What is considered monitored anesthesia care?

September 23, 2025 •

3 min read

According to the American Society of Anesthesiologists (ASA), monitored anesthesia care (MAC) is a specific, planned anesthesia service performed by a qualified anesthesia provider for a diagnostic or therapeutic procedure. This specialized approach focuses on patient comfort and safety through the administration of sedatives and analgesics while continuously monitoring vital functions.

Quick Summary

Monitored anesthesia care (MAC) is an anesthesia service where a qualified provider administers medication and continually monitors a patient's vital signs throughout a medical procedure. The sedation level is adjustable, from light to deep, but patients can typically breathe on their own without full unconsciousness.

Key Points

Continuum of Sedation: MAC is not a single level of anesthesia but a spectrum from minimal to deep sedation, managed by an anesthesia provider.
Qualified Oversight: Unlike simple procedural sedation, MAC requires continuous monitoring and management by a dedicated, qualified anesthesia professional.
Spontaneous Breathing: A key distinction from general anesthesia is that patients under MAC maintain their own ability to breathe without mechanical assistance.
Faster Recovery: Benefits include quicker wake-up times and fewer post-operative side effects, such as severe nausea.
Tailored Care: The anesthesia provider customizes the medication and sedation depth to match the specific patient and procedure requirements.
Broad Application: MAC is used for a wide range of minor, diagnostic, and outpatient procedures, including endoscopies, eye surgery, and dental work.
Emergency Readiness: Despite the lighter sedation, the anesthesia team is always prepared to handle complications or convert to general anesthesia if necessary.

Understanding Monitored Anesthesia Care (MAC)

Monitored anesthesia care, often abbreviated as MAC, is an anesthetic technique used for various medical procedures. It offers a spectrum of sedation tailored to the patient and procedure, unlike general anesthesia where a patient is completely unconscious. A qualified anesthesia provider administers medication and closely monitors the patient's condition throughout the procedure. MAC often allows for quicker recovery and potentially fewer side effects compared to deep, general anesthesia.

The Role of the Anesthesia Provider in MAC

The continuous supervision by an anesthesia professional is a key differentiator of monitored anesthesia care from moderate sedation. The provider is involved throughout the patient's experience.

Before the Procedure

The provider assesses the patient's medical history and health, evaluates risks to determine if MAC is suitable, and discusses the plan with the patient.

During the Procedure

Anesthesia drugs, such as sedatives and pain relievers, are administered intravenously and adjusted as needed. Standard monitoring of vital signs like blood pressure, heart rate, and oxygen saturation is used. The provider must be prepared to manage deeper sedation or emergency situations, including converting to general anesthesia if required.

The Spectrum of Sedation

MAC involves a range of sedation levels, from minimal to deep, as defined by the ASA.

Minimal Sedation: Reduces anxiety; patient responds fully to commands.
Moderate Sedation: Patient responds purposefully to verbal or light touch commands; spontaneous breathing maintained.
Deep Sedation: Patient responds purposefully to painful stimulation; airway support may be needed.

Common Procedures for MAC

MAC is suitable for outpatient or minor procedures, often combined with a local anesthetic. Procedures include endoscopies, ophthalmic procedures like cataract surgery, minor orthopedic work, dental surgery, pain management procedures, and biopsies.

MAC vs. General Anesthesia: A Comparative Table


Feature	Monitored Anesthesia Care (MAC)	General Anesthesia
Consciousness Level	Light to deep sedation, not complete unconsciousness.	Complete loss of consciousness.
Airway Management	Patient maintains own airway and breathing.	Requires active management and mechanical ventilation.
Recovery Speed	Typically faster recovery.	Slower recovery, potential for grogginess.
Potential Side Effects	Fewer common side effects.	Higher risk of nausea, vomiting, sore throat.
Required Expertise	Continuously present qualified anesthesia professional.	Dedicated, expert anesthesia team.

For more detailed information on anesthetic care standards, you can consult the American Society of Anesthesiologists website.

Benefits, Risks, and Recovery

Benefits of MAC

MAC offers enhanced comfort, rapid recovery, reduced complications like those related to intubation, and a tailored approach to sedation.

Risks of MAC

Potential risks include oversedation, airway compromise, adverse drug reactions, and inadequate sedation requiring conversion to general anesthesia.

Recovery from MAC

Patients recover in an observation area. Grogginess may last a few hours, but most patients can go home within a couple of hours. A responsible adult must be present for 24 hours, and activities like driving or drinking alcohol should be avoided.

Is MAC Right for You?

Your anesthesia provider will determine the most appropriate anesthesia based on your health, the procedure, and your comfort. MAC is a safe option for many minor or diagnostic procedures, offering a gentler experience and faster recovery than general anesthesia.

Frequently Asked Questions

Patients often feel relaxed, groggy, and sometimes sleepy, entering a state referred to as 'twilight sleep'. Depending on the depth of sedation, they may be able to respond to verbal commands but often have little or no memory of the procedure afterward.

The main difference is the level of consciousness and how breathing is managed. With MAC, you remain breathing on your own, while with general anesthesia, you are completely unconscious and require a breathing tube.

MAC is used for many minor and diagnostic procedures that do not require full unconsciousness. Examples include colonoscopies, upper endoscopies, cataract surgery, dental procedures, and some minor orthopedic surgeries.

You may be in a state of 'twilight sleep,' meaning you are relaxed and sedated but can sometimes respond to commands. Many patients don't remember the procedure, even if they were technically not fully unconscious.

MAC must be administered by a qualified anesthesia provider, such as a physician anesthesiologist or a certified registered nurse anesthetist (CRNA), who focuses entirely on your sedation and safety.

Potential risks include breathing difficulties, a drop in blood pressure, nausea, and allergic reactions to medication. However, these are less frequent and often less severe than those associated with general anesthesia.

Recovery is typically much faster than general anesthesia, with most patients able to go home within a few hours. You will need a responsible adult to drive you home and stay with you for the first 24 hours.

Because a qualified anesthesia provider is continuously present, they are trained and equipped to manage the patient if the level of sedation becomes deeper than intended, including converting to general anesthesia if necessary for safety.