Monitoring under Anaesthesiologist's Care (MAC) 1. What is MAC? MAC (Monitoring under Anaesthesiologist's Care) is provided by anaesthesiologists for a procedure performed under local anaesthesia or sedation. It may be requested by a surgeon, dentist, obstetrician, physician, endoscopist, radiologist, radiotherapist, or other proceduralists. MAC shall include:   •  Pre-anaesthetic assessment with adequate explanation of the procedures and risks by the responsible anaesthesiologist. •  Adequate instructions for peri-operative preparation (e.g. patient must adequately fast the same time as preparing for general anaesthesia) •  Adequate monitoring of the patient. •  Administration of intravenous sedation if required. •  Other therapeutic measures as required. •  Transfer of patient, if required, to an appropriate Recovery Area. 2. What does Sedation mean? Sedation will often be given to patients during MAC. Definition of Sedation: Sedation is the depression of the central nervous system and/or reflexes by the administration of drugs by any route to decrease patients' discomfort without producing unintended loss of consciousness. 3. What are the risks of sedation during surgical procedures? Risks of Sedation: Protective Reflexes may be obtunded (e.g. Gag Reflex), Aspiration/ Aspiration Pneumonia is a serious consequence if the patient has not adequately fasted. Respiratory drive may be depressed by the sedatives and so as the muscles involved in respiration resulting in Airway Obstruction, Hypoventilation and Hypoxia. The variety of drugs given for sedation will have adverse effects on the Cardiovascular system (e.g. unstable blood pressure and heart rate) which may cause serious complications such as Myocardial Infarction and Cerebrovascular accident. The sedation may outlast the proposed procedure which the patient may be drowsy and sleepy even after the surgical procedures. 4. How long should be the fasting time if I am going to have surgical procedure under MAC? The fasting time should be the same as preparing for having general anaesthesia (GA). Generally, no food should be taken 6 hours and no clear fluid (e.g. water) should be taken 2 hours before the procedure. 5. What are the discharge criteria for discharging patients under same day admission or day surgery ward? Generally, •  The patient should have stable vital signs e.g. Blood Pressure, Heart Rate, Saturation. •  The patient should be fully awake and oriented. •  The patient should be able to eat and drink with no nausea and vomiting. •  The patient should be fully ambulant. •  Pain and nausea should be well controlled. •  The patient should be able to pass urine after the procedure (especially for urological surgery). 6. What are the precautionary measures to take when I am about to go home the same day after the surgical procedure? Discharge of out-patient/ patient for same day admission from hospital: •  The patient should have a responsible adult to escort him/her home. •  The patient should be warned not to drive or operate machinery or sign legal documents for at least 24 hours. •  Written information including possible complications and how to obtain medical advice, if and when required, should be given on discharge.