Retired RN here. I was working ICU once back in the early 90's and the cardiologist came in along with the anesthesiologist. The patient needed a cardioversion. The cardiologist told a story of a big dude, years ago, who he was performing the same procedure on using only Valium. After about the 3rd shock the guy rose up in the bed and said if you do that one more time I am going to whip someone's ass. Times have changed.
I've had 4 cardioversions 2 were propofol/ketamine (the first time was a really interesting experience .. the second I had a really bad reemergence episode). The other 2 were propofol/fentanyl .. no problems at all there, it's a pretty good combination for cardioversions I'd say.
As somebody who does medical-based stories, this is extremely helpful for accuracy in writing anesthesia-focused scenes. Thank you so much for making this.
After having had far too many surgeries, I can say the anesthesiologist is the most important person working with the surgeon. If he does a good job you have a successful experience. Everyone is afraid of being that one person who is paralyzed but experiencing the whole surgery and can’t tell anyone. Only once did I wake up and see them working on my foot.
Yikes, I recently saw a video of a young woman explaining her experience of being conscious but paralyzed during surgery. She has pretty severe PTSD now.
I found this video super interesting especially given the fact that I had surgery last week (local anesthesia with sedation). I got a copy of my anesthesia report and many of the same medications you mentioned were used (Midazolam, Fentanyl, Propofol, Lidocaine, and Zofran). I was so glad that I didn’t feel sick from the anesthesia as I did after a previous surgery. Little did I know that it’s probably because of the Zofran. Love these videos. They are very interesting!
I’m trying to mentally prepare myself for surgery on Friday. This video was very helpful to help me understand what I could possibly be given. It doesn’t help that I have extreme anxiety so I’m trying to look at everything and I would say this was one of the most informative videos I’ve watched. Thank you so much.
I’ve been under general anesthesia 4 times for reconstructive surgery. The first 2 times, I had such bad nausea that the medical staff were worried about my wrenching causing my stitches to pop! Thank goodness, I had Zofran (Ondansetron) for surgeries 3 and 4; I was completely comfortable when waking up from those
As someone who requires surgery pretty often your knowledge and teaching us has me feeling so much more safe during these procedures as I'm put to sleep. Thank you for your hard work 😄
You always explain things so clearly that it really helps those of us not in the medical profession but having procedures and curious about this component. Why do some patients have such a hard time coming out from anesthesia?
I appreciate that! What you're describing is a phenomenon called delayed emergence, which can be due to factors related to medications that interfere with cognitive function, or occasionally (and unfortunately) neurologic deficits that develop during surgery. There are many other reasons but these are the ones that come to mind first.
...or they might be part-horse tough cooks.... 200m+ barely touched me for a Tietze syndrome attack... took me 23 shots to numb me for a root canal before my dental practice started using osteocentral anæsthesia; and 10x the FSH dosis for Ivf, Just found 5 eeggs but i have the cutest, sweetest kid :)
Thyroid storm from hyperthyroidism can be an emergency, but it's a different one from a patient who has malignant hyperthermia (also can be an emergency).
The main thing is to remove the offending agent (succinylcholine or volatile anesthetics), turn up your gas flows above minute ventilation, 100% oxygen, increase minute ventilation, and get the danteoline in. 2.5 per kilo initially. It has to be mixed with a pretty large amount of sterile water 60 ml and you’ll need multiple vials so you’ll need people dedicated just to mixing it. I’d put in an a-line and get an ABG with electrolytes because the patient is probably hyperkalemic and you’ll have to treat that too. CaCl, insulin, d50, etc. One of the first things you should do is GET HELP and if you’re in an outpatient center call 911 early. pack the groin and axilla with ice. That pretty much covers most of the things that would kill the pt. I believe some protocols also call for placing charcoal filters but if you have removed the vaporizer and increased fresh gas flow above minute ventilation then the chances of rebreathing a significant amount of vapor is pretty low
Thank you for making this video! As a perioperative nurse, it was extremely helpful in understanding what medications induce, maintain and emerge a patient from anesthesia. This is something that you don't learn in perioperative nurse training.
