MAC vs GA

[DebDynamite]

Hello. A quick question for you gas guys & gals:
If you were having surgery tomorrow, for an outpatient procedure that takes about 20 minutes, would you prefer MAC or General? My GYN says he does not have a preference, that if I receive MAC it is fine with him, but I'm slated for general anesthesia (through hospital protocol). Should I ask my anesthesiologist to gimme MAC instead? I am in love with my teeth, don't wanna be intubated and am not sure why general is warranted here- I am also assuming that GA has more risks overall & a worse hangover than MAC. pls correct me if I'm wrong, I'm a slow MS3 vaguley remembers Pharm & step I- June was a long time ago you know. Any thoughts on how to politely discuss this with my gas doc tomorrow?

Thanks much.
DebDynamite MS3

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[rn29306]

Assuming you have no contraindications, talk to your anesthesiologist about a LMA. No intubation, no tracheal or vocal cord instrumentation. For sure GA depth of anesthesia. Possible deep removal at the end....I was gonna say it could be a straight up mask case, but 20 minutes is kinda long on the hands / forearms for that.

A MAC could certainly be used, but me personally, if someone were shoving something up my privates, I'd want the benefits of a GA. Most MACs in this case are essentially generals with o2 applied.

I would tend to think that a quick GA with LMA would have less hangover effects than a heavy MAC (ie straight fentanyl and versed based), although a propofol infusion based MAC with narcotic supplementation would certainly have a quick turnaround too.

I'd take a GA LMA over a MAC in this case. Talk to your anesthesiologist. He or she will give you what is safest for you. That's what the pre-op interview is for. Let us know how it goes.

 

[militarymd]

If you look at the ASA's Closed Claims Database....the "MAC" is MUCH more dangerous than GA.....that's just the facts..maam.

 

[DebDynamite]

Thanks much! I'll post post-op with a follow up.

 

[bullard]

Why not let the anesthesiologist decide what's most appropriate instead of bringing up your unfounded concerns? Were you planning on telling the OB/GYN how to do the procedure?

 

[Noyac]

I'd just ask the anesthesia doc tomorrow which one would be best. He/she would probably know best since they know the GYN doc and the procedure being performed.
Bottomline, a 20 min procedure whether GA or MAC will not give you much of a hangover feeling. And I'd doubt that many people would use a endotracheal tube on you for this case anyway.

 

[meddog1]

Get a little Versed, maybe a little Fentanyl pre-op, then just chill and let the sandman take you to dreamland.

 

[VentdependenT]

or one could ask for a spinal and a dexmetatomidine drip....or 10 mg of haldol. EPS be damned.

OR....one could ask for a straight ketamine drip. Is it GA? Is it a MAC? Who knows. Muhahaha.

I still want to try out neuroleptanesthesia but that damn goofy black boxed droperidol is difficult to utilize from a litigious standpoint. Maybe I could whip something up with thorazine eh.

All jokes aside what Noyac said is the best answer.

 

[supahfresh]

MAC is more dangerous because you may be forced to convert to GA in less than optimal conditions.

 

[DebDynamite]

Assuming you have no contraindications, talk to your anesthesiologist about a LMA. No intubation, no tracheal or vocal cord instrumentation. For sure GA depth of anesthesia. Possible deep removal at the end....I was gonna say it could be a straight up mask case, but 20 minutes is kinda long on the hands / forearms for that.

A MAC could certainly be used, but me personally, if someone were shoving something up my privates, I'd want the benefits of a GA. Most MACs in this case are essentially generals with o2 applied.

I would tend to think that a quick GA with LMA would have less hangover effects than a heavy MAC (ie straight fentanyl and versed based), although a propofol infusion based MAC with narcotic supplementation would certainly have a quick turnaround too.

I'd take a GA LMA over a MAC in this case. Talk to your anesthesiologist. He or she will give you what is safest for you. That's what the pre-op interview is for. Let us know how it goes.

I ended up with GA w/LMA & versed to set the mood. My anesthesiologist was great, and I had no worries whatsoever. My initial concers were over the thoughts of having a trainee trying to intubate me (all modesty aside, I have beautiful teeth ), and the hangover feeling. I wasn't worried a bit about the actual competency of the gas doc or anything like that. I'm just vain abut my teeth and my ability to start working out again. The hangover effect is definately here, but I'll be fine tomorrow.

Thanks so much for your timely feedback!

 

[meddog1]

Ahhh yes, the age-old chipped teeth problem. Does happen with some recognizable frequency.

 

[jetproppilot]

I ended up with GA w/LMA & versed to set the mood. My anesthesiologist was great, and I had no worries whatsoever. My initial concers were over the thoughts of having a trainee trying to intubate me (all modesty aside, I have beautiful teeth ), and the hangover feeling. I wasn't worried a bit about the actual competency of the gas doc or anything like that. I'm just vain abut my teeth and my ability to start working out again. The hangover effect is definately here, but I'll be fine tomorrow.

Thanks so much for your timely feedback!

Glad you and your pretty smile emerged OK.