaluations such as Bispectral Index are very useful. MAC can be obtained with the association of fast half-life drugs or drugs getting a clinical effect which can vary according to the surgical requirements, using an infusion regiment. Apart from the pharmacological choice, this procedure can be performed with patient controlled sedation techniques or with continued intravenous infusion or with target controlled infusion.