I needed several surgeries as a kid and can still remember my first experience with mask induction, as it was horrific. For 20 long seconds or so before going to sleep I felt like I was drowning and unable to communicate at all. I could feel the excitement phase you described as my heart started to race and my body started to move uncontrollably. On subsequent procedures I requested the IV experience, despite hating needles, because it beat the alternative. I really think a proper study should be done to test the assumption that mask inductions are less distressing for pediatric patients, because my own experience as well as many of the comments I'm reading here might suggest otherwise.
I agree that they should look into it. I know kids will hate needles, but they can have an iv placed whilst sitting in their parents lap, with emla cream, and be rewarded with tv or cuddles afterwards. It doesnt have to happen right in the theatre, unlike the mask where you can't do the traumatic part a little ahead of time. Obviously with toddlers that may not work, but i think it should be considered for kids like aged five up.
I prefer inhalation induction, because I have what’s called collapsing veins. I had one particular surgery when I was seven, a tonsillectomy, in which case I lost count of how many times they tried to find a a suitable vein. I kept begging for the mask, I remember that much they said I was too big. The stress I went under just to put me under, made my blood pressure spike uncontrollably on the table, and I had to be sedated for two days, following my surgery to get my blood pressure back down. Ever since then, I tell doctors about my experience, and it seems to fall on deaf ears. I have had two surgeries since that one, and both of them were traumatic as they tried to find a vein, but to no avail before finally just living with one, and then I wake up to a blown out vein, and a huge bump on my hand or arm. Every induction I’ve had, for total, using the inhalation method were pleasant, and not as stressful.
As someone with sensory and auditory processing disorders (both autistic spectrum disorders) as well as anxiety I’m so glad you made this video because the thought of anesthesia being induced by a mask has been absolutely terrifying to me in the past and was one of the biggest reasons why I was afraid of needing surgery but hearing that IV induction is a much more preferred option was a huge relief to me! I’m actually one of those people for which IV/needle insertion is sort of a euphoric experience and I love watching when possible as a result so I’d absolutely love that option for surgery. I have deep veins but they’re really good veins for giving blood so I can imagine that they’d also work quite well in the opposite direction (provided that they don’t infiltrate like they did whenever I tried giving platelets). Great video!
Wow! I have ASD too, but I HATE needles, and the thought of being awake as they put a nylon needle into my veins was terrifying. When the anaesthetist asked me, I said "I hate IVs, can you gas me and stick me?"
@@realdanpatterson yeah, it’s weird to me that I love it because for the most part I’m a sensory avoider with everything as apposed to a seeker but for some reason that one is the opposite for me and I’m guessing it has something to do with my proprioception and/or high pain tolerance that makes the deep pressure more pleasurable for me whereas with people who are more sensitive to pain usually have a harder time.
I’ve had many surgeries, and have long been confused between why the “preference” from mask to IV suddenly changed… Now I know, it’s just because I’m an adult, and kids tend to hate needles! I used to have to BEG my pediatric doctors to let me get anesthesia through an IV because of a terrifying experience I had with the mask as a toddler (I’m still afraid of ALL masks). I really appreciate your videos, Max!
I've had a few surgeries, some as a kid, yet never offered mask induction. Guess they thought the chronically ill kid whose had dozens of IV blood draws can handle a poke for a surgery. I always wondered why they stick you if it isn't needed. Turns out the alternative isn't unambiguously better. Masks seem a wee bit horrific, in addition to being a wee bit dangerous. I don't like needles, but if I need to get a poke, I'll do it.
I had a traumatic experience with anesthesia as a kid. i'd never liked masks due to undiagnosed autism/sensory issues, and the doctor told me he wouldn't use one but did at the last minute anyway. this video helped me understand why he might've done that. it makes me happy to hear how dedicated you are to children's comfort, and recognize how critical it is for them and their future treatment! my situation was an odd case, so i thought i'd talk about it so anyone here might learn from it. you can't mitigate every possible traumatic thing for a pediatric patient, but you can try your best. that's more than enough. :)
I remember the wrestling match that occurred when I had my tonsils out when I was just barely 6 years old. It took 6 large adults to hold me down in order to keep the mask over my face to put me out. And then, I got them back good. I didn't wake up when they figured I should have because they figured, with how much I fought them and how surprisingly strong skinny little old me was, they put me under way deeper than normally done. When I finally came to, I found myself with a mask on my face AGAIN (oxygen this time of course) AND my hands and feet tied down cuz they figured I was gonna go berserk again ..... which I did. Aaaaaaaand, then there was the time, 4 years later, I was gassed again when I needed some extensive dental surgery. Yet another wrestling match to put me under. So, when I had to have surgery as an adult, I told them anesthesia only by IV. I don't want to go thru the trauma of a mask on my face. IV I got to go under, but then when I woke in recovery ...... I found a full mask on my face for oxygen and the panic set in again. I just do not do well with a mask. Yeah, before you say it, I am ok with the masking for COVID.
@@tinydancer7426 jesus, i'm so sorry :( there had to be a better way to prepare you for that besides restraining you so brutally. i was held down as well, and i was already half-under so i didn't have much fight left in me. they sure as hell knew they were terrifying me though
Pediatrics would be lucky to have you, I hope you get in where you want. Not only do you have the knowledge and skill for it, but I have a feeling you've got an arsenal of cheesy jokes and fun scrub caps to get a kid smiling, laughing, and comfortable before their surgery. Thanks for another great video Max.
