Anesthesia when the power goes out 

Was going to say, I’m not in the hospital yet but I have worked on the buildings before and I thought I remembered every one I had ever worked on having some pretty massive generators either in the parking garage/basement or roof. I would imagine if there was a flood and the generators were in the basement it might be trouble, but I’m sure there are protocols for that too.

Hello fellow ICU enthusiast 😅 We have a really good backup power in my ICU we had it tested recently when there was massive overload/ "hackervattacks" (that's what they told us) targeting our power infrastructure (Sweden 2023...) we had 10 power outages / day for more then a week. But that's not what I was going to way in on. I had something scarier happen afew years back... when there was a lighting strike in the main O2... Thingy... Turns out that there was no actual pressure monitor on the main O2 flow so suddenly all 10 respirators all over the ward started doing "the bad beep"... I can tell you that there was a hussle with getting tubes hooked up.. Oh yes, there was a hussle 😂

My cousin is a gynecologist in Palestine and had to deliver 8 babies without anesthesia because ...well...there was no electricity and it was tough

Was it the Spacelabs machine?

wow, much respect to you and the doc, that would be super hectic

@@ConnerColemanMSHS no, it was a Draeger if my memory serves me correctly.

That’s great. The US likewise mandates that hospitals have backup generators that can run for at least 96 hours. However it is possible for backup generators, or the electrical system connecting them to the ORs, to malfunction.

Make sure they're not in the basement.

Yes, during Hurricane Sandy in New York City the back up generators were flooded. I specifically remember NICU nurses carrying preemies down staircases while manually ventilating them.

You would have thought they would’ve learned not to put the generators in the basement after what happened during Allison and Katrina.

@@mariachi2013 the hospitals in NY were built long before either of those storms.

What we do is just start the generator and them the whole building *usually* has power.

In my hospital, we had a backup generator plus a large battery bank UPS. (Universal Power Supply) for the ORs. No surgeries could be started unless there was two sources of power. That means that no surgeries could be started if the utility power was out or the emergency generator was offline. Any started surgeries that were started could be completed. When we lost utility power, the lights didn't even blink in the ORs. All OR equipment kept running like there wasn't even a problem. When the building first opened, we had a lot of power loss until they put in a dedicated line to our building. The generator would start with the loss of power automatically. Our backup generator had a major problem and while it was under repair, we had a trailer mounted generator brought in and wired to the system so surgeries could go on. In my 25 years at that facility, utility power was our only problem. I had a direct phone number to them, so I did not have to go through channels to get the system restored ASAP. Lastly, no surgeries could be started unless a facility engineer was on duty, which was always. That was more than just power. Oxygen, OR air and vacuum as well as HVAC was under our control and responsibility. He had to be there 1/2 hour before the start of surgeries and stay until the last surgery was completed. I'll stop here before this becomes a book.

I am surprised the machine did not self test its batteries. I have a fairly basic APC UPS on my gaming PC and it self tests monthly, surprised a machine that actually runs a life critical operation does not warn of a failing battery or charge system.

I wonder if there's a documentary on these engineering systems. That sounds incredibly interesting.

Sure, but imagine the case of a faulty circuit breaker, cable cut, etc. - still some potential sources of prolonged outages.

The answer of what to do depends on factors such as: How far along in the surgery are they, how urgent/emergent is the surgery, is it possible and/or safe to complete the surgery vs. end early, and other related factors like these.

It's very rare. Most anesthesiologists in the US will not experience a power loss in their entire career.

Great observation! Nitrogen is actually not piped into operating rooms, but it’s in this simulation lab to drive some of the pneumatic processes that power the simulated mannequin.

Medical air has been specially filtered and also comes at a specific (dry) humidity level. We use that in combination with pure oxygen because delivering 100% oxygen to certain patients can actually pose a health risk (particularly babies and people who have received a cancer drug called bleomycin) and can actually cause lungs to not function as well under anesthesia.

