Monitored anesthesia care.

The use of sedative and analgesic adjuvants during local and regional anesthesia can improve patient comfort while optimizing intraoperative conditions and increasing the range of procedures that can be safely and comfortably performed. Similarly, these techniques may be applied to procedures in which local anesthetic agents are unnecessary, or in which their administration is impractical. Although local anesthetic-based techniques are frequently perceived as safer than general anesthesia, the use of potent sedative-hypnotic and analgesic drugs (especially when used together) may cause significant depression of respiratory function. The need for vigilant monitoring, supplemental oxygen administration, careful titration of sedative-analgesic medications, and facilities and equipment for resuscitation is no different than when general anesthesia is employed. The availability of agents with more specific actions, shorter half-life values, and fewer adverse side effects, combined with a better understanding of drug actions and interactions, as well as new administration techniques, should make MAC safer and even more acceptable to patients.