Honestly when I had my surgeries at the children hospital they used to give us numbing cream and it was an excellent way to get kids to feel comfortable with iv insertion so much so that now as an adult needle iv is my preferred method and I don’t even notice that they have even put it in
I remember that part to as someone who’s also had surgeries at Children’s before it did make a difference when they installed the IV in me m so glad they have that stuff it was easier
@@Crazyreviewer123 same here and I reckon if they offered it to adults more of them would be more willing to have an iv insertion instead of being so reluctant
@@surgeon1016 I agree, the first time I donated blood I asked for the anaesthetic, stupid really as both were needles and I didn't ever again but I'd be reassured with numbing cream if needles bothered me, plus they can be brutal placing the iv!
As someone who's been through the ringer as far as medically. The trauma from this mask still gives me ptsd. I have awful memories of my parents holding me down at age 6 and I was screaming while the mask was over my face.
I was three when I had surgery to put pins in my elbow. Mind you, I was pretty much hopped up on pain meds so all I remember is being put on the table and the nurse saying sweet dreams and the mask going on my face and then waking up in the PACU
I remember asking if they'll put the IV in after I'm out. They did not, and still used a mask. IVs give me bad memories, so I can understand even if I prefer maks.
@@saphiriathebluedragonknight375 unfortunately IVs are pretty mandatory for safe induction. It's just not safe to not have an IV and induce, for many many cases. Some you can avoid it for sure.
Several years ago (was considered an adult at the time…. I think), I had a procedure where they put me to sleep with mask (and I’m guessing iv anesthesia). I STILL have traumatic memories from that induction. I don’t know if they didn’t dose it right or what, but it took forever to actually go to sleep, and in the mean time, I felt completely out of body, but awake. Thankfully it did take effect fully before the procedure so I didn’t have memory of that. The next surgery I had awhile after that (I have had a lot of surgeries), I just remember getting iv anesthesia. No mask. It was almost immediate that I was out. SO much better.
In the 60s, I was mask induced, twice, with ether. I was like a starfish, with five grown men holding me down 7-y.o. me. Yep, I understand the PTSD part, when anyone tries to put a mask on me now! I have vivid recollections of the post-op hallucinations, as well.
Just a quick comment to say that you're a very good youtuber. You can keep a layperson glued to your videos. I'll assume you don't get the glory of a trauma surgeon or a ER doc, but you do a hell of a job explaining the ins and outs of anesthesia. I wish all doctors were as informative as you are. I wish you the best of luck in your career, and I sure would feel at ease with you as my anesthesiologist. I grew up kinda in the area. Colts Neck NJ so I've heard of your hospital.
As a person who has gotten general anesthetic’s before. I personally do not mind both methods, but my preferred method is actually the mask. With an IV you have to find a vein and they have to put a catheter in your arm or hand. I did not really hurt. That’s when I was getting my wisdom teeth out. For ingrown toenail surgery I had the mask and this is why I would prefer the mask significantly. When the mask was on my face, I wasn’t nervous because I knew I was going to get lightheaded, and I was very familiar with feeling from when I was very little and although it freaked me out, I knew what to expect this time. So the mask is on me. And they’re just doing oxygen. No IV in my arm. And then the anesthetic slowly starts to come through and every time with that mask it calms me down, even as it starts to slowly flow through the mask. It to me smells like spray paint. And after a few inhalers, then I start getting the very strong lightheadedness. And at this point, I’m just very very relaxed. com. And with a really strong lightheadedness, losing awareness of where I was at. Voices are fading away, and my feeling is fading away, but I’m really calm through all of this. And the next thing I knew I am slowly waking up in recovery. And I’m speaking about this especially that sometimes I get seizures. I don’t know how but that mask every time has me from a little bit of shaking to really calm once the oxygen or anesthesia starts flowing through it. A big reason I’m comfortable with the mask.
I remember my first experience with needing an IV. I was giving an oral medication and about 30 minutes later I was ready to put the IV in myself, lol. I've since gotten over the fear of needles. As per the usual, another great video! You're going to be great working with kids!
As a little kid I would’ve freaked out over the IV but if I need surgery now as a young adult I wouldn’t mind an IV. If a patient of any age had an IV started at the scene of an emergency and later needed surgery, it makes sense to use anesthesia through the IV
I have really bad anxiety around IV's and while getting my wisdom teeth out, I'm so thankful they gave me IV anesthesia. I was out like a light and didn't even realize until they were waking me up. It was definitely helpful to me to not be able to remember anything that happened besides the 5-10 minutes of just having to sit there with the IV in my arm prior to the surgeon coming in
Its oddly comforting seeing people in the comments speaking about their feelings about having the mask vs. having IV induction. Being a cancer survivor, I've definitely been through many procedures that required me to be put under. I was mortified by mask-induced anesthesia because of the scent of the mask, the taste of the fumes; it made me panic every time! Even as a child, I vividly recall asking to get poked so that they can use IV induction--a LOT faster and more comfortable! Even to this day, if I think deeply enough, I can STILL smell the scent of those masks!
So far I’ve been given both options (for context I’m 20). I tried a mask once and it felt like I was being smothered or suffocated so never again. The iv feels natural, like ur eyelids feel heavy and u fall asleep. It wasn’t traumatizing bc it was my choice, it wasn’t forced on me.
