Monitored anaesthesia care (MAC) without sedation Home A-Z Health Information Health Library A-Z Monitored Anaesthesia Care (MAC) Without Sedation Overview Monitored anaesthesia care (MAC) without sedation is an approach where patients remain awake and alert during a procedure—owing to their not receiving sedation (induction of a state of relaxation or drowsiness in a patient, typically through the use of medications) or general anaesthesia—while receiving careful monitoring of vital signs and localised anaesthesia for pain management. However, the anaesthesiologist may administer local anaesthetics (for pain control) or other drugs to alleviate anxiety and discomfort, without causing sleepiness or loss of consciousness. The main focus in MAC without sedation is on maintaining the patient’s safety and well-being throughout the procedure. MAC without sedation can be used for various procedures like minor or minimally invasive surgeries (e.g., endoscopies, biopsies, or dental procedures), diagnostic procedures (e.g., colonoscopies), plastic or reconstructive surgeries, and cardiac and vascular interventions, i.e., medical procedures aimed at diagnosing, treating, or managing conditions that affect the heart and blood vessels (e.g., angiograms). Benefits Though MAC without sedation is not always feasible or appropriate for all patients, particularly those undergoing complex or invasive procedures, it offers several benefits in terms of recovery, communication, and complication risks. The same have been enumerated below.Reduced risk of sedation-related complications: Sedation—particularly in critically ill patients—can lead to complications such as respiratory depression (a condition where breathing becomes slow and shallow—or in more severe cases—stops altogether), low blood pressure (hypotension), or delirium (especially in older adults). Avoiding or minimizing sedation reduces these risks. In the absence of sedation, other side effects that can arise from the depressant effects of sedative medications are also avoided.Improved patient monitoring and interaction: Patients who remain awake can communicate their symptoms, feelings, or discomfort to medical staff. For example, patients may notice adverse reactions early, such as chest pain, shortness of breath, or dizziness, and can immediately report them, aiding quicker diagnosis and treatment.Reduced recovery time: Quicker recovery from the surgical/diagnostic procedure is ensured as the patients undergoing MAC with sedation are awake and alert. The absence of sedation often means that patients experience less grogginess or fewer delays in cognitive function.Enhanced psychological well-being: For some patients, being aware and in control during treatment provides a sense of normalcy and reduces the psychological impact of being unconscious such as anxiety.Shorter hospital stay: Not needing to recover from sedation or anaesthesia can contribute to a shorter hospital stay. This is particularly important in the context of intensive care, where reducing time in the hospital is beneficial for overall patient care and cost-effectiveness.Lower risk of drug dependence or interaction: By not using sedatives, patients avoid the risks associated with the prolonged use of sedative medications, such as dependence, withdrawal, or drug interactions that can complicate other aspects of their care. Risks Though MAC without sedation can be beneficial in certain circumstances (e.g., when it is crucial for the patient to remain aware or to avoid sedation-related complications), it comes with its own set of risks and challenges. Careful patient selection and meticulous monitoring are necessary to ensure that the procedure goes smoothly and to mitigate these potential complications. Risks associated with MAC without sedation have been provided below.Anxiety and discomfort: Some patients may experience significant anxiety or emotional distress from being awake during a procedure, especially if it is invasive. This may lead to tachycardia (increased heartbeat), hypertension (high blood pressure), and an overall feeling of discomfort.Inadequate pain relief: Local anaesthesia might not provide complete pain relief for some patients, especially in those undergoing more complex or invasive procedures. In the absence of sedation, patients may experience discomfort or pain, which can make the procedure difficult for both the patient and the medical team.Psychological effects: Remaining awake during surgery or medical procedures can sometimes lead to panic attacks, claustrophobia, or trauma if the patient finds the environment overwhelming.Difficulty managing patient movement: If the patient is awake, there is a greater chance of involuntary movement or jerking, which could interfere with the procedure. Even small movements can compromise the success or safety of delicate procedures (e.g., in case of bone or eye surgeries).Vocalisations: Some patients may show signs of distress by crying or shouting, which can complicate the procedure or cause discomfort for both the patient and the medical staff.Risk of inadequate monitoring of anxiety or pain: If the patient is awake, medical professionals may focus on monitoring the local anaesthesia and other vital signs but might miss subtle signs of increased stress or discomfort if not properly assessed.Nausea or vomiting: Some patients may experience nausea or vomiting even without sedation, particularly if they are anxious or have a sensitive stomach. Nausea and vomiting can lead to a risk of aspiration (inhalation of vomit into the lungs), which could cause a serious condition called aspiration pneumonia.Respiratory or cardiovascular effects: Stress and anxiety can lead to increased heart rate, elevated blood pressure and heart rate, and even respiratory changes, which could complicate the procedure, especially in patients with underlying heart or lung conditions.