Dang I had no clue there was so much u have to learn in anesthesia the whats whens and how. So u guys not only need to know reg meds but also the more serious stuff! WOW! 🤗
I’m in the U.K. and due to go into hospital in 4 weeks for a cardiac catheter. I’m a congenital heart patient. So have had meany surgeries over my 39 years. I have always had a huge fear of general anaesthetic. Your videos are extremely informative and very easy to understand.
I have worked many, many years in the OR as a RN. I always thought a successful surgery was like a perfected dance. We all work together and get the best and safe outcome. I really enjoy your enthusiasm!
Excellent video. I am a boarded veterinary anesthesiologist who uses IV lidocaine since the 80s. I thought it wasn’t used in human patients anymore. I am glad it is still in use :)
Thank you very much for this video. I find it super interesting! I had surgery a few months ago and I became really interested in medicine and anesthesia. Have a great day! :)
You’re a smart young man, I wish more young men would strive to achieve the skills you now possess. I just had one of your colleuges put me under for 5.5hrs at North Central Surgical Center, Dallas, Tx. I think your creating these videos help educate the public and helps you to stay on your game. God Bless,
This is absolutely fascinating information, after a surgery once my grandfather had a really hard time coming out of his paralyzed state in recovery like he should’ve and thus was still “asleep” for far longer afterwards as if his body wasn’t properly ridding the medication from his system like it was supposed to and I often wondered why until now. Crazy balance/dance you have to do with the timing that I’m sure it’s never always perfect when things arise that complicate it, wow!
I recently had a colonoscopy screen and was given propofol by an anesthesiologist. I was impressed how quickly I recovered from the propofol. A few minutes after awakening, I was able to dress and walk on my own without grogginess. Amazing medication. In the past I was given something else and was sedated for the rest of the day. This is a huge advance in this field I think.
I wasn't that out of it when I had mine. I was completely conscious and aware. So much that I watched it all on a screen in front of. The doctor did a sightseeing tour in a very entertaining/ funny way. I couldn't feel a thing but remember a surreal yet positive experience.
Probably one of my favorite specialties: part doctor, part chemist, part engineer, part wizard. And not much blood and gore or long chats with the patient.
I never thought I could handle doing medicine but this has sparked my interest and if I did choose a medical fashion it would probably be this however I'm not going into the medical field.
This was such a well detailed video Dr. Max! You've been keeping anesthesiology at the top of my consideration list for medical school! I can't wait!!!!
@@MaxFeinsteinMD I’m strongly considering it honestly! Your perspective of things has really given me some helpful insight. Keep up the great videos 🤙🏾🤙🏾🤙🏾
@@darriontunstall3708 “if at first you don’t succeed, try, try, again”. Don’t lose sight of the goal brotha, I’m sure there’s a way for you. We’ll probably be collaborating over a case one day, you never know 💪🏾
Wow you are a gift to humanity my friend. I can tell by your enthusiasm that you truly love your chosen field. I have a friend who was a successful anesthesiologist and he got hooked on drugs! I mean seriously hooked on drugs, he would bring a cardboard box full of vials of liquid cocaine home with him. He started getting sloppy in the operating room and the surgeons noticed it and called him out they also blocked him from practicing. They had an intervention for physicians that had become drug dependent and he successfully Completed the program but within four months was worse than he ever was and subsequently was sentenced to two years in prison for a variety
I just would like to say thank you for your videos. I always have had an interest in medicine especially after working as an IT contractor at several hospitals. I recently had a heart cath and stent placed and while I was terrified going in watching several of your videos beforehand put me at ease. Thank you for all you do.
TOP NOTCH info Max! This is the exact information that I have been longing for and wondering about since I have had so many back surgeries and my EMS background. WOW! A lot to know and you seem to have it all in your head/mind, which is a good thing...umm, not the meds in your mind, but the knowledge.
