@kathyhg I recently had a major surgery. The steps that were taken with me were that the pulmonologist in Massachusetts corresponded with the surgeon in Connecticut saying that I would be at high risk for general anesthesia if this, this, and that were necessary in terms of incisions etc. . General anesthesia in terms of being intubated might have been problematic due to my lungs, but ultimately I was given a spinal and something else, and honestly, I don’t remember even getting the spinal! Your best bet, in my opinion, is to make sure all doctors involved are aware of your MAC and communicate either by phone or email as to what is the safest anesthesia that will work for you and for your particular surgery. It’s an easy request for them to honor and will set your mind at ease in the long run. My surgeon actually insisted on having that piece in place. Good luck. irene5