Monitored Anesthesia Care (intravenous sedation)

Monitored Anesthesia Care (MAC) is a type of anesthesia that is used for certain types of surgeries or medical procedures. Unlike general anesthesia, which puts you to sleep completely, MAC is a form of sedation that allows you to remain conscious but relaxed throughout the procedure.

During MAC, you will receive medications that will make you feel drowsy and relaxed, but you will still be able to breathe on your own and respond to verbal commands from the medical team. The medications used in MAC may include a combination of sedatives, pain relievers, and local anesthetics.

A skilled anesthesia provider will closely monitor your vital signs, such as your heart rate, blood pressure, and oxygen levels, throughout the procedure to ensure your safety and comfort. If you experience any discomfort or pain, the anesthesia provider can adjust the medication to alleviate these symptoms.

MAC is often used for procedures that are considered to be less invasive, such as colonoscopies, endoscopies, or minor surgeries, and is generally considered to be a safe and effective option for patients who may not need general anesthesia. However, it’s important to note that not all procedures are suitable for MAC, and your anesthesiologist will determine which type of anesthesia is best for your specific medical needs.

General Anesthesia

General anesthesia is used to induce a temporary loss of consciousness and sensation to pain during a surgery or medical procedure. Unlike other forms of anesthesia, such as local or regional anesthesia, which only numb a specific part of the body, general anesthesia puts the entire body in a state of unconsciousness.

During general anesthesia, medications are administered through an IV or inhalation to induce a state of unconsciousness, allowing the surgical team to perform the procedure without causing the patient any pain or discomfort. In addition to unconsciousness, general anesthesia also causes a temporary loss of reflexes, including the gag reflex and a temporary airway in the form of a breathing tube or a laryngeal mask airway is typically inserted after the patient is asleep.

The medications used for general anesthesia are carefully selected and dosed based on the patient’s age, weight, medical history, and other factors to ensure a safe and effective outcome. Anesthesia providers continuously monitor the patient’s vital signs, such as heart rate, blood pressure, oxygen saturation, and carbon dioxide levels, throughout the procedure to make adjustments as necessary.

After the procedure is complete, the patient is carefully monitored in a recovery area until the effects of the anesthesia wear off. Some patients may experience temporary side effects of general anesthesia, such as nausea, vomiting, sore throat, or dizziness, but these symptoms typically resolve within a few hours.

Regional Anesthesia

Regional anesthesia is a type of anesthesia used to block sensation to a specific area of the body, such as an arm or a leg, during a surgical procedure. Unlike general anesthesia, which puts the entire body into a state of unconsciousness, regional anesthesia only numbs a specific area of the body.

Ultrasound-guided nerve blocks are a type of regional anesthesia that involves the use of ultrasound imaging to precisely locate and target a specific nerve or group of nerves with medication. The ultrasound technology allows the anesthesia provider to visualize the nerves and surrounding tissues in real-time, which helps to increase the accuracy and safety of the procedure.

During an ultrasound-guided nerve block, the patient lies down on an examination table, and the ultrasound probe is placed on the skin over the area where the nerves are located. The anesthesia provider can then visualize the nerves on a monitor and use a needle to inject a local anesthetic medication directly into the nerves, which blocks sensation to the targeted area of the body. Ultrasound-guided nerve blocks are commonly used for procedures such as joint replacement surgeries, as well as other orthopedic procedures.

Regional anesthesia is often coupled with intravenous sedation or general anesthesia depending on the extent of the surgery.

Examples of nerve blocks performed regularly by our anesthesiologists include: supraclavicular, interscalene, axillary, femoral, adductor, popliteal, truncal blocks (rectus sheath, transversus abdominus plane, PECS, serratus anterior), quadratus lumborum, etc.

Obstetric Anesthesia

AAR provides in-house obstetric anesthesia coverage 24 hours a day, seven days a week. Our anesthesiologists cover obstetric services at three Rochester Regional Health hospitals – Rochester General Hospital, Unity Hospital, and Newark Wayne Hospital. Both Rochester General and Unity cover 1500-1700 annual deliveries and Newark Wayne Hospital covers approximately 750 annual deliveries.