This is so interesting as a layman. I just had spinal surgery and my anaesthesiologist was amazing. He made me laugh, he calmed me down, he answered all my questions and I had zero anxiety before he put me to sleep. All whilst he was sorting the medications and administrating these, he tried his best to make sure I was ok and assured me that he was going to look after me no matter what. Its amazing how impactful their job is.
Great video! A few weeks after surgery, be sure to request an itemized statement of all hospital and surgical charges. Not only will you get a list of all the drugs and doses you were given during surgery you will also know the cost.
I'm having surgery in a few weeks and understandably I've been very nervous about it, although I'm more worried about being under general anesthesia than I am about the procedure itself. My only other experience with GA was traumatizing because they gave me enough to paralyze me but not enough to sedate me, so I'm trying to learn more about it before I talk to my anesthesiologist in order to be able to properly articulate my needs and concerns. This video was exactly the resource I was hoping to find. Thanks for your help!
Med student here in Canada interested in anesthesia. It would be great if you can give us an idea of what you do preoperatively and postoperatively. Perhaps give us a hypothetical case you'd be assigned and the protocol you'd run through. I was wondering if there was any diagnostics and critical care associated with anesthesia and how frequent youd encounter this. Perhaps represented through a case? Keep up the great vids!!
Most important team member they put you to sleep and wake you up the waking up part is key ….5 surgeries and I always want them to know all my potential issues this is one person you never hide anything from
Yeah, this is why in the West Wing ep where Bartlett got shot, the First Lady briefed the anesthesiologist on his MS, because he needed to know that to properly manage his regimen.
I had general anesthesia for an emergency C-section because of preeclampsia/HELLP syndrome. After the anesthesia, I was on not only morphine for pain but magnesium sulfate to prevent seizures. I had a nurse by me at all times to wake me up and remind me to breathe. So many drugs in a short time! I swear my memory hasn't been the same since. I can deal with that because modern medicine and medications saved my life and the life of my son.
I had a hip arthroscopy and I literally had every level of anesthetic. I had sedation, skin numbing(local), an epidural (CNS regional), nerve block (PNS regional), then they knocked me out for the big shibang (general). I saw the prescription orders in my records and was amazed to see how much goes into making surgery as comfy and safe as possible.
Hey Doc, My All time favorite educator/ speaker was a friend by the name of Scotty Bolleter (at the time with San Antonio Airlife)... He did a talk (think Ted Talk) at a Texas EMS conference in the late 90’s called (appropriately) “Comfortably Numb.” It was a class on Pre-hospital anesthesia and at the time we (a few of the attendees) thought we were advanced using both short and long acting paralytics, Sux, (RSI) Roc, Pancuronium... along side amnesiacs (Versed) and anti-emetics... I worked as a Paramedic both ground based and air based on fixed and rotor wing aircraft. While it has been years since I’ve pushed any meds, your down to earth delivery and fore-sight explanations hit home and I’m enjoying the videos you make... I just had a procedure done and was giving the anesthesia Doc a hard time... The new (to me) nasal cannula with the tab that covered my upper lip and hung into my mouth, was hooked to a monitor for respiration’s and I asked if an old fashioned mirror (fogging with expirations) was too much to ask for... lol ... I didn’t care for the tab... until she started the Propofol... Then I didn’t care about anything... What strikes me is compared to even only 40 years ago (my original knee surgery), I can/did have a knee replacement outpatient or at the most one overnight stay... (I have an extensive cardiac hx) with little pain, (even at home) no grogginess, no anxiety, no nausea.... Medical marvels and amazing professionals such as you and your colleagues across the country are improving patient care in amazing leaps and bounds... Thank You...
