Monitored Anesthesia Care: Less Safe than You Think

Rates of respiratory complications were higher with MAC than those previously reported with endoscopist-directed propofol sedation.

Research on safety outcomes of monitored anesthesia care (MAC) is lacking. Only one small study of MAC provided by certified registered nurse anesthetists has been reported.

To document adverse outcomes of MAC, researchers retrospectively reviewed 17,999 endoscopic procedures performed during 8 years in a hospital in Italy. Patients received MAC in cases of increased anxiety or therapeutic difficulty of the procedure.

Complications during MAC occurred in 792 patients (4.5%). Hypotension, which necessitated intervention, occurred in 312 patients (1.8%) and involved intravenous (IV) fluids or colloid in all patients; 22% received pharmacologic support with IV ethylephrine. Aspiration occurred in 18 patients (0.1%). The severity of these events …

Reviewing Author

Douglas K. Rex, MD

Disclosures

Consultant/Advisory BoardOlympus Corporation America; Boston Scientific

Speaker’s BureauOlympus

Grant/Research SupportMedtronic; Boston Scientific; Colonary Solutions; Paion Medical; Medivators; Braintree Laboratories

Editorial BoardsWorld Journal of Gastroenterology; The Journal of Clinical Gastroenterology; Techniques in Gastrointestinal Endoscopy; Gastroenterology & Hepatology; Expert Review of Gastroenterology & Hepatology; Medscape Gastroenterology; World Journal of Gastrointestinal Pharmacology and Therapeutics; Annals of Gastroenterology & Hepatology; World Journal of Gastrointestinal Oncology; Comparative Effectiveness Research; Journal of Anesthesia & Clinical Research; Gastroenterology; World Journal of Gastrointestinal Pathophysiology; Gastroenterology Research and Practice; GI & Hepatology News; Gastroenterology Report; Clinical Epidemiology Reviews; JSM Gastroenterology and Hepatology; GI Journal Watch; Austin Journal of Gastroenterology; World Journal of Gastrointestinal Pharmacology & Therapeutics

Leadership Positions in Professional SocietiesAmerican Society for Gastrointestinal Endoscopy (Treasurer); US Multi-Society Task Force (AGA, ACG, ASGE) (Chair)

Douglas K. Rex, MD

Disclosures

Consultant/Advisory BoardOlympus Corporation America; Boston Scientific

Speaker’s BureauOlympus

Grant/Research SupportMedtronic; Boston Scientific; Colonary Solutions; Paion Medical; Medivators; Braintree Laboratories

Leadership Positions in Professional SocietiesAmerican Society for Gastrointestinal Endoscopy (Treasurer); US Multi-Society Task Force (AGA, ACG, ASGE) (Chair)