Department of Anesthesiology, Critical Care & Pain Management - Hospital for Special Surgery, New York, NY, 10021, USA.
Department of Anesthesiology, New York Presbyterian, Columbia University Irving Medical Center, New York, USA.
BMC Anesthesiol. 2021 Jun 29;21(1):183. doi: 10.1186/s12871-021-01403-9.
Monitored Anesthesia Care (MAC) is an anesthetic service involving the titration of sedatives/analgesics to achieve varying levels of sedation while avoiding general anesthesia (GA) and airway instrumentation. The goal of our study was to determine the overall incidence of conversion from MAC to general anesthesia with airway instrumentation and elucidate reasons and risk factors for conversion.
In this retrospective observational study, all non-obstetric adult patients who received MAC from July 2002 to July 2015 at Mount Sinai Hospital were electronically screened for inclusion via a clinical database. Patient, procedure, anesthetic, and practitioner data were all collected and analyzed to generate descriptive analyses. Subsequent univariate and multivariate analyses were used to identify specific risk factors associated with conversion to GA.
Overall, 0.50% (1097/219,061) of MAC cases were converted to GA. Approximately half of conversions were due to the patient's "intolerance" of MAC (with or without failed regional anesthesia), while the other half were due to physiologic derangements. Body mass index, male sex, American Society of Anesthesiologists Physical Status Classification, anesthesia team composition, and surgical specialty were all associated with risk of conversion to GA.
This is one of the first and largest retrospective studies aimed at identifying reasons and risk factors associated with the conversion of MAC to GA. These findings may be used to help better anticipate or prevent these events.
监测麻醉管理（MAC）是一种麻醉服务，涉及镇静/镇痛药物的滴定，以达到不同程度的镇静，同时避免全身麻醉（GA）和气道仪器。我们研究的目的是确定从 MAC 转为 GA 并进行气道仪器的总体发生率，并阐明转化的原因和危险因素。
在这项回顾性观察研究中，通过临床数据库对 2002 年 7 月至 2015 年 7 月在西奈山医院接受 MAC 的所有非产科成年患者进行电子筛选以确定是否纳入。收集并分析患者、手术、麻醉和执业者的数据，以生成描述性分析。随后进行单变量和多变量分析，以确定与转为 GA 相关的特定危险因素。
总体而言，0.50%（1097/219061）的 MAC 病例转为 GA。约一半的转化是由于患者对 MAC 的“不耐受”（伴有或不伴有局部麻醉失败），而另一半是由于生理紊乱。体重指数、男性、美国麻醉医师协会身体状况分类、麻醉团队组成和手术专业均与转为 GA 的风险相关。
这是首次也是最大的旨在确定 MAC 转为 GA 的原因和危险因素的回顾性研究之一。这些发现可用于帮助更好地预测或预防这些事件。
