General Anesthesia Vs. MAC  

General anesthesia and MAC (monitored anesthesia care) are two of the most commonly used forms of anesthesia in the plastic surgery industry. Anesthesia is a safe and time-tested form of medicine used to temporarily reduce sensation or eliminate feeling in a particular area of the body. It is most often used during medical or surgical procedures to reduce pain, anxiety and discomfort.

While many patients understand the general concept of anesthesia, the differences between general anesthesia and MAC may be unfamiliar to some.

In this guide, we will explore the core differences between these two types of anesthesia, as well as when each type may be used. We will also discuss the advantages and disadvantages of each method so that you can understand and potentially decide the best option for your surgical needs.

The Basic Of General Anesthesia

General anesthesia is a specially formulated combination of medications designed to cause a complete loss of consciousness and block body sensations during surgery. Because they are placed in a sleep-like state, patients who are under general anesthesia are unable to feel anything that happens to their bodies throughout the procedure, including the pain of the procedure or the movement of the anesthetist’s hands as he or she performs medical procedures.

This type of anesthesia can be combined with muscle paralysis so that the anesthetist can more easily move the patient’s body. General anesthesia is most frequently used for surgical procedures, such as hip replacements, cosmetic procedures and even surgeries to correct congenital birth defects.

The most common method of delivery for general anesthesia involves a combination of an intravenous (IV) line through the arm and anesthetic gases to induce a sleep-like state.

The Benefits Of General Anesthesia 

• Vital airways are always protected
• No movement from the patient during the surgery
• No chance of remembering anything from the procedure
• No chance of feeling anything during the procedure

What Are The More Serious Risks Associated With General Anesthesia?

Once again, these events are exceedingly rare and controls are put in place to address them immediately if they should arise, but they include:

• Peripheral nerve damage
• Aspirational pneumonitis
• Waking up under anesthesia
• Cardiac arrest

What Surgeons Do To Improve Safety:

• Perform due diligence when it comes to learning about a patient’s medical history
• Do not agree to administer anesthesia to elderly patients who do not need it or those that suffer from heart disease, Parkinson’s, Alzheimer’s or have suffered a stroke
• Adopt the latest technology, including wireless communication and monitoring equipment
• Educate patients about what they can do at home before and after their procedure to ensure their own safety

What Are The Side Effects Of General Anesthesia?

• Nausea & vomiting
• Dry mouth & sore throat
• Sleepiness & fatigue
• Slower reflexes
• Confusion as you begin to wake up
• A temporary impact on your short-term memory

“Unhealthy people may have an increased risk of experiencing a cardiovascular events — which makes our detailed patient screening process so important. There is a greater likelihood of post-operative nausea and vomiting, however we now have a litany of medications, as part of ERAS protocol, that we can offer to prevent this. It also takes longer to wake up after surgery.”

What Does General Anesthesia Feel Like?

Most patients describe the feeling as a warm or cold injection. Some have mentioned a very temporary stinging feeling near the IV that only lasts for a few seconds.

At Donaldson Plastic Surgery, We Employ General Anesthesia While Performing The Following Procedures:

• Breast surgeries (breast augmentation, lift, reduction and implant removal)
• Tummy Tuck
• Liposuction
• All neck lifts and the large majority of facelifts

What Is MAC Anesthesia?

MAC stands for “monitoring anesthesia care.” Under MAC, a patient receives medication through an IV to sedate them while breathing on their own with assistance from an oxygen mask. They may have lucid moments where they remember being in the operating room but for the most part, they experience amnesia about the process once they wake up. The patient doesn’t require a breathing tube and can potentially move around during the procedure. They are continuously monitored and sedation is adjusted as needed.

MAC is sometimes referred to as “conscious sedation” or “twilight sleep.” This form of anesthesia is used for minor or quicker surgical procedures, such as colonoscopies, dental procedures and some eye surgeries.

The Drawbacks Of MAC

Because the patient is still conscious, they have the ability to move throughout a procedure which can be very dangerous and make a surgeon’s job more difficult. The patient may require more local anesthetic throughout the process which can lead to Local Anesthetic Systemic Toxicity (LAST). If they become over-sedated, they may lose their airway which would require emergent intubation. Patients may also remember parts of their procedure which can be unpleasant.

The Core Differences Between General Anesthesia & MAC

General anesthesia is often used during surgical procedures that require a complete loss of consciousness and involves the use of an endotracheal tube in the throat. This type of anesthesia is only available at a few hospitals and surgery centers, and it must be scheduled in advance. MAC is used in a wide range of minor procedures. This method is used more often than general anesthesia because it is less intrusive than IV monitoring and satisfies the needs of more common surgeries.

Can A Patient Ask For MAC Anesthesia Instead of General Anesthesia?

Context matters strongly when discussing MAC as an alternative to general anesthesia. Simply put: there are some procedures that are too intensive to have performed while the patient is in a twilight state. A patient can endorse a specific method over another but the ultimate decision of which type is safest is up to the doctor and anesthesiologist. A patient can then decide if they feel comfortable moving forward with that surgical procedure based on the professional recommendation.

“Some facelift-only patients may be candidates for MAC anesthesia, and I am willing to consider this as an option. However, they still have to go to the operating room because we do not have anesthesia providers in our office.”