A biting commentary on monitored anesthesia care with conscious sedation

Area of Science:

• Anesthesiology
• Patient Safety

Background:

• Monitored Anesthesia Care (MAC) requires clear operationalization for effective practice.
• Existing guidelines for intravenous conscious sedation were established by the AANA in 1988.

Observation:

• There is a need for better operationalization of MAC and its components.
• Quality risk evaluation and patient assessment guidelines specific to MAC and conscious sedation are lacking.
• Certified Registered Nurse Anesthetists (CRNAs) must adhere to established guidelines for conscious sedation.

Findings:

• The AANA Board of Directors adopted guidelines for registered professional nurses administering intravenous conscious sedation.
• These guidelines are part of the Professional Practice Manual for the Certified Registered Nurse Anesthetist.
• Medicare carriers are directed by HCFA to determine the appropriate standard of care for MAC.

Implications:

• Enhanced vigilance is necessary during MAC procedures, even minor ones, to manage potential complications.
• Standardized guidelines for MAC and conscious sedation are needed to ensure consistent quality of care.
• Providers must recognize MAC as a standard of care and practice accordingly.