Masking is only done for kids or mentally challenged adults. If you were an adult during surgery it was an IV anesthetic. But everyone gets oxygen via a mask before going off to sleep and they easily believe they had a mask induction but that is not accurate.
Same! They didn’t warn me that nothing would be flowing before placing the mask on my face so I started breathing like normal which caused me to feel like I was being suffocated but my arms were already strapped down and I couldn’t really tell them I was starting to panic. I have had IV induction for every other surgery (I have had 7 surgeries in my lifetime) I didn’t know there was an option between the two types that could be used nor did I ever think to ask the doc before hand which on he or she plan on using. Due to chronic knee injuries I have very little cartilage left in my knee and I’m still pretty young so as I get older I will most likely have to have a partial or complete knee replacement. Next time I go in for a surgery I will definitely be talking to them about what option they plan to use. I definitely would prefer IV. Since I have to have antibiotics anyway for all my surgeries (the way it’s been explained to me is that due to some underlying health conditions I am more vulnerable to post opp infections so they always put me on IV antibiotics before I go in for surgery. So it just makes sense to use the IV method. I have no aversion to needles because I have worked in healthcare, have been giving myself injections for emergency migraine treatment for years, and was my moms practice dummy when she went through paramedic school. I have even offered to be a practice patient for any new nurses/trainees because I don’t get freaked out. And I have very easy to stick veins so I’m prefect for newbies to get their confidence up.
That might be because bad use of the anethesia or a reaction of your body, i have been induced by mask when i was 16 yo and it was fast and not unpleasant at all
I had anesthesia through a mask as a kid, VERY traumatic for me, so much so that I was very afraid to get anesthesia 5 to 6 years later for an MRI, I got IV anesthesia for that MRI and it was so much more pleasant, I dont like needles but I cannot stand the smells from inhaling anesthesia through a mask. I feel like I can't breath and it makes me feel absolutely sick. I am speaking as someone who has cerebral palsy and autism. I have had my fair share of procedures over the years. I am now 23 years old and those bad experiences still haunt me from back when I was 10 years old 😥
I'm 28 and I just got my first general anesthesia surgery a month and a half ago, and I more or less got both. the actual anesthetic was administered through IV, but they also gave me oxygen through the mask which apparently is common practice, I think it was called "pre-oxygenation". honestly if I didn't ask how they'd put me under before surgery, I wouldn't have known it was IV, because when they put the mask on me I was focused looking at the rebreather bag while the anesthesist administered the anesthetic in my arm on the other side which I couldn't see. all I remember was feeling lightheaded and next thing I know I woke up in the recovery like nothing happened. either way I'm really glad they put the mask on me because I literally didn't feel the induction until lightheadedness kicked in.
Maybe this is what I had too? I had major abdominal surgery a few years ago. I know the anesthesiologist had put a needle in my back, which was the local anasthetic to keep the majority of my torso numb even after the surgery. I had another needle too, in my arm. They injected some sedative/calming medication, which felt pretty nice to be honest. When I had laid down on the operating table I was given oxygen in a mask. Then they took it away and I think someone said that I was going to fall asleep now, then they gave the mask back and told me to breathe normally. I always thought that was the anasthesia, but maybe it was oxygen and they actually used an IV to put me to sleep. Then there was a very slow blink and when I opened my eyes again it was very bright and the surgery was over. Someone probably told me at some point what was going to happen/what exactly they were going to do but I was so nervous, I think I missed all of it. I was so cunfused when I watched this video and saw there were all these drawbacks to using a mask for anasthesia induction, I thought "Then why would they do that with me?"
The last thing I remember during TIV induction is the smell of the anaesthetic exiting my lungs just before I pass out. I did catch one doctor in a lie, tho. Just before I went under, I commented that I could smell the anaesthetic coming OUT through my lungs. "Strange", I thought, since O2 is mostly or practically odorless. Next thing I know, he said "we're giving you a little nitrous, too". Caught him in a lie just before I went under. Niiiiice! I have been induced prior to pre-ox, via IV, and didn't know about the mask. And the nurse, THAT TIME, told me the truth. It was oxygen, and pre-ox generally isn't necessary with Brevital, since it's a fast-acting and short-acting anaesthetic, and is suitable for light to moderate sedation, as well. Diprivan didn't exist back then, or it would have been a good choice for a pediatric anaesthetic.
would love to see a IV insertion guide Max! I heard anesthesiologists are the best at starting IVs. it would be a blessing to the world to see how you approach it with your own insights
I wouldn't let a Doctor stick me with ANY needle, EVER. Once my primary care Physician said " I can give you the injection if you like" I said, " That's all right, the nurse will do it" Nurses are the ones who give the best injections.
Paramedics are 😁 as a former medic I did 15-20 ivs a day while the ambulance was moving then became a nurse I do ultrasound sound guided IVs and on my for CRNA
5:52 one thing I will note: while pediatrics has its own issues (different physiology), the simple concern of avoiding medical trauma exists in adults as well. I also like that you mention the discomforts of a mask induction. I personally prefer IV, simply because that's what I remember getting and I don't remember anything going wrong. I also have a very high pain tolerance (courtesy of unrelated chronic health issues), and have needed a lot of blood tests growing up (for still-more unrelated health issues that have since resolved without incident), so for as long as I can remember I simply haven't given a crap about just having one IV (as long as it comes out or gets relocated *before* the vein it's in gets completely borked).
