A biting commentary on monitored anesthesia care with conscious sedation.

In summary, a continued emphasis needs to be placed on better operationalization of the concept of MAC and its components, not merely for reimbursement, but for practice sake. Quality risk evaluation and patient assessment guidelines unique to MAC and conscious sedation need to be established and closely adhered to. In 1988, the AANA Board of Directors adopted suggested guidelines for registered professional nurses engaged in the administration of intravenous conscious sedation. These guidelines were an addendum to Position Statement 2.2 entitled "Qualified Providers of Conscious Sedation" and are found in the Professional Practice Manual for the Certified Registered Nurse Anesthetist. It is incumbent upon all CRNAs who provide such services to not only be familiar with but also practice in accordance with these guidelines. Finally, as HCFA directs each Medicare carrier to determine when MAC is the appropriate standard of care, we as providers must recognize the same. Within each case scheduled under MAC lies the challenge to provide and maintain a high degree of vigilance in perhaps the more minor surgical procedure, while always anticipating and recognizing the potential for the unexpected that can make it hard for any professional to swallow.