HI Max, I have watched your video so many times before and its really helped ma lot in understanding the Anesthesia drug administration and other information relating to it. I am actually a marketer inotroducing these Anesthetic drugs to our doctors here and i believe its necessary first to have basic understanding about these products. Its really very good to learn so many useful things.
I had three surgeries within 6 months where I was under general anesthesia. After that, I had memory issues for about a year. As a professor of statistics at a business school, these memory issues caused me to forget the meaning of important concepts. It was unpredictable, I would get to a word like regression and “get hung up” and often would struggle getting through the topic. Now, about 5 years later, my doctor wants me to get a colonoscopy and I decided to postpone the procedure until after December because I am teaching a class (retired now work as adjunct). I will get my colonoscopy in the spring when I am not teaching.
Interesting comparison from veterinary medicine. We use a lot of alpha 2 adrenergic agonists and no paralytics (most general small animal clinics don’t have ventilators).
Thank you for sharing your knowledge. I've had surgery 3 times with General Anesthesia and I've always been curious about how they do it exactly. Very fascinating!
Used to be interested in anesthesia as a nurse. But decided to become an np. It still interests me and thank you for this informative video. Would love to know how you adapt your medication preference by the type of surgery?
This video is so informative and neat! I was wondering, since you use an opioid, are there special procedures for someone with a current/past opioid addiction?
Many years ago I had a breast biopsy and the anesthesiologist talked me into a mask/gas induction. It was the single most terrifying event of my life. I proceeded to avoid any type of sedation for years. I was 15 years past recommended colonoscopy range before I gave in to my husband's insistence. Propofol was not terrible but still disconcerting I knew when I was going out as opposed to just going out. However as opposed to gas, where I went out in panic attack and woke up in panic attack, I faded out and woke up. Knee replacement delayed too long but after watching you I pray for a responsive anesthesiologist who will listen to my rantings. FYI 35+ years as ICU/PACU RN
That was really helpful! thanks Max! I'm prepping for my 2 anesthesia rotations in the next few months and this will definitely help me in the OR on electives
Ask about the use of lidocaine infusions for opiate free anesthesia techniques. How often are they used, and how well do they work at reducing narcotic needs. They’re often used in combination with neuraxial blockade for a balanced technique.
This is the exact information that I have been longing for and wondering about since I have had so many back surgeries and my EMS background. WOW! A lot to know and you seem to have it all in your head/mind, which is a good thing...umm, not the meds in your mind, but the knowledge.
What do u use If pt is allergic to fetanyl? I love the profanol I get with spinal blocks. Quick to be out quick to wake up. I love your videos. Makes us not fear surgery so much! Thank u
Hi Sherry! Fentanyl allergies are extremely rare, I suspect most anesthesiologists won't encounter that in their career. Other medications that effectively relieve pain during surgery include morphine and hydromorphone, so I would probably use those in a patient with a fentanyl allergy.
@@MaxFeinsteinMD I had a anesthesiologist not believe that I was allergic to it gave it anyway I immediately went into anaphylaxis. Thankfully it was a nurse that noticed huge welts at same time anesthesiologist notice 02 dropping fast . He was in the recovery rm with me. I was still entubated . If it weren't for the concern he showed and the fact he stayed with me I would of swarn at him..after that a allergist did a scratch test and blood work but before labs had a chance I was wheezing had a hive that covered half the back. He told paramedics something about like only given a small amt that was diluted to prevent a bad reaction So I warn surgeons test me as some anesthesiologists don't listen. So far they listen. I like u cover pre op anxiety pain and nausea. So many my husband and I have encountered did not.if I got 1 like u I'd be so blessed. 💜💜💜💜AMEN TO U!!
@@sherrydawson6253 I'm allergic to some plastics or tape, and rubber. Doctors don't believe. It's hard. I'm fine with staples to close surgical incision but not plastic sutures.
This information is fascinating. I've had several surgeries. I like to learn as much as I can about everything done to me. I never realized there were so many medications to put someone under. I really enjoy your channel. Thanks for teaching us It truly is fascinating.
