Monitored Anesthesia Care (MAC) is an anesthetic technique that integrates vigilant physiologic monitoring, tailored pharmacologic sedation, and readiness to transition to general anesthesia if required. Unlike simple sedation, MAC is provided exclusively by anesthesia professionals and adheres to full ASA monitoring standards, ensuring rapid recognition and management of airway or hemodynamic compromise. Commonly used agents include propofol, midazolam, opioids, dexmedetomidine, and, occasionally, ketamine, titrated to maintain patient comfort while preserving spontaneous ventilation and hemodynamic stability. Ideal patient candidates are cooperative, medically stable individuals undergoing minimally painful and stimulating procedures, while those with severe comorbidities, anxiety, or difficult airways may require alternative anesthetic approaches. Procedural selection and preparedness to convert to general anesthesia are central to patient safety. For internists, understanding MAC clarifies its distinction from procedural sedation, its pharmacologic underpinnings, and its implications for perioperative risk assessment and postoperative care.