To Your Good Health | Patient has to choose anesthesia
Published 2:46 pm Sunday, August 30, 2026
DEAR DR. ROACH: I’m 78 years old and in pretty good health. 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?
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
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
DEAR DR. ROACH: My doctor has prescribed Cardizem for atrial fibrillation (AFib). I’m already on Xarelto for stroke prevention, but I read that Cardizem lowers your blood pressure, as well as your heart rate. My blood pressure is usually around 130/65 mm Hg in the afternoon and around 110/58 mm Hg in the morning. My heart rate rarely goes above 60 bpm. My electrocardiogram shows a normal sinus rhythm most of the time
I also read that Cardizem shouldn’t be taken with Xarelto, as it can increase the risk of bleeding. Is this drug right for me? I appreciate any advice that you can give
ANSWER: About 4% of North Americans have AFib, which is an abnormal irregular heartbeat. Most people with AFib benefit from anticoagulation such as rivaroxaban (Xarelto), but many also need medication to slow down their heart rate
Not everyone needs it, though, and since your heart rate is seldom high, I’m puzzled as to why your doctor has prescribed diltiazem (Cardizem). It’s very good at slowing down the heart rate in people with AFib, but it’s not clear to me that you need it
Diltiazem does increase the risk of bleeding in people who are taking Xarelto or apixaban (Eliquis), compared to a beta blocker. The risk is small (about 1 extra bleed per 100 people per year), but a beta blocker (such as metoprolol) might be a better choice for someone who’s taking Xarelto if they need a slower heart rate
— 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 or send mail to 628 Virginia Dr., Orlando, FL 32803
