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 consciousness and sensation or eliminate feeling in a particular area of the body. It can also be used to reduce anxiety and discomfort surrounding a procedure.

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.

This type of anesthesia can be combined with muscle paralysis so that the surgical team can more easily move the patient’s body. General anesthesia is frequently used for surgical procedures such as hip replacements, cardiac surgery, 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. 

The Benefits Of General Anesthesia 

• Breathing is 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 

Is General Anesthesia Safe? 

Yes, when performed by a licensed anesthesia provider, General Anesthesia is considered very safe. The risk of a catastrophic event from anesthesia alone is about 0.01 and 0.016% — and this includes emergency surgeries. This risk is even lower in healthy people undergoing elective surgeries. While under general anesthesia, a patient receives constant support to maintain proper breathing and close monitoring to ensure their vital functions (heart rate, blood pressure, oxygen levels, etc.) are at optimal levels. 

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: 

• Aspiration
• Waking up during a procedure
• Cardiac events
• Loss of Airway

What Surgeons Do To Improve Safety:

• Perform intensive due diligence when it comes to learning about a patient’s medical history 
• Do not agree to administer anesthesia to elderly or unhealthy patients who are at high risk of complications
• Adopt the latest monitoring and communication technology
• Educate patients about what they can do at home before and after their procedure to ensure their own safety

What Patients Can Do To Improve Safety:

• Partake in a fast for 6 – 8 hours before the procedure
• Stop smoking at least 4 weeks before surgery
• Abstain from alcohol for at least 48 hours beforehand
• Maintain a healthy body weight
• Detail any medications being taken well ahead of time
• Scour family medical history for any events of adverse reactions to general anesthesia
• Be truthful and transparent about personal medical history 

What Are The Side Effects Of General Anesthesia? 

• Nausea & Vomiting (medications can be given to combat this)
• Dry mouth & sore throat 
• Sleepiness & fatigue
• Confusion when waking up
• A temporary impact on short-term memory 

“Unhealthy people may have an increased risk of experiencing cardiovascular events with General Anesthesia — which makes our detailed patient screening process so important. There is also a greater likelihood of postoperative nausea and vomiting. However, we have a litany of medications, as part of our Post-Operative Recovery Protocol that we can offer to prevent this. It also takes longer to wake up after surgery.”

Dr. Michelle Sieffert

What Does General Anesthesia Feel Like?

Most patients describe the feeling as a warm or cold feeling sweeping over their body. Some have mentioned a very temporary stinging feeling in the IV that only lasts for a few seconds before falling asleep. Some people have very lucid dreams during anesthesia, others don’t remember dreaming at all. Most people feel like they were asleep for mere minutes once they wake up.

General Anesthesia Recovery

Throughout the procedure, different medications will be administered through the IV to help aid in recovery. These include:

• Antibiotics 
• Pain control medications 
• Medicines to reduce nausea 

It can take up to 24 hours for the anesthesia medications to be fully out of your system, which makes it incredibly important to have adult supervision while you recover. While the more inhibiting side effects of anesthesia medications will be gone after a day, the lingering tiredness and fatigue may last up to 72 hours depending on the patient and the intensity and length of their surgery. 

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
• Deep Neck Lifts
• The large majority of Facelifts 
• Rhinoplasty

---

What Is MAC Anesthesia? 

Under Monitored Anesthesia Care (a.k.a. MAC), a patient receives medication through an IV to sedate them while breathing on their own with assistance from an oxygen mask. The medications are often the same ones used in General Anesthesia, just in lower dosages. 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. 

Is MAC The Same As Sedation?  

No. The primary difference between MAC and sedation is the level of patient consciousness, monitoring, and dedicated resources, as well as the amount of breathing support required (such as the use of a breathing tube) that go into the process.

What Is MAC Recovery Like? 

Relative to general anesthesia, MAC recovery has a shorter recovery timeline. Fatigue and other after-effects of the sedation only last up to several hours after the procedure, and are more mild in nature. It may take up to 24 hours for all of the anesthetic medications to be out of your system. 

The Benefits Of MAC Anesthesia 

The advantages include a lowered risk of post-operative nausea/vomiting, no necessary breathing tube and a quicker wake-up after surgery. 

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 to keep them comfortable 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 that 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 to maintain comfort and safety, and involves the use of an endotracheal tube to assist with breathing. This type of anesthesia is available at most all hospitals and surgery centers. MAC is used in a wide range of smaller procedures in both hospitals and surgery centers, and is even used in office-based procedures. It is becoming more widely used as anesthetic medications evolve and improve. This method is used more often than general anesthesia because it is less intrusive and satisfies the needs of less invasive surgeries. 

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

Context matters strongly when discussing MAC as an alternative to general anesthesia. There are some procedures that are simply 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 patients may be candidates for MAC anesthesia. However, they still have to go to the operating room because we do not have anesthesia capabilities in our office.”

Dr. Michelle Sieffert

About The Author

Dr. Michelle Sieffert is a board-certified plastic surgeon at Donaldson Plastic Surgery. She works with trained and licensed anesthesia providers in the operating room to ensure the utmost safety for her patients. Dr. Sieffert continues to adapt her advanced surgical techniques to meet the best practices surrounding anesthesia while dedicating time to educating patients about the benefits of both general anesthesia and MAC.