What is Monitored Anesthesia Care

Anesthesia is a term that refers to techniques, procedures, and medicines that help a person stay safe and comfortable during a medical procedure. Monitored anesthesia care, or sedation, is one type of anesthesia. Your anesthesia specialist may recommend sedation if you will be having a procedure that does not require you to be unconscious, such as:

• Cataract surgery.
• A dental procedure.
• A biopsy.
• A colonoscopy.

During the procedure, you may receive a medicine to help you relax (sedative). There are three levels of sedation:

• Mild sedation. At this level, you may feel awake and relaxed. You will be able to follow directions.
• Moderate sedation. At this level, you will be sleepy. You may not remember the procedure.
• Deep sedation. At this level, you will be asleep. You will not remember the procedure.

The more medicine you are given, the deeper your level of sedation will be. Depending on how you respond to the procedure, the anesthesia specialist may change your level of sedation or the type of anesthesia to fit your needs. An anesthesia specialist will monitor you closely during the procedure.

Let your health care provider know about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any use of steroids (by mouth or as a cream).
• Any problems you or family members have had with sedatives and anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have, such as sleep apnea.
• Whether you are pregnant or may be pregnant.
• Any use of cigarettes, alcohol, or street drugs.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Getting too much medicine (oversedation).
• Nausea.
• Allergic reaction to medicines.
• Trouble breathing. If this happens, a breathing tube may be used to help with breathing. It will be removed when you are awake and breathing on your own.
• Heart trouble.
• Lung trouble.

Before the procedure

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your health care provider about:

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.

Tests and exams

• You will have a physical exam.
• You may have blood tests done to show:
  • How well your kidneys and liver are working.
  • How well your blood can clot.

General instructions

• Plan to have someone take you home from the hospital or clinic.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

• Your blood pressure, heart rate, breathing, level of pain and overall condition will be monitored.
• An IV tube will be inserted into one of your veins.
• Your anesthesia specialist will give you medicines as needed to keep you comfortable during the procedure. This may mean changing the level of sedation.
• The procedure will be performed.

After the procedure

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• Do not drive for 24 hours if you received a sedative.
• You may:
  • Feel sleepy, clumsy, or nauseous.
  • Feel forgetful about what happened after the procedure.
  • Have a sore throat if you had a breathing tube during the procedure.
  • Vomit.

Monitored Anesthesia Care, Care After

These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After your procedure, you may:

• Feel sleepy for several hours.
• Feel clumsy and have poor balance for several hours.
• Feel forgetful about what happened after the procedure.
• Have poor judgment for several hours.
• Feel nauseous or vomit.
• Have a sore throat if you had a breathing tube during the procedure.

Follow these instructions at home:

For at least 24 hours after the procedure:

• Have a responsible adult stay with you. It is important to have someone help care for you until you are awake and alert.
• Rest as needed.
• Do not:
  • Participate in activities in which you could fall or become injured.
  • Drive.
  • Use heavy machinery.
  • Drink alcohol.
  • Take sleeping pills or medicines that cause drowsiness.
  • Make important decisions or sign legal documents.
  • Take care of children on your own.

Eating and drinking

• Follow the diet that is recommended by your health care provider.
• If you vomit, drink water, juice, or soup when you can drink without vomiting.
• Make sure you have little or no nausea before eating solid foods.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you have sleep apnea, surgery and certain medicines can increase your risk for breathing problems. Follow instructions from your health care provider about wearing your sleep device:
  • Anytime you are sleeping, including during daytime naps.
  • While taking prescription pain medicines, sleeping medicines, or medicines that make you drowsy.
• If you smoke, do not smoke without supervision.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You keep feeling nauseous or you keep vomiting.
• You feel light-headed.
• You develop a rash.
• You have a fever.

Get help right away if:

• You have trouble breathing.

Summary

• For several hours after your procedure, you may feel sleepy and have poor judgment.
• Have a responsible adult stay with you for at least 24 hours or until you are awake and alert.