Yeah, I hear you. Some prefer ether - the bottle or the hammer - but I prefer neither. Always opt for local, whenever possible. I've even had a couple of knock-out docs tell me I made a wise choice. Hospitals will sometimes lie to their patients - especially in the ER - to wit: there is no local that we can give you to set a Colle's fracture. Bullshit. I've had other doctors offer me the option, even oral surgeons for advanced orthodontic procedures which required cutting and suturing the gumline. If I ever need a root canal, I will choose the dentist with prudence. I always joke: "What??? No Diprivan?", or "no local doc, give me Propofol!". Michael Jackson would have been proud...
Another very important benefit of mask induction is that the patient does not lose spontaneous ventilation, thus making it a safe choice to "take a look" at a patient airway without commiting to a full iv induction. I have used this technique in environments where there is not an appropriate difficult airway equipment like endoscopy or radiology rooms. Also, induction with sevoflorane provides a lesser degree of hemodynamic drop, which makes it a reasonable alternative for sedation procedures in elderly patients or patients with ventricular disfunction.
Interesting! A patient can certainly become apneic and no longer spontaneously ventilate with an inhalation induction. I also wouldnt want to "take a look" while they're spontaneously ventilating but with gas onboard because they could be in stage 2 and suffer a laryngospasm.
My 7 year old got gas to sleep and i was very grateful. She was prepared to get a needle as i had spoken with her to prepare her. I've only been put under with medication but I've had the mask on to administer o2 prior to rsi.
I've been operated on a lot. I remember distinctly being put under with a mask when I was a child. I hated the smell, the phycical sensation and it made me panic. I think I was about 8 years old when I learned that IV was an option and I asked for that instead.
Great video. I’ve had a lot of surgery due to spina bifida. I’m 52. As a child, general anaesthesia was always induced with a mask, which I detested (I felt like I was suffocating and there was a distinctive taste). As soon as I was able, I requested iv induction and found it SO much easier. Personal preference I suppose.
I prefer the IV in the crook of my arm , and I don't like being "slammed" into sleep. Also, I like getting something to relax me before entering the OR.
I think I prefer the IV, the mask freaked me out. I had major surgery when I was a teen, I remember slowly falling asleep while having a panic attack and remember thinking "bye mom" since she was holding my hand. I recently had the IV for my wisdom teeth removal, they gave me oxygen which put me into a panic attack so I made them stop. Once they put the stuff in the IV, I blinked and the surgery was done. The only thing is I hate getting the needle on top of the hand, it hurts like mother fuka.
Ugh for my recent surgery this was the first time i was ever put under as an adult. They first tried putting the iv in my hand but it was a student nurse learning how to do it and she screwed it up so it really freakin hurt as she had to remove it and do it over the head nurse finally came over and put it in my forearm but man that hurt.
@@TheRebelAndTheGirl I think actually the forearm hurts more then the hand. I've had both for blood tests and IV's both hurt, but with they had to use a kid sized IV on me, which wasn't too bad... but man does the forearm one hurt!
Versed is a WONDERFUL calming agent prior to general anesthesia! I’m a BIG baby for needles, and have high anxiety. All I can say is, Versed makes me not give a crap and completely takes the anxiety away prior to surgery. Thank you Lord!
I've had both the mask and the IV. I've gone under anaesthesia several times (I've disability since birth) and I've never had a bad experience yet. Most of the times it's been the mask and this video helped me understand why most anaesthesiologist chose to. Personally both the mask and the IV are fine. I'm more familiar with the masks so I'm not intimidated by them as I know what will happen to me. IV's are however quicker way to go to sleep. Masks are okay but the smell gets pretty strong and you can smell it even hours after the surgery. Again it all depends on the situation and the doctor. For anyone who hasn't had a anaesthesia yet, don't be scared you'll be fine. By the time you wake up you'll won't remember half of it anyways. Side note: Remember not to panic. Whenever I got under the mask the doctor would always say that if I'm feeling uncomfortable I could raise my hand to let them know, this however depends on the doctor ig
Doctor Feinstein; Thank you for this and other videos. You explain terribly complex subjects in a straightforward and easily understood manner. One point I'd like to add however regarding the use of IV Anesthesia. IV needles are not enjoyable, but they can be made very tolerable with a simple lidocaine injection prior to inserting the IV needle. This procedure is very valuable when placing the IV needle into a patients hand.
I tend to agree with you, and I often use lidocaine. However, a lidocaine wheel is probably about as uncomfortable as a 22g peripheral IV, so I reserve the lidocaine for bigger needles.
@@MaxFeinsteinMD I've had nurses use some special kind of saline prior to IV insertion. The needle used for that saline is to tiny that you don't even feel it, and if they're quick enough with the needle stick, it makes it nearly totally painless.
having major surgery at sinai may thirteenth, and have had numerous procedures before, and i remember IV sedation for all procedures i can recall. no clue if i was masked for my pediatric dental procedures, but i had an IV for all adult ones. personally i have yet to meet an anesthesiologist i didn't trust, and whatever they feel is comfortable and appropriate for me after reviewing my extensive medical history is what i've always consented to. i was always great with needles as a chronically ill (JRA) kid though, so maybe all my pediatric procedures had IV anesthesia because i was so calm about it and had a ton of fun helping phlebotomists find my veins. thanks max!
