Advances in the Clinical Application of MAC: A Review of Drug Selection, Combination Therapy, and Administration Methods

Abstract

Monitored anesthesia care (MAC) is a widely used anesthetic technique designed to provide titratable sedation and effective analgesia during a variety of medical procedures, ensuring patient comfort and safety. MAC is not only applied in surgical interventions but is also extensively used in diagnostic examinations such as sedation gastrointestinal endoscopy and pediatric magnetic resonance imaging (MRI) scans. With ongoing advances in medical technology, the selection of drugs, optimization of combination strategies, and refinement of administration methods for MAC continue to evolve. This narrative review, based on a structured literature search, summarizes recent developments in MAC drug selection, combination therapy, and administration methods. We highlight the quality and limitations of the current evidence, provide scenario-based practical recommendations, and outline emerging agents and delivery technologies, alongside unresolved questions that warrant further investigation.Overall, the existing evidence indicates that refined drug combinations (eg, propofol or dexmedetomidine in combination with opioids) tailored to specific procedural contexts and individual patient needs, alongside target-controlled infusion technology, are significantly enhancing the safety, comfort, and efficiency of MAC. However, the optimal drug combinations and standardized administration pathways still require further high-quality research.