I recently had my first ever general anaesthetic in my late 50’s for a routine foot op………never felt so ill in my whole life. Should have been in recovery for 20 minutes max and was there 7 hours as they couldn’t get on top of my PONV. I knew I was high risk before the op because being female, non smoker, history of motion sickness etc, and I’d done my own research…..but the anaesthesiologist didn’t take me seriously or do a proper risk assessment in my view. I’ll be much more assertive next time for sure. After the op they ran out of different things to try so eventually sent someone to the ward to my case and retrieved my own anti nausea tablets I use……felt much better within an hour, they still had to keep me in overnight when it should have been day surgery. I wish you’d been my anaesthesiologist!!
I'm someone who always vomits for days after anesthesia until a wonderful anesthetist told me about scopalimine patches. I met him 2 days before knee surgery, he gave me a patch and said put it on in the morning of surgery as soon as I wake up. It was a miracle for me.
I'm an anesthesiologist resident in Spain and I love and appreciate your videos so much. This kind of information for the non medical public is so important. Thank you
Why are emesis basins so small? I get it if you're unconscious, but if I'm awake and holding the thing, can't you give me something bigger and more dignified to throw up in? Edit: even the Wikipedia article says they're garbage for actually catching vomit and are frequently avoided for such purpose. AND YET...
I had a migraine/suspected concussion when I was in a&e after falling off my bike and hitting my head with no helmet. I remember being handed a bin (might have been an open/unused sharps bin) as I was about to throw up with no warning (I was 10 years old and a bit dozy, the a&e doc had reaction senses like spider man). I think the nurses/HCAs/cleaning staff/my mum appreciated the doc’s smart move, little to nothing to clean up!
I too have never understood why the emesis basin is so small and curved. If you hit the basin with it's curved shape, it could easily go everywhere. When I was working at an imaging facility I grabbed a trash can....to heck with that little emesis basin.
inside the OR,if the patient is already lying on the operating table or bed and was anesthetized and up to few hours after the operation your not allowed to lift the patient's head up to vomit and the patient is prep not to ingest food or water few hours prior to OR so theirs no need to have a big emesis basin or even trash bin to throw up.
We usually give our patients emesis bags, they hold nearly a liter of fluid and they're a long skinny plastic thing so the vomit lands far from your face and won't spill out. I usually save the emesis basins for patients to spit in brushing their teeth if they can't get to the sink to do it.
I have absolutely ZERO interest in becoming an anesthesiologist and as far as I know have no surgeries coming up. However your calming demeanor and delivery of your video are bringing me much peace (or escape) during a turbulent time for me. Thanks max.
I had a hysterectomy three weeks ago and after surgery I have been dealing with really bad nausea, a complicated uti, antibiotics, and weekly iron infusions. I finally decided that I needed my Doctors help. Thankfully, now have Zofran on board at least until I can get over three more weeks of recovery. Thank you for your time and this video!
Dr. Feinstein, I enjoy your channel, Im in school right now for my BSN and on the way to becoming a CRNA. I think it would be amazing if you did a video talking about the role of a CRNA with the anesthesiologist.
I’m super prone to PONV as we discovered after my first surgery as a child….puked like the exorcist. 😂 Now, I make sure to tell my anesthesiologist that I need EVERY single anti nausea med in my anesthesia cocktail and I also request the Scopolamine patch to be placed behind my ear before I go under. Even then, when I wake up, I’ll still feel nauseous and need an extra dose of Zofran. Last surgery I had was a total hysterectomy a couple years ago and I still needed a dose of Zofran plus a dose of Tigan after waking up. Thankfully, it did the trick. Nausea disappeared, I never threw up, and I was able to take in broth and jello.
Ever since a surgery where a method referred to as TIVA (Total Intravenous Anesthesia) was used by the anesthesiologist, I've never gotten PONV ever again. Upon asking about it, I was told that the gases that are often used, are most often the cause of PONV.
That is correct. However there are some circumstances where using inhaled gas instead of TIVA provides an overall more favorable risk profile. It depends on the circumstances of the patient and the surgery.
Thank you for providing your insight into that. I always like to understand why something is done in a particular way vs another. I love the videos you make. You're a really good educator as well as an anesthesiologist.
In the past I always ended up with a raging headache and then would throw up after surgery. The last major surgery I had, I got off caffeine before having it so I wouldn't end up with a caffeine headache after surgery. I was thrilled to not throw up. I can't prove being off caffeine helped because I know the anesthesia might have been a different type, but my next surgery I plan to do the same thing.
