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Anesthesia

MAC sedation for Flexor Tendon cyst removal?

10/26/2007

Question:

I am going to have a cyst removed from my flexor tendon sheath. They are going to use MAC sedation. I am extremely terrified of this. After reading several reviews on this type of sedation, I am now worried that I will be aware of what is going on, and if this happens, I know I will freak out. I want to tell the anestiageoligist (sp?) that I want him to knock me out before the surgeon even touches my hand. I am so scared. Can you tell me if he will do that. I just don`t think I can go through with this if he doesn`t. The cyst is so painful and restricting that I need to get it removed though. Any advice on this MAC would greatly be appreciated. If you could tell me around about way I will feel when I am on it. I know everyone is different.

Answer:

Clearly you are very frightened about your upcoming surgery. I'm sure you realize that, in the scheme of things, a cyst removal from your tendon sheath is a pretty minor procedure. it's natural to be somewhat anxious but I do wonder what you've been reading and why you are so scared.

If it's pain you are worried about you can be sure that a competent surgeon and anesthesiologist together will make sure you are pain free during the procedure. If it's done under "MAC" - that is moderate or deep sedation - you may be "aware of what is going on" in that you may feel the surgeon touching, moving or applying pressure to your hand. You might be correct about that alone being enough to freak you out, but I doubt it.

After discussing your anxiety with the anesthesiologist I'm sure he or she will give you some anxiety-relieving sedation - such as midazolam - before you reach the operating room. That will probably be enough to calm you down. During the procedure itself you will probably receive additional midazolam together with intravenous sedation - e.g. propofol. These drugs in high enough doses can produce general anesthesia - unconsciousness - but the aim is usually a state of sedation short of general anesthesia.

If you are absolutely unwilling to have the procedure in the way it has been planned you should speak with your surgeon and anesthesiologist, preferably ahead of time. It is likely that they will be rather understanding of your fears, reassure you that all will go well, but offer you the option of general anesthesia if that is what you desire. A necessary condition however is that facility in which you are to have the procedure done must have the capability of providing general anesthesia including the appropriate after care. Also there might be additional out of pocket cost to you.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University