Monitored Anesthesia Care (MAC) refers to a range of sedation from light to deep sleep and is typically administered by a Certified Registered Nurse Anesthetist (CRNA) under the oversight of the operating physician, not an anesthesiologist. It is growing in popularity in endoscopic surgeries (endoscopy), radiology tests and other minimally invasive procedures performed in ambulatory surgical centers and doctor's offices across the country. The drug of choice when performing MAC with sedation is propofol (brand name, "Diprivan"),
Issues With Propofol
Propofol is typically administered via a peripheral intravenous (IV) line and can produce varying depths of sedation when used in carefully titrated dosages. It also offers certain advantages over general anesthesia including:
- Quicker recovery to baseline activities versus other sedatives
- Fewer side effects than general anesthesia
- Rapid onset and shorter waking and recovery times
- Reduces the need for opioids resulting in less nausea and vomiting
While propofol has many benefits, it is not without significant risks. The response to Propofol can be unpredictable and there is no antidote to reverse its effect. Some patients quickly cross over from light sedation to deep sleep without warning, resulting in full respiratory arrest in a matter of seconds. For this reason, the American Association of Nurse Anesthetists and the American Society of Anesthesiologists issued the following joint statement in April, 2004 regarding propofol administration:
Because sedation is a continuum, it is not always possible to predict how an individual patient will respond. Due to the potential for rapid, profound changes in sedative/anesthetic department and the lack of antagonistic medications (antidotes), agents such as propofol require special attention.
Whenever propofol is used for sedation/anesthesia, it should be administered only by persons trained in the administration of general anesthesia who are not simultaneously involved in the surgical or diagnostic procedures. This restriction is concordant with specific language in the propofol package insert, and failure to follow these recommendations could put patients at risk of significant injury or death.
Issues With Monitored Anesthesia Care (MAC)
Despite these clear warnings, MAC with sedation continues to be administered by providers and facilities that are ill prepared to respond to foreseeable emergencies. If you or someone you know has suffered a serious injury because of a preventable anesthesia accident or mistake, you should contact an attorney at Burnside Law Firm LLP to learn more about your legal rights.
First and foremost, monitored anesthesia care (MAC) should only be administered by health care providers who are experts in general anesthesia, resuscitation and the use of emergency equipment. Secondly, it is imperative that anesthesia providers diligently monitor ventilation, oxygenation, cardiovascular status, and neuromuscular function throughout the procedure. Continuous clinical observation and vigilance is the basis of safe anesthesia care.
When emergency situations arise—and they certainly will—anesthesia providers must be prepared to respond with proper airway management and the administration of fluids and emergency drugs. They must also be prepared to provide Basic Life Support (BLS) or Advanced Cardiac Life Support (ACLS) protocols when necessary. Unfortunately, anesthesia accidents occur too often because anesthesia providers fail to exercise that degree of skill and care required under the circumstances; Examples include:
- Failure to timely react to decreasing oxygen saturation levels
- Failure to properly monitor a patient's vital signs (pulse, respiration, blood pressure, oxygen saturation)
- Failure to properly administer oxygen during the procedure
- Administering too much anesthesia medication such as propofol
- Administering the wrong medication
- Failing to react to physiological signs of distress
- Failure to set proper threshold alarms on monitoring devices
- Failure to have the proper equipment ready in case of emergency
- Failure to follow BLS and ACLS protocols
- Failure to deliver emergency medications in a timely fashion or correct dose
- Failure to have adequate number of qualified personnel immediately available to assist in the event of emergency
When mistakes occur during the administration of anesthesia, the consequences can be devastating and include:
- Anoxic brain injury
- Brain damage
- Heart attack or failure
Many injuries can be prevented altogether if medical providers adhere to the standard of care required of them when administering MAC with sedation or other anesthesia. If you or a loved one has experienced injury on account of an anesthesia error committed by a certified registered nurse anesthetist (CRNA), anesthesiologist, or other medical provider, you should contact an attorney at Burnside Law Firm LLP for a free initial consultation to learn more about your legal rights. We have successfully represented people injured by anesthesia errors and we have the resources necessary to pursue meritorious claims.
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If you suspect medical negligence, do not hesitate to contact our Augusta, Georgia, lawyer. We offer experienced, strategic advocacy in cases involving IV infiltration and IV injury. Call 800-569-1937 or contact us by e-mail for an initial consultation.