Ugh. I have unpredictable reactions with benzos. My eye surgeon gave me Versed (midazolam) and it didn't work. I recalled details of the proceedure AND the conversation between the staff wile the procedure was going on. I also have a horrible reaction to naloxone -- severe nausea and migrane. In general my body does not like opioids either -- they make me nauseated and jittery. I'm really boring at parties too.
I was always interested that when I go thru general anesthesia that the doctor will explain to me about what drugs he uses and how much of anything he gives me. I have been thru general anesthesia several times now and woke up totally fine. I guess the main thing to worry about is the amount of what you give not only what. It has to be super accurate. I am not trying to become such a doctor myself I am just a science and chemistry lover, ironically despite not being strong in math to which I use calculator if I need there is no shame in it. Thank you doctor Max, you gave me the answer no doctor will have the time or patience to give normally.
Because the patient can't blink when he's under general anesthesia. And blinking helps the eyes keep hydrated and lubricated. If the patient's eyes are open for several hours without blinking, there's a risk of developing keratitis (or corneal ulcers). During vitrectomy or any ophthalmic surgeries, the eyes are constantly lubricated with various drops
I'm studying for the CAPA (Certified Ambulatory PeriAnesthesia) certification. I've been a perianesthesia RN for 12 years and this video is very helpful. Thank you.
Yo Max, you’re videos are very interesting! They make me glad I didn’t choose to be an anesthesiologist. That said, I've had the dubious privilege of having been under GA for at least 15 times, many for eye surgery, but also 2 major orthopedic operations. Both involved the insertion of screws and other related hardware into my left ankle (fracture) and right foot (osteoarthritis). The ankle procedure people used some sort of gas that left me feeling like I'd been breathing through an exhaust pipe. The foot surgery was more recent, and instead they used a nerve block and milk of amnesia (aka propofol). I agreed to it with the assurance that I be completely oblivious to the whole ordeal. It worked, thankfully. Is there a trend toward using propofol and nerve blocks in anesthesia these days? Another thing that seems to have been phased out is the use of a preop medication like demerol, etc. They haven’t used it for me in a long time. I found it preferable as it relieved anxiety, plus made for a pleasant buzz. I’m hoping my days of surgery are behind me, but who knows? Unfortunately, not all of the anesthesiologists were as informative as you…
Has surgery today after rupturing my patellar tendon. Because of your videos I was able to make a better informed choice when selecting what to use and what questions to ask. Told her about you too! All is well, I am already home.
I love watching your videos! I'm having my 5th brain surgery next month and it's my 42nd overall surgery and these are very informative. But I want to know what medication makes my ears ring really loud right before I'm asleep
I have water on the brain (Hydrocephalus) so sadly I'm used to these surgeries but I'm not liking when everything stops working. I really hope your situation goes well!
👍👍👍 Another GREAT video from Max’s school of Anesthesia!! This is good information for patients! How long do you stay with the patient after the surgery is over? Thanks Max
The short answer is that it depends on how stable the patient is. If vital signs aren't stable, I stay with the patient in PACU until either they are stable, or I've done a thorough workup and signout with the anesthesiologists running PACU. I'd say 99% of my patients are stable and I'll leave within 5-10 minutes of getting to PACU so I can prepare for the next case.
Ok while I understand no 2 inductions are same. I have had 2 surgeries that have had same Anesthesiologist and General surgeon. 1st time I was induced the Anesthesiologist gave me the paralytic meds before induction, that 30 to 60 seconds was horrible couldn't move and was well aware of that. The 2nd surgery I asked Anesthesiologist if they could make sure I was sedated before he paralyzed me, because it was scary feeling. You would of thought I was questioning credentials. Could you explain why this was his thinking
I just came across your comment. I was aghast when I saw 43 surgeries for hydrocephalus because I am being evaluated for this. Getting a 2nd opinion. I thought after the shunt installation, replacement like every five years. OMG!
