Hadzic's Regional Anesthesia > Part II. Foundations of Regional Anesthesia > Section Two. Pharmacology > Chapter 11. Sedation–Analgesia during Local & Regional Anesthesia Paul F. White, PhD, MD

Sedation–Analgesia during Local & Regional Anesthesia: Introduction

"During local and regional anesthesia, it is a common practice to administer both sedative and analgesic medications to enhance patient comfort during the operation. Use of local anesthetic infiltration and peripheral nerve blocks (PNBs) techniques in combination with intravenous (IV) sedative–hypnotic and analgesic drugs is commonly referred to as monitored anesthesia care (MAC). In many centers around the world, over 50% of all ambulatory (day-surgery) procedures are performed utilizing these techniques (Table 11–1).¹ When patients undergo surgical procedures under local anesthesia with IV sedation—analgesia in the operating room (OR), the old terminology used to describe the care of these patients as "conscious sedation." As the term implies, conscious sedation was a minimally depressed level of consciousness that retained the patient's ability to maintain an airway independently and continuously and to respond appropriately to physical stimulation and verbal commands. The American Society of Anesthesiologists (ASA) avoids this term in their Practice Guidelines for Sedation and Analgesia by Non-anesthesiologists² because it is imprecise and instead refers to this practice of anesthesia as MAC...."