I have had both IV and mask. I also have terrible needle phobia. The mask induction worked wonderfully. Nice drift to sleep with IV taking over after I'd never notice. No complaints. Then I had IV conscious sedation with propofol. Some sadist knocked out the real anaesthesiologist and decided it was time to crank it to 11. Apparently I'm one of the few lucky people who don't get along with propofol and get the burning sensation. He came in, did the flush (which hurt) and snarked at my reaction. THEN began the push with "This is propofol. Most people tolerate it fine, but there are a select few who experience a burning sensation. If you're one of them, you'll feel that... NOW." Cue panic. I'm sure the nurses were so much happier when I stopped fighting and went down. AND, despite being warned I don't stay down, stopped the meds for too long during the procedure so I woke up. Not a great time.
Hey max! I got the chance to do research at mount sinai and after watching your videos I've never been more excited for this summer. Thanks so much for all the info!
I was put under anesthesia using the mask induction up until I was 16 years old and got sick to the stomach almost every time but the last surgeries I had an I.V. put in and the mask was 100 percent oxygen and didn't get sick when waking up
A very long time ago, I was anesthetized with ether. I told you it was a long time ago. I was about five years old. It was not a pleasant experience. First there is the awful nauseating smell and the sense of suffocating. Then there were the hallucinations along the way. I don’t recommend it. Thank goodness they don’t do that anymore. A funny part of it is the way the anesthesiologist got me to breathe it. I was struggling and pulling away, I am sure. He said,”Don’t you like that smell? Just blow it away as hard as you can.” I did. What is the next thing you do after you have blown all the air out of your lungs? Right.
Great info! I always ask for a I.V to put me to sleep, I don’t like the mask over my face lol! I really enjoy donating to the anesthesiologist Foundation, since it was hard for me to go to college to be a anesthesiologist physician, I really wanted to be a anesthesiologist physician! I’m working on becoming a patient advocate for Anesthesiologist! I think it takes a special person to be a anesthesiologist or CRNA! I look up to all anesthesiologist and CRNA! I have had 14 surgeries because of my cerebral palsy! I’m 33
I also have cerebral palsy and loved working in emergency and acute care medicine as an EMT-B // RN. I am awaiting a pancreas transplant, but would love to consider CRNA or AGACNP school even as a 41 year old.
I’ve had both types. When I was younger the common practice ( this was in the 1960s) was the mask, very disconcerting for a kid. When I was put under with an IV I could feel when the injection started but my last surgery all I remember was breathing O2 through the mask and then waking up 2 days later in the ICU. I imagine in 60 years the art improved.😎👏
To Dr. Feinstein: Another fascinating video from you doctor. TY. Having worked in healthcare myself (many years ago) as a hospital-based Paramedic at a Level I Trauma Center, I of course knew all the hospital surgeons and anesthesiologists and would occasionally go into the OR to watch a case. I never once saw any type of surgeon who would go anywhere near a scalpel unless the patient had IV access. For obvious reasons of patent safety and it’s the SOC. The only exceptions I ever witnessed were extremely critical trauma patients whom, for various reasons, did not have IV access successfully made in the field and arrived at the TC without any lines established. In those circumstances I witnessed mask anesthesia while trauma nurses and/or ER residents, attendings and sometimes myself tried to gain IV access ASAP. On rare occasions this took place while a critical patient was being wheeled straight to the OR. I was hoping doctor that you might do a follow-up video to this one, on the subject of emergency mask anesthesia induction and emergent IV catheter placement and the scenarios in which you may have seen this, or could provide some teaching pearls. Your videos are awesome BTW Dr. F. Many folks, including myself, really appreciate you posting so frequently.
I had a mask induction for anesthesia when I was seven years old. I had open heart surgery. However, back then, they didn't have the meds that they had. My surgery took place in 1969 on Feb 12th in Fontana, CA. I had excellent, well, mostly excellent care.
I’m 19 and have been under anesthesia 12 times. The first 3 times was when I was 2 and 3 so I really only remember the last 9 times I was put under. When I was 10 I was put under laughing gas for dental work. The 8 other times I’ve been under have been for surgeries. 2 iv sedations and 6 mask sedations. The two times I was put under via iv the anesthesia going in my arm hurt extremely bad, it felt like my arm was on fire. When I woke up both times I had a massive headache and felt extremely uncomfortable. No matter what I did I couldn’t get comfortable, I couldn’t even get comfy in my own bed when I got home. When I was put to sleep via the mask, I felt really relaxed and when I woke up felt extremely sleepy but comfortable. The last few times I’ve been put under have been through both mask and iv at once, but it still turned out much better than just the iv sedation for me. It’s interesting reading all these comments about people doing better with iv sedation rather than mask sedation, but everyone’s different. For me when I wake up from a mask sedation I feel really relaxed and sleepy, when I wake up from an iv sedation I feel like I got hit by a truck.
Nitrous seems so ineffective I wonder why it is used in adjunct with the other inhaled gases. I have read the answer to this before but I still don't really understand. What a great channel you have. I always learn something new.