@@curtiswritt8474 - Thanks for the reply. Wow. I have been avoiding this and spinal repair surgery like the plague. I think time is running out for me. Headaches 24/7 for four months. Morphine no relief. Just discharged from the hospital five days ago. Grrr! Best of luck with you!
great content, thanks for the great videos! I have always been curious about pain and how humans manage. For example, watching game of thrones or documentaries about regimes in other countries and seeing all the torture and physical pain they seem to survive through, I just wonder if that is possible or do humans begin to suffer irreversible damage (psychological, brain or physiological) at a certain level of pain? or does the body go back to normal once the pain stops? do you use the same class of meds that a pain management doctor would use? seems like anesthesia is more about preventing pain, and pain management is about managing chronic pain, but they seem similar. I saw a netflix show recently about a serial killer in asia back in the 70s. he seemed to use a paralytic drug, given orally (like a pill) and the person would be awake, conscious, but paralyzed. he would rob them and throw them in the ocean in that state. I have to imagine that would be horrible. I also hear horrible stories about people waking up during surgery, but I am not sure if that is true. or the anesthetic never fully takes and the patient goes out, but stays conscious somehow? I dunno, maybe those are just urban myths, but that also sounds frightening, but then i hear that in brain surgery, the patient has to be awake, so how is that possible, lol....sorry for the rambling comments!
Great detailed video and so knowledgeable about every drug given from surgery START until SURGERY IS FINISHED. Thank You Dr Feinstein, for sharing this valuable information to us. I am scheduled for a Total Right Reverse Shoulder Replacement soon and was thinking about the sequence of meds given to put patients to sleep. Unfortunately, I had to have 4 Rotator Cuff Surgeries in 2023, due to my Blood Thinner meds, that were causing my Rotator Cuffs to Deteriorate as well as my tendons and ligaments. FYI Take Good Care and Stay Safe my Friend! Great Job! 👏👍🤗🇺🇸🫡🙏🙏
In a future video could you talk about "emergence delirium" ? It's happened to me twice. The second time a huge methane molecule was attacking me (yes, I am a scientist).
I would definitely avoid using a gas called nitrous oxide in patients with emphysema, as it has the potential to cause lung damage in these particular patients. I would also opt for certain medications that are known to open up the airways a bit more because these patients are prone to having airways close up or spasm.
Though I am not in a medical field this is super interesting. I keep watching these videos and I love the way this guy explained Everything. I'm not in the field but I've always found anesthesia a very interesting field and have always been fascinated by it.
I absolutely love how detailed your descriptions are and that it doesn’t seem like you’ve filtered your content in any way. Thank you for explaining the anesthesia process.
Thanks for sharing this. I've had a few surgeries with success in anestesia intervention. I never really understood all the moving parts. Thanks for educating.
Approximately what percentage of patients would you say need paralytics for surgery? What kinds of circumstances warrant the use or avoidance of paralytics? Lastly, why is TIVA not the standard of care for almost everyone, I feel volatile anesthetics cause so many more side effects than IV agents and are so much worse for the environment.
Oh that’s a great question, I’m sure there are statistics out there but my guess is that maybe half of patients receiving care from an anesthesiologist are paralyzed? Really just depends on the surgery and the patient. I wouldn’t say that volatiles have so many more side effects than IV agents. PONV risk increase but that’s also dependent on patient and surgical factors. TIVA with propofol also causes more vasodilation than any volatile so that could make it less favorable. Iso in particular can provide cardiac benefits that TIVA doesn’t. You’re definitely right about the environmental issues. Lastly, end tidal gas is such a reliable indicator of anesthetic depth whereas the BIS is questionable. Just my 2c
@@MaxFeinsteinMD Thank you so much! I would love a video on the anaesthetic and airway considerations for ECT, I always wonder why some patients get twitching feet or fingers even though they are given succinylcholine and how are patients ventilated before, during and after ECT.