For those that don't know there was an urban legend where people kept dying in scary numbers at a hospital icu and what actually happened was the janitor was unplugging life support to plug in a vacuum. I would feel terrible for the janitor as well as everyone else.

@@bungus2414 You have any idea how many alarms would go off if that was actually true? In a similar vein, we had a facilties guy that went into clean our server room and literally hit the kill button for the entire server room when he just meant to hit the button that unlocked the door.

@@bungus2414 We had a similar problem at a university computer facility located on a floor of the library. Apparently one of the new custodial hires hadn't gotten the proper briefing on how to clean the data center and between 2am and 4am every few days, a rack of servers would lose power, then 10 or 15 minutes later, it'd come back. Then another rack on the other side of the room would lose power similarly. Finally figured out it was a custodian unplugging operating systems and plugging in his cleaning equipment. And shortly afterwards we finally (after years of requesting it) got permission from higher authorities to take the data center off the master facility key so the custodians had to come in only when staff was present. Catching a custodian pawing through grades on printed sheets wasn't enough to convince the administration, but this bit of idiocy got their attention.

I was thinking the same thing. Server rooms have entire walls covered in batteries to bridge the gap, why the hell wouldn't an OR have full-room battery backup lol

Big pressurized tanks

If it's anything like oxygen storage for industry, it's refrigerated liquid oxygen kept under partial pressure in insulated tanks. It's kept liquid so they can store way more oxygen in the same volume. It boils off fairly easily, so they can keep a constant pressure in the lines, and vent any excess safely away from the building.

I see no reason why you can't. It's administered by hand when you're first anaesthetised, and bags of fluid like saline are gravity fed very regularly so i suspect there's a similar set up for syringes in theatre so the anaesthetist has free hands for everything else. Edited to add due to below correction, yes anesthesia can be continued to be administered by hand, but not propofol evidently!

As shown here, inhaled anesthetics can be delivered without power supply, so they could substitute propofol infusion to maintain the patient unconscious. In the event of a formal contraindication to inhaled anesthetics, then yes, you could try to emulate the continuous infusion using an app to calculate the infusion rate, but it would be cumbersome. Ideally we would rather use other IV anesthetic that could be given in a bolus dose, knowing that the patient would most likely have a delayed recovery, given the alternatives usually have longer times to be metabolized. The same reasoning applies to the infusion of remifentanil.

@@MishaElla94, the continuous infusion of propofol and remifentanil, to mention only the most common drugs used for total IV anesthesia, are meticulously controlled by specific algorithms that will, at any given moment, inject each one’s exact amount solely to maintain the stipulated plasmatic concentration. This allows us to have fewer adverse effects and ultimately a smoother and faster wakening after surgery. To reproduce this by manually injecting them is very difficult, if not impossible.

very interesting, thank you! I was running purely on my experience with fluids as a ward RN, glad to be further educated, much obliged. @@henriquelaydner4080

​@@henriquelaydner4080see: Michael Jackson

It does not, the whole hospital has backup generators that power the whole hospital

Yes! This video goes into more detail than the prior video.

epic!@@MaxFeinsteinMD

It’s not impossible, but very unlikely. Even more than experiencing such a scenario. Moving patients around is one of the most challenging things in a hospital, more so when they are in critical condition, which is exactly what an anesthetized patient being operated is, no matter how healthy he was prior to surgery. In most cases it would be safer to work around the electrical problem and proceed in the same room.

Yes hospitals in many countries (including mine, the US) are actually required by law to have backup generators.

I'm not Max, but I know someone who studied medicine in the UK (pre-Brexit), and then trained in Anesthesiology at Metropolitan Hospital in New York City. I don't know whether she matched or applied directly, but I do know that hospital does accept some non-match applications.

Separately, mid 30s is definitely not too old to be accepted into US medical training. I personally know at least a few others who are doing residency from that starting point right now.

Depends on the drug. Propofol doesn't, and fentanyl does, for example.

Mt. Sinai Hospital has a very robust backup generator system.