Great video! I’ve been hesitant to have post weight loss skin removal surgery for multiple reasons regarding my sensory and auditory processing disorders being the biggest because of their effects on the entire experience but your videos have answered so many questions that have helped me understand that it’s actually possible for me to have it sometime in the future when I have the time and money to and I really appreciate them, keep up the great work!
I'm a real puker, so that was interesting. I feel so bad for all the PACU nurses who have been in my trajectory. I had 3 surgeries in 2020 and they seemed to figure me out by the 3rd one. I have vague memories of them putting little gauze pads with peppermint oil in my oxygen mask to help with the nausea. It was a really nice complement to the drugs.
We have come a long way with treatments for nausea and vomiting. Back in the 80s there was little they could do. I remember any family members that woke up after surgery had issues with it. I work in a hospital and reguarly walk through PACU and rarely see anyone vomiting or complaining about nausea. I have been put under twice for outpatient procedures and had no issues. Same with children and adults that are dealing with stomach issues. Back in the day you just had to deal with it, now there are medications that are very effective for most people. My brother went through chemo the year before last and only vomited twice. Zofran worked well for him.
After I'd had several surgeries, one day it just popped in to my head that if I get gas I end up vomiting after I wake up, but if I go to sleep through IV meds I'm fine, so I now point this out when I'm going in and it's been working out for me.
Same here, only had 1 surgery on the gas and puked for a good long while. as someone with emetophobia thats really amazing... but when i get the magical white syringe i go under and wake up basically ready to go home. as if i just took a short powernap. amazing stuff
Have you heard of ClearFast? I had surgery at a Scripps facility in 2020. They had recently started a new system-wide protocol that worked wonders for me. They have the patient drink a bottle of ClearFast at midnight, and another one right before leaving for the hospital. The liquid passes so quickly from the stomach (it’s gone prior to surgery) that there is no danger of aspiration during surgery, but the additional carbs, proteins, and hydration significantly cut down on the need for additional anti-emetics (and decrease required nursing minutes posy-operatively). I have a long history of vomiting after surgery despite prophylactic meds - this drink is such a game changer. I actually felt good afterwards. (The protocol also has you drink a bottle once you wake up.) The drink was developed by someone connected to Scripps, and they’re trying to spread the word that clear, colorless liquids are demonstrably safe a few hours before surgery, but adoption has been slow - I think there’s hesitancy around changing long-standing safety protocol. But the benefit to patients (and the reduction in nursing time required) is significant.
My mom had this protocol used for her colonoscopy and she's 69. It was a breeze for her. She was walking and upright completely fine right after surgery, although I obviously monitored her. I'm hoping if I ever have to go under again they will use ClearFast.
Interesting video. I'd love to see more anti-dopaminergic drugs for nausea/severe vomiting without the bad side effects such as dystonic reactions. Curious to see how this drug works out as an overall anti-emetic for non-PONV cases.
I almost died 15 years ago when I aspirated after having cervical neck surgery. I was left in recovery room and my sister came in to see me and found me unresponsive. I don't remember much on my recovery but I was in CCU for over a week and spent another week in regular hospital room. I am terrified now of ever having any general anesthesia because of this experience.
@@bioshawna They sluffed it off as something that "routinely" may happen. My sister spoke with a nurse when in was in ICU and she admitted that I should have been monitored while in recovery. Unfortunately we never saw a lawyer after my experience as I was just happy to know I survived. I still am hesitant of anesthesia even when I have had twilight anesthesia for colonoscopy, I let the doctor know about what happened to me before.
Thank you very much for the information on this topic. While I'm no fan of puking, if it's the worst thing to put up with after surgery, life could be much worse.
I'm one of the fortunate ones. Since diagnosis of kidney disease in 20202 and since requiring semi annual bilateral ureter stents as an outpatient procedure at hospital with anesthesia, I've never had a problem with Ponv.
I get nauseous from anesthesia so the last time I went under, I asked for some antiemetic and I was up and walking very fast. If anyone gets nauseous post op, def tell your anesthesiologist and they will do what they can to help.
