Dr. Neimkin MAC cases

It has come to our attention that we are having to covert from MAC to General on a significant number of Dr. Neimkin’s cases at PDSC. Please use the following to help guide your MAC anesthetic in his cases to avoid this in the future while preserving patient comfort and safety. As always, this is a guide that should be altered as needed to patient-specific circumstances.

Preop:
Ensure patient receives 1-2 mg Versed before heading to OR.

Intraop:
Titrate Versed in 0.5-1 mg doses and Fentanyl in 25-50 mcg doses until patient is resting comfortably but still responsive to verbal and/or noxious stimuli.

May also consider use of Benadryl in 12.5-25 mg doses for patients who are particularly anxious.

Use small doses of Propofol during administration of local by surgeon. Maintain spontaneous ventilation.

If patient cooperation is needed (ex: ptosis repairs), utilize small doses of Versed and Fentanyl to keep patient comfortable throughout remainder of procedure.

If no patient cooperation is required, may consider small doses of Propofol to maintain patient comfort.

Precedex and Ofirmev may be beneficial adjuncts to anesthetic as well.