Our anesthesiologists, some who are OB anesthesia fellowship-trained, are skilled in the assessment and management of both low and high-risk pregnant patients. Our goal is to deliver the safest and highest level of care for both mother and baby.

When patients present on Labor and Delivery, we are available to provide a variety of anesthetic services, including:

• Epidural Analgesia Epidurals are the most common form of anesthesia used on the Labor and Delivery floor. Often patients request alternative forms of pain control, such as IV pain medications and nitrous oxide, in early labor. As labor progresses, patients may request epidural analgesia. Our anesthesiologists are notified of the epidural request and come to the patient’s room to discuss the procedure, including risks and benefits. We place epidurals in the patient’s labor room and we continue to monitor patients throughout their labor course to ensure adequate pain control. If a patient requires cesarean delivery during their labor and she has an epidural in place, the epidural can often be used to make patients numb and comfortable for surgery.
• Spinal Anesthesia Spinal anesthesia is the preferred, and most common, anesthetic used for cesarean delivery. Spinal anesthesia delivers a single dose of medication into the spinal fluid to ensure complete numbness during surgery. This allows patients to be awake for the duration of their cesarean section. In the majority of cases, we allow patients to have a support person with them during their section.
• General Anesthesia This form of anesthesia is reserved for patients who require urgent or emergent cesarean delivery when there may be inadequate time to provide neuraxial anesthesia (spinal and epidural anesthesia). General anesthesia may also be used for patients who are unable to have a spinal or epidural placed due to pre-existing medical conditions which would make it unsafe for them to have neuraxial anesthesia.

Our practice offers an OB Anesthesia consult service for patients who have complex medical conditions or who have questions or concerns about anesthesia. Often patients are referred to our OB Anesthesia department by their OBGYN, Maternal Fetal Medicine physician, or midwife provider if the patient requires additional coordination of care between OB, Anesthesia, and other medical departments.

Cardiac Anesthesia

Within AAR, our Cardiothoracic Division is a small group of anesthesiologists with fellowship training in adult cardiothoracic anesthesia and with certifications in advanced Perioperative Transesophageal Echocardiography.

We provide anesthesia and procedural imaging for a large volume of complex heart and lung operations, including but not limited to:

• Complex coronary revascularization on and off cardiopulmonary bypass (CABG, OPCAB)
• Open and minimally invasive treatment of valvular heart disease (e.g. Open valve replacement or repair, Minimally invasive MVR/AVR/TVR)
• Durable and temporary mechanical circulatory support in advanced heart failure (LVAD, ECMO, Impella)
• Operations on the proximal thoracic aorta
• Robotic (minimally invasive) pulmonary cancer resections including lobectomy and pneumonectomy
• Robotic (minimally invasive) complex foregut operations (e.g. Ivor-lewis / Mckeown esophagectomy)

The Sands Constellation Heart Institute also offers a high volume, cutting edge structural heart intervention program and electrophysiology lab. The AAR CT division provides interventional echocardiography for a variety of structural heart procedures such as:

• Transfemoral and alternative access TAVR, including minimalist approaches to anesthesia and more complex procedures (BASILICA, Valve-in-valve, etc)
• Transcatheter mitral interventions (MitraClip TEER, Valve-in-valve implantation for failed mitral prosthetics, balloon mitral commissurotomy)
• Investigational transcatheter tricuspid valve interventions (CLASP II trial)
• Transcatheter PFO and ASD closure
• Left atrial appendage occlusion (Watchman device)
• High-risk lead extraction
• Impella protected complex high risk (CHIP) PCI including left main disease
• ECMO protected RFA for ventricular tachycardia

We are also involved in SCHI’s clinical research. Most recently, along with cardiology, several of our team members were sub-investigators on the ASAP-TOO and Champion AF trials, for which RGH was one of the nationwide research sites. These were prospective, randomized, multi- center investigations to establish the safety and effectiveness of the WATCHMAN Device for subjects with non-valvular atrial fibrillation who are deemed not suitable for anti-coagulation therapy to reduce the risk of stroke.