I get terrible PONV and unfortunately require a lot of surgeries, both GA and Twilight. My most recent GA following a moderate back surgery the Anaesthesiologist told the nurses to bring me a lemonade ice block as he suspected low blood sugar was makings me feel sick also (not diabetic). The nurses in recovery were very hesitant, but due to allergies I had maxed out anti nausea drugs. They got me the ice block and it was the most helpful thing ever. I was watched like a hawk eating it. I usually have the same Anaesthetist and didn’t on this occasion so I appreciated a new idea. I will let the others know in future that helped immensely!
I tend to get violently ill after surgery from anesthesia. My wife said she is never going to let me do another outpatient surgery again, she said she will insist I only do in-patient from now on.
Me too. I get very sick from anesthesia. Even after pain shot they gave me for cervical spine and lumbar spine. Really don’t want too repeat those as they don’t help much at all for my pain and not worth side effects and hassle it takes too do the shots as neither my husband or I drive and don’t want too inconvenience anybody else having to pick us up after anesthesia
I have always had terrible PONV! But when I had the heart surgery in 2005 I was so surprised that I didn't have nausea!! I didn't vomit once!! Thank you Dr. Feinstein for this information. I have a very good idea now about why I didn't throw up or vomit after the ❤ surgery!! I was so grateful to the medical staff for not vomiting!! 😊
I had a partial knee replacement 4/5. I did my pre-surgery drink to reduce gastroparesis. I had nerve block, Versed, spinal & propofol. I was mildly queasy when I sat up before trying to walk and had IV Zofran. I walked. I peed. I was getting discharge instructions and out of nowhere threw up -- had only had water so that's what it was. Then I was fine and had no more nausea or vomiting.
OH THANK GOD. Meds have gotten to the point that I'm still very nauseous but I don't throw up. If you get rid of the nausea that'll take like 50% of my anxiety in terms of surgery. It's THAT unpleasant for me.
I always get sick after surgery. They have not yet found the perfect cocktail for me to prevent it. This makes me even more anxious about having surgery.
I had my appendix removed a few yrs ago and was vomiting blood after surgery. It turns out my throat has narrowed a fair amount as I’m aging, so I now need a much narrower intubation tube. 😊❤️🇨🇦
Hey Max thanks for your videos, I had sedation for my endoscopy today and had a nice chat with the anesthetist about the drugs he was using and dosage, he asked if I'm in the medical field because I knew so much from your videos :) PS propofol is awesome
@@TheRagingWookie From my own experience: I felt REALLY happy after I got propofol. Like, unnaturally happy. It was like the best sleep ever. I don't remember anything about the procedure itself. After I woke up, I was laughing and telling some weird jokes to the doctors. Then I had to wait until these effects passed. Felt ok afterwards, except for a minor vertigo. Had no other side effects.
My last surgery I had horrible nausea and vomiting post op. Which was very unfortunate for me because it was after a 7 hour abdominal surgery. And I don't think I have ever felt so much pain in my life. I had literally every risk factor for it which sucked. I have a rare metabolic disease that means propofol is off limits and volatile anesthestics are our only maintaince option which sucks for me because there's nothing we can change to lower the risk. As least I now know that compazine works way better than Zofran for me. If I ever have abdominal surgery again they are defiently going to know that!
When I had oral surgery in 1987, I received the anesthesia by mask and I vomited several times following the surgery. When I had a hernia repair surgery in 1993, I received the anesthesia by IV and I never got sick once.
In 2008, I had a sigmoid resection (not laproscopic), and was very concerned about PONV. During my pre op consult, I was assured that with new powerful meds, it shouldn't be a problem, and happily, I had zero PONV issues. That was the last thing I wanted after having abdominal surgery.
Amisulpride on the other hand can have quite dangerous side-effects, like malignant neuroleptic syndrome, QT prolongation, stroke, venous thromboembolism, leukopenia, neutropenia, agranulocytosis, hyperprolactinemia (various tumors), liver toxicity and it, like flumazenil, lowers epilepsy threshold. So it’s really a risk-benefit analysis.
What a great video! I usually get sick from general anesthesia. I can't even have premeds before surgery because they make me sick. At one point, the right cocktail was found but I haven't had general anesthesia in over 24 years.
I understand the importance of having an empty stomach before surgery! It has been preached to me for decades. I have always followed the rules. I have always wondered how this issue is dealt with regarding a trauma patient who may just eaten before a need for surgery. I guess that is where an anesthesiologist really shows there talent! You may have patient history. or knowledge of what you can or cannot give. I would guess that in these situations you are more concerned about just keeping the person alive at any cost.
