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Death During Monitored Anesthesia Care

  • Kevin D. Marcus
  • Jonathan L. Benumof
Chapter

Abstract

Out of the operating room surgical procedures are generally a large part of any typical anesthesia practice. While some of these off-site procedures may not be perceived to be as invasive or complex as their operating room counterparts, these procedures nevertheless present a unique challenge to the anesthesiologist. Often, these out of the OR locations have different equipment and resources that, if unrecognized, can leave an anesthesiologist underprepared in an emergency. This chapter presents an unfortunate case of loss of life after an out of the OR gastroenterology procedure where monitored anesthesia care (MAC) was employed. Topics explored include the definition of MAC and a review of the ASA guidelines on standard monitors and levels of sedation, as well as a review of the use of propofol for MAC anesthesia. This chapter also examines the advantages of having an anesthesia machine available to anesthesiologists in off-site locations, as well as a brief review of the use of exhaled carbon dioxide to confirm endotracheal tube placement during cardiac arrest.

Keywords

Endoscopic retrograde cholangiopancreatography (ERCP) MAC anesthesia Depth of anesthesia Moderate sedation Deep sedation Conscious sedation ASA standard monitors Ventilation monitoring Oxygenation monitoring Capnometry Capnography Anesthesia in remote locations Anesthesia closed claims Propofol sedation Colorimetric CO2 detection End-tidal CO2 Cardiac arrest Return of spontaneous circulation (ROSC) 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Kevin D. Marcus
    • 1
  • Jonathan L. Benumof
    • 2
  1. 1.Department of AnesthesiologyMission Hospital – Mission ViejoMission ViejoUSA
  2. 2.Department of AnesthesiologyUniversity of California, UCSD Medical Center, UCSD School of MedicineSan DiegoUSA

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