Level 4, general anesthesia is the most comprehensive state of anesthesia. During this state, the patient has a loss of consciousness, and is not in a position to respond to requests or prompts (such as to roll up on their left side, to raise their arm or to answer any questions)—nor will they experience or remember any pain. There are medical procedures which would require a general anesthesia versus a MAC anesthesia or a local anesthesia. These are all determinations that must be made by the anesthesiologist—but while keeping the wishes of the patient in mind.