Thank you for the video, Dr. Feinstein! I just had my 6th ortho surgery on my left hand yesterday, thankfully all 6 was done with nerve block and sedation, so I didn’t get much ponv ( nothing a dose of zofran can’t fix)
wait what are the side effects of dexamethasone that he is referring to? Is it the psychiatric ones, like anxiety and agitation? Also why wouldn't it be appropriate for him to say that?
My great uncle created the ASA guidelines at Rhode Island Hospital he had a twin brother that was an anesthesiologist too. Meyer and Elihu Saklad I enjoy all your videos 7:35
Dr. Feinstein, I enjoy yoiur channel and find it very educational and enlightening. As a kid back in the early 50's, I had surgeries for Spina Bifida, Clubbed feet and other birth defects.. Back then they used ether. Whew...talk about nausea and vomiting..that stuff was rough! I've had more surgeries since that time and waking up was so much easier without the N/V. Thanks for an interesting topic.
I vomited up a bunch of green bile the day after my surgery in March. Ironically the vomiting was triggered by dissolving Zofran on my tongue. It wasn’t pleasant but I felt so much better afterward.
I am extremely prone to PONV and don't tolerate most opioids as well as gas anesthesia; which means that for me to get the best surgical outcome possible, I need everything you can throw at me. I usually request TIVA and a prophylactic dose of aprepitant about 2h before induction. And then anesthetists give me ondansetron and dexamethasone during anesthesia AND a dose of either haloperidol/droperidol + dimenhydrinate before emergence.
Hey Dr. Feinstein, I've watched many of your videos and this one is going to serve me very well for my next surgery in June. I drew a "NO PONV" sign on a piece of paper and held it up to the anesthesia team before my last procedure. We had a nice laugh. Must have worked because I didn't have ANY PONV afterwards.
Thank you! I got lots of dexamethasone during my cancer treatment, but I always got it in a diluted bag over like 45 minutes. I was curious but I couldn't find it on Google.
Dr. Feinstein, you were born to be a physician and more specifically an anesthesiologist. All those years of medical school drudgery and even O. Chem before that clearly paid off, because IMHO you clearly know ur stuff! When it comes time to sit for the Boards, you should be given a pass. Just show ‘em your impressive YT body of work….instantly Boarded!
I feel like the only person that Zofran just doesnt work very well for. I have better success with it if i have right when nausea starts but if I've been nauseous for while or have made it to the active vomiting phase, it does nothing for me. Phenergan though....has never let me down 😂 i fought for 3 years with gallbladder issues before javing it removed and the amount of Phenergan i got through iv's ruined my veins, but boy was it my best friend for a while.
Im a post op vomiter. Last time i had surgery i remembered to tell them that and they gave me zophran before i woke up and other nausea meds after i woke up.
This brings back memories. I was diagnosed with gallstones at 16 and while on the year long waiting list I ate Ondansetron for breakfast. First thing I wanted post op was more anti emetics!
I only get nauseous when volatile anesthesia is used. I make sure to let my anesthesiologist know before surgery and they've been great about controlling my nausea. Great video, Max. Get some more humor in there like your older ones 🙂
Vomiting is a nasty thing, but especially after anesthesia it is horrific I had it big time after surgery back in 2010. It still haunts me to this day even though it was 13 years ago. The inhaled anesthesia is disgusting. That smell, taste and feeling will be in my memory forever absolutely horrible 🤢🤮😭
Hey Dr F, Veterinary technican here, and Mom of a child that had an anesthesia Event, Can you do a video on Pediatric Laryngospasm upon extubating in asthmatic children, (or just maybe Anesthesia concerns in asthmatic kids) My Daughter was extubated after a T&A and when into a Laryngospasm, they had to push Succs and intubate her again then she started having retractions and wheezing back under anesthesia, she was 2 years old, we had to wait about 5 min before trying to extubate her then she was on Q2 Albuterol admitted into PICU and had aspirated, BTW i was not told any of this until on of the nurses came and got me 45 min after it happened, her O sats where very low, and I was told to get a MRI or CT if she ever had any symptoms of Hypoxia its been about 8 months since then and I have noticed some speech delays or regression, and occasion odd behaviors that I am considering Getting her that MRI, anyway
What works for me is Phenergan. For some reason drs refuse to give Phenergan after surgery anymore so I throw up violently for hours after any surgery. My drs argue with me and tell me Zofran will help me or that patch behind the ear but none of these help. I wish drs would listen to their patients and just give me what works ie. Phenergan
Agree. Zofran doesn't do much for me either, however, IV Phenergan (which works!) caused blood clots in 2 veins in my arm. Was on blood thinners for 3 months.