With my rare craniofacial deformity syndrome (Treacher Collins syndrome), I have severe upper airway obstruction due to jaw deformities and small oronasopharyngeal cavities. This makes my airway difficult (and sometimes impossible) to access and maintain. I've had over 30 surgeries (mainly craniofacial). In my childhood they put me to sleep with the mask, but then had extreme difficulty visualizing my glottis and vocal cords with normal laryngoscopy, much less intubating me. Often a tracheostomy was necessary. Finally, in my high school years, they began using fiberoptic awake intubation (which is still used on me to this day). After a long process of numbing my mouth and throat, then finding my vocal cords with the fiberoptic bronchoscope (while I'm still awake and alert with a little sedation), they eventually get the endotracheal tube into my trachea (either orally or nasally). So far it has worked the best for me (and has been the safest technique for me). They still have ENT on call just in case this fails and a tracheostomy is needed, anyway. Once the ETT is in place and secured, then they attach the anesthesia circuit from the machine to the ETT and begin administering the gas mixture. At the same time they inject propofol IV into me. The propofol takes effect almost immediately, before the gas even has a chance to start working on me.
I suspect that a line would be in before you left your room but (and I do blame you for this Dr Feinstein!!) the last time `I was anaesthetised was by a guy I didn't like. Every question was viewed as a criticism. Then at long last anaesthetist said "now I want you to take a deep breath" so I thought of Dr Feinstein's comment that he liked to fill his patient's lungs with its of O2. What I thought was O2 was, in fact sevoflurane. Way to go. I loved it. 6 times quicker than intravenous induction and twice as nice.
No need for a whole video. We simply get a new one as quickly as possible. Unless the patient’s veins are oddly difficult, it’s usually easier than getting one with the patient awaken because one of the effects of general anesthesia is venous dilation, making veins easier to spot and to advance the catheter into them.
in addition to what the other comment says, you can also administer some medication through the breathing circuit or intramuscularly while attempting to reestablish IV access!
Does IV site matter? I have almost non-visible veins on my hands and arm thus most medical staffs usually have a tough time inserting an IV needle on such sites. Can it be done on the feet or neck?
Hi. I'm loving following your videos and learning new things. I am a Registered Nurse in Australia and I'm interested in and looking into becoming an anaesthetic technician. Could you do a video of what an anaesthetic techs role involves? Thank you so much.
When it comes to general anesthesia with the mask vs. IV, when I was a kid, masks felt pretty heavy. And I felt I couldn't breathe. So then I opted for the IV type of the anesthesia. But as time progresses, the people who make the masks have found a way to make them lighter and softer so that way, the patient can be put to sleep and hardly notice that the mask is even there. When I went in for the colonoscopy, they put the mask on, and turned the operating lights off. And within less than a minute, I was out like a light.
i always get put under with a mask as i have small veins very painful,difficult to get an iv i also have ptsd they place the iv after i’m asleep such a great informative video
Ive only been put under anesthesia once in my life. It was through an IV to have 4 wisdom teeth removed. I counted backward from 10 and got to 7, then i woke up. I wasnt in any pain but i felt really stoned/drunk for about 10 minutes. The recovery was quick and i was able to walk on my own pretty much right away. Anesthesiologists are highly trained and specialized, so i knew i was safe and in good hands. Im sure that i will need to be put under again at some point in the future, so im glad ive had a good experience to look back on. Communication is key. If youre concerned or afraid about anything, you should vocalize whatever you're thoughts are. This used to be a huge fear of mine but the best way of overcoming any fear is talking about i and walking through it! Best of luck, everyone! :)
Great video....loved the topic. You seemed to cover the subject really well. Being a person who is hard to get an IV started (the last 2 times I had blood drawn for lab work once took 4 tries, the other 5 tries) I can respect why I'd need to go through the problems of having an IV done anyway
I had Procopo via IV on Thursday & then a mask. I have to say it worked perfect. lol i had a colon surgery. my Anesthesiologist was gr8. She was very nice
I had anaesthesia administered via IV as a child and it was done so smoothly. Plus, they did this in a separate room before the OR so I didn’t see any of the stuff that could be used. Couldn’t have been done better.
Interesting video! I've had both types of induction. I prefer the IV method, for at least it doesn't smell bad. In addition, newer general anesthetics are MUCH, MUCH better than ones used around 30-40 years or more ago. The induction is EASY. Waking up is MUCH BETTER. With the older stuff, I used to wake up with VERY BLURRY VISION, probably to where I couldn't even see the big E on an eye chart (20/200), plus there was a risk of nausea and vomiting. The older stuff also required at least several hours before I could safely walk. With the newer stuff, such as Propofol, it's possible to safely walk again in as little as 30 minutes after waking up. I also had some procedures done this year due to kidney stones, and they used an LMA (laryngeal mask airway), which is increasingly used instead of the traditional intubation. I get the impression that not only does LMA not go as far down the through as intubation, less lubricant is needed, which means much fewer rashes for me when waking up. Yes, i am allergic to stuff like SurgiLube. Thanks be to God that even with my sleep apnea (also have a tracheostomy due to the severe sleep apnea--related to birth defects), LMA works fine for me. By the way, I have a Montgomery cannula, which is a type of button cannula. Normal intubation can still be done if needed. As for endotracheal tubes, I WOULD like to shove one down the devil's throat--and plug the other end, so he can't breathe! The BEST devil is a DEAD one! May God's peace be with you--in the name of Jesus. From John Nozum
i had mask induction when i had major surgery they told me to take a deep breath the first deep breath i literally felt myself fall out of the world. Everything lost focus and i was instantly fatigued. they said "good" and told me to relax and said try my best to take another deep breath. I'm pretty sure i took a half breath and the next thing i know i had a nurse smiling at me in the recovery room. I saw no major downsides.
