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DEAR DR. ROACH: I'm 78 years old and in pretty good health. I walk 3 miles four times a week, bike 8 miles once a week, and lift weights twice a week. Besides eye drops for glaucoma, the only medication I take is 20 mg of lovastatin each day. Due to corneal edema, I'll be having a partial cornea transplant.
My surgeon has asked me to decide which anesthesia I want: MAC or LMA. Can you explain the difference between them? Any advice or insights regarding these two forms of anesthesia would be helpful.
-- C.W.S.
ANSWER: MAC is monitored anesthesia care, which is used with a regional block. LMA refers to a laryngeal mask airway, which is used with general anesthesia.
Both of these techniques are commonly used with eye surgeries, and both can be appropriate in some situations.
To be honest with you, if my surgeon asked me to decide between the two types of anesthesia, I'd (gently or maybe not so gently) refuse to do so. Although I'm a physician with a wide knowledge base, this choice is utterly out of my area of expertise! This should be a decision that's made by the surgeon and anesthesiologist, with input from my general physician if necessary.
One major advantage to MAC is that by avoiding general anesthesia, there's less coughing (which is a big potential problem after eye surgery). It may be preferred for an adult with few medical conditions who can understand and cooperate with the procedure. A large study showed very few complications with this choice.
Without knowing anything more about your eye anatomy and the exact procedure that you have planned, I'd generally prefer the less-intensive approach.
Still, as a medical advice columnist, I'm not equipped to make a decision for you, even after some study of the question.
I also think it's unfair to put the burden of this decision on a patient. You don't have the expertise to make this decision. You can certainly give your preference if you have a strong one, but only your eye surgeon and the anesthesiologist can make this decision.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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