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Is the anxious patient a good candidate for surgery under monitored anesthesia care (MAC)?
This particular patient is quite anxious and is anticipating postoperative nausea and vomiting (PONV). His baseline agitation may prevent a quiescent state during microsurgery. Oversedation could easily precipitate hypoxia and hyper-carbia, resulting in loss of patient cooperation. Intravenous narcotics might exacerbate nausea and vomiting.
Intraoperative and postoperative nausea, vomiting, and dizziness are recognized complications of middle ear surgery. Prophylactic administration of antiemetics may be helpful in addition to benzodiazepine sedatives. 5-Hydroxytryptamine (5HT) blockers, such as ondansetron, granisetron, or dolasetron, may prove to be useful; how-ever, insufficient data exist to warrant their prophylactic use in middle ear surgery. 5HT blockers when combined with dexamethasone have an excellent record of preventing PONV in the general population. Low-dose propofol infu-sion during the procedure, as part of the sedative tech-nique, may also help to keep the patient calm and reduce the risk of PONV.
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