I have MHA, so my kids are considered to have it until we can test (they are adults now). When one of my kids was about 4 they needed the usual ENT procedures. The aneasthist didn’t want to use the mask and use the the IV. They were given some cream on their skin to numb the site for the IV. I stayed in the anaesthetic bay until they had the IV in.
Hi, Dr. Feinstein Thanks for this video, I have been waiting gor this topic for a long time, I always enjoy your videos. I had a needle broke off in me when I was 13, we got our shots at school in those days, I have had an extreme needle phobia ever since and loose all control at even the sight of a needle. When you showed those needles in your video, it caused me to panic attack even though I closed my eyes the second I saw them. I also have a mask anxiety really bad, I'm ok, though, if I hold the mask while the Doctor turns the gas on. How do you handle patients like me who have extreme phobias, I also loose all control if I see restraints anywhere near me as well, sadly, I injured a nurse real bad about 6 years ago when she tried to sneak up on me to give me a needle for a bone scan. Thanks for taking the time to read my comment, your feed back is appreciated.
i can remember one time having general anaesthetic, which was when i had my wisdom teeth removed. The needle they put in didn't hurt much, which was nice as I've had some pretty painful needles before
I've done both. I was born with a bi-lateral cleft lip & palate. The mask does feel odd, and you start to overthink when the mask is on you about when you will fall asleep. The IV is seamless. I hate IV's, but if you had to choose one or the other; it would be IV.
Mask anesthesia caused me claustrophobia!! It was a terrible experience. At one point, I almost got up from the table. Took me several mins to go under. I also had a super loud ringing as I went under. The second time around I got a procedure, the anesthesiologist put me under via IV which was INCREDIBLY LESS STRESSFUL
I still have a large bruise on my arm 6 days after my IV canula was removed. But I was glad I went under quickly, there was a moment I felt I was dying before I went under.
I have the full package of issues. I'm mortally afraid of needles, allergic to Epinephrine in local anesthetic, and suffer severe vasovagal syncope when I have injections. I also have PTSD from some terrible experiences at the dentist as a teenager which has given me severe dental phobia. I've really had to push hard in the past to be put out with gas as anesthetists don't want to use it. Had it for dental work when I was 16 as it was the only way they could get me in the chair. After about 10 seconds of gas, I was thrashing about in the chair so hard, both my shoes came off and nurses had to hold me down. Eventually passed out. It went well as far as I was concerned, although it took so long for me to wake up when the dentist had finished, that the nurses carried me out the chair and put me on a bed in a recovery room. When I woke up, one of the nurses said "If you're like that asleep, we're glad we didn't keep you awake!"
I had a complicated case of appendectomy: one surgery in a small hospital and after ten days (had iv all the time) was transferred to the local center hospital for another surgery (not in US). At first they planned to operate me in a small hospital twice, but when I was already undressed, getting ready for the second surgery, my surgeon came and told me, the operation was canceled and I would be transfered to another hospital. And of course, I wasn't able to eat or drink before the surgery (which supposed to be in the morning, but with a transfer ended up in 5 pm). I came to a new hospital with an iv from the previous. But they took it off, and were really struggling to put a new one into my 10DaysInHospitalNoWaterIn12Hours veins. But when they finally made it, I was given a mask as my anesthesia provider. And I was in shock, when I woke up with iv in another hand. Really wanted to know is it a common thing, or my doctors were scared as hell, when found out, iv isn't working Apologies for my English!
Nothing gets me more excited than a good TIVA with TCI using Propofol (Schnider) and Remifentanil (Minto) 🤪 Rapid induction (more so for Marsh given the PK model overshoots) and rapid emergence, inherent antiemetic properties, no greenhouse gas emissions, potential for NMBA-less intubation if your initial Remi target is high. But yes, for paeds 8% Sevo is usually the way to go without screaming the theatre suite down.
I never had any surgeries as a kid so I’ve always had an IV administered preoperatively. I use Elma cream about an hour before but the real challenge is trying to avoid getting poked multiple times due to small veins. I’ve heard from a friend who had surgery as a kid that kids get to pick a flavor for the mask induction. I wish there was a way to add flavors to IV meds (ube is my fave!).
If you are going to put someone under using a mask, tell them that the medication smells horrible. Thought I was breathing vehicle exhaust so I fought it a lot.
I wish you’ve not missed the opportunity to show that, no matter how big is the needle, only it’s tip brakes the skin so the IV catheter can be introduced into the vein.
Pro to total IV anesthesia: some patients have horrible post anesthesia vomiting. It runs in the women in my family. I started with it in my 20s. Prior to my last bowel resection I told my pain management doctor this who happens to be an anesthesiologist, and he told me to tell the anesthesiologist on my case during my preop consult, that I need total intravenous anesthesia. So I did. 180 degree difference. Much more positive experience.
Never realized this always thought you were just asleep almost immediately when the mask was placed on my boyfriend had surgery and was just told to think of a nice happy place like a beach etc was a sleep before he new it was in the recovery room didn’t thrash around or didn’t have a suffocating feeling the experience is different for everyone I guess but most people would just be out before they would be in much discomfort .
Had to have an operation once for some oral surgery. Had propofol by injection, no problem. Fast forward 5 years later and now I needed an operation in Germany (US citizen). Went to a german hospital and they decided that mask/gas was the way to go. Getting knocked out went fine, but when I came out of it I have never had such a nausea and vomit fest as that afternoon. Oh well. Over now.
I have had induction with both as a kid and an adult, finding that while mask induction is rough (I got Halothane as a kid & Isoflurane as an adult), waking up is smoother compared to i.v. induction. Having undergone a few dozen surgeries, what has made pain relief and recovery even better for me is Dexmedetomidine.
It is definitely not very good without additional stronger pain meds (lidocaine, opioids, etc…). Edit: it used to cost around $700-$800 per bag where I used to work, which is really sucky.
Hey Max. In one of your videos about what happens before anesthesia, I thought you said the mask was used for every patient regardless of age to give them 100% oxygen since they’re apneic under Propofol. Even at 31, I’ve never liked the mask. I’m obviously not asking for medical advice, but when I’ve requested IV anesthesia instead of the mask technique, Anesthesiologists get a little irritated with me.
Pre-oxygenation is not the same as inhaled induction. Even though it’s more efficiently achieved by tightly adjusting the mask over patient’s face, we can let it be a little looser for comfort. During induction with an inhaled anesthetic it’s critical to tighten it effectively to avoid leakage, which would prolong the process and also pollute the OR air.
@@henriquelaydner4080I understand the difference between pre-oxygenation and inhaled agents. However, I thought that mask was needed regardless of which method is used, since the patient will likely not be breathing on his or her own in the induction phase
I enjoyed your comparisons. For children though, I guess I always assumed that a mask induction would be followed by a catheter placement, for the just-in-case scenarios. If I were an anesthesiologist, I would be a Nervous Nelly, with no 'port' in a storm!
As a very young child, I was once induced with ether. Not very pleasant. Over subsequent years, I was induced with N2O 3x...not unpleasant at all and no side effects. Propofol is great, of course, but I always tell the anesthesiologist that I'm allergic to benzodiazepines because they are completely unnecessary and leave me significantly confused and lacking good judgement for many hours after what would otherwise have been full recovery from anesthesia.
I had a lot of surgeries as a kid & always preferred the iv start because I hated the smell of the gas. The smell seemed to get everywhere including in my hair.
Ime they usually put the IV in in the prep room before surgery. They put a second one in when I was under. I do remember when they put the prophol in and it was count to 10... more like 123... woke up in the recovery room. I do remember them pulling a tube out of my throat at the end of the surgery and putting a mask on but was numb enough not to care. Definitely gonna say the needle is the way to go.
The two times I remember having anesthesia (I’ve forgotten some from when I was a kid), one was mask one was IV. I’d say mask was worse simply because I was still awake when I made it to the operating room and was briefly afraid they’d operate on me before I passed out. Then I opened my eyes and I was in recovery. My more recent IV anesthesia I was out as soon as they rolled me into the hallway.
I had to get a mask for a surgery, when I was an adult. An IV couldn't be gotten. I was getting my mediport for my difficult veins. My veins are so bad, it's been deemed a genetic flaw for me. No, I've never done ANY drugs, never even smoked a cigarette. But, I have Epilepsy and need to have access regularly. So, I went into surgery without an IV and as soon as my port was placed, it was accessed. I've had 7 I.O.'s even.
I don't care how they knock me out for a procedure...just as long as I don't wake up during the procedure. Had that happen during a test where I needed anesthesia. Didn't feel a thing or see anything but I could hear the doctor.
Thanks Doctor for such useful information.i was wondering how doctors/anaesthetist make sure that Now is the perfect time to start surgery/first incision and patient will not move at all.
Hey Max, how about something quite exotic, effective, safe (and *very* expensive), namely Xe / O2 induction and / or anaesthesia? You may even go open circuit and charge the patient for the xenon gas wasted 😁.
As a kid I can remember having aneyesurgeryand I was freaked out crying.when the gurney gotta the operating room I remember my eye surgeon coming out and picking me up and cradled in his arms. Iwas about 4. He sat down on a chair near the table and took the mask from the anesthesiologist. He placed I gently over my face and sang to me as I drifted off. Now as an adult I get an IV even though I have sensory issues. It seems that once the anesthesiologist learns thatmidazolam (Versed) puts me right out that they give that first. Of course I've also got obstructive sleep apnea so I assume they do it that way to get me intubated asap. But this last procedure I had something must have been done different because I had a laryngospasm in the recovery area. It was the only time after having multiple surgeries that I remember that happening.
When I was in the OR (high on calming meds) I asked if I could see the anesthesia go in, assuming it was an injection, but she sounded unsure and I couldn't understand her cause the surgeon started talking at the same time as her and that's the last thing I remember before waking up
I was 4 - 5 yrs old my parents told me I just had to go to the hospital before I could start kindergarten. I remember being in a room and it was that 70’s blue hospital color. I’m looking around and realizing it’s a surgical room. I freak out and they put a mask on me while holding me down. That smell/taste was horrible. It has given me a lasting trauma to surgeries and simple procedures. I talk to the surgeon and anesthesiologist before the surgery so they understand and we can plan a safe surgery for me. For me what could have saved me this trauma was my family telling me the truth. BTW this was all because of my ears. Now as an adult you can’t see my ears because they really sewed them to my head. I probably would have grown into them. My oldest son had ears like mine and he looks very normal.