Thanks for the video!! I had bad motion sickness( POMV) after i wake up from my minor procedure. For sure it was not fun after received Phenergan...yes, nausea and vomiting stopped, but HR dropped, BP dropped and felt quite dizziness for 2 days..
For anyone who wants to answer, when I was a child (in the 70s &80s) I had a few surgeries and always experienced severe nausea and vomiting for at least 24-36 hours. Now that I’m an adult, I’ve had 3 surgeries and have never experienced any nausea or vomiting. Do you believe this is most likely due to improvements in medications used or more likely related to my adult system handling it better? I tend to think it’s more related to changes in medication protocol.
It could be both. Newer meds and our bodies change. I went through the same thing. Had my tonsils out and was given ether. Threw up for hours. Had a very bad headache for four days also.
Yup,I'm one of those people...After one procedure,I was still in the hospital and went longer than eight hours before dinner..And halfway through dinner...Guess what...I was very annoyed.
Curious, when a patient comes in to the er as a trauma patient and is unconscious etc. and needs to go to emergency surgery, do you still give general anesthesia? If so, how do you know the patient is "asleep" and unable to feel anything if the patient is already unconscious and not responding? Could you do a video explaining an anesthesiologists job during trauma situations?
I don't feel nauseated or vomit afterwards, I feel bone deep cold. I always request a warm drink (water, tea, coffee, etc.) but rarely get it, though they usually bring warm blankets.
I had my jaw rebuilt after a head on motorcycle accident destroyed it. My mouth was wired shut afterwards and I wore a pair of wire cutters on a chain around my neck. Years later I thought...If I had gotten sick by the time I got the wires cut which would ruin the recon I just had, I would have aspirated. There isn't any time to say oh hang on there a minute, need to cut those wires. They need to come up with a better way to stabilize jaw fractures and recons without wiring ppl mouth shut
Dehydration is /was always the issues Ive had after surgery. I recently underwent surgery for a complex shoulder break (proximul humas) and I was denied water for two days before the operation. I wa heaving up the medication given.. I'm in Euroize by the way.
I have severe emetophobia so my main fear with any surgery is that I might throw up due to anesthesia, almost to the point where I didn't get a tonsillectomy for a cyst. Surgery?? In my throat?? BY MY GAG REFLEX???? Zofran was my friend
I'm not sure. It's an injectible steroid that has all the implications of steroids: mood, hormone regulation, increased blood sugar, skin conditions, depressed immune system...and it can affect growth in children. Most of these are from prolonged use though, not from the single dose you get during surgery.
2:17 Waking patients up - A nurse had said when she woke up a patient that had received . anesthesia . They had unfortunately attacked her from the after effects and disabled her . I suppose she came up to their side and ? I would suggest that you touch or jiggle a patient's toes / feet to get them to wake up . This way you are obviously far away from their hands and arms ,
I saw Haldol in the emesis basin. Do you use this for PONV? That's a new one on me, PACU RN of 25 years. 2nd dose of Zofran, Reglan, diphenhydramine, promethazine are great choices for PONV.
I have noticed this very often and am just going to put it here: In Germany we do not use midazolam regulary. We did, but since it does not prevent delir and aggrevates Awarness from an explicit to and implicit experience it is now actualy fraund apon. There has to be specific reasoning in prescribing it. Ít is used in children and if patients explicitly ask for an anxiolitic. Even if you suspect intraoperativ awarnes we do not use it. Reasoning being that we want the explicit memory to be able to go into talking about it and if needed psychotherapy. Same thing goes for unpleasent experiences being made prior to general anesthesia. Midazolam makes psychotherapy close to impossible.
Thank God i've never felt what PONV feels like, after going under general probably more than 15 times. However i do feel urgent need to smoke after emergence and i got wrecked by medical staff multiple times for doing it 😅
Hey everyone, ever since I got an appendectomy five years ago I’ve had nausea every day. What I don’t get is why i seem to be getting used to all the usual anti-nausea medications. Has anyone else had this problem?
@@madi4481 my jaw was malformed as a kid and when I was fully grown, at 17, they needed to fix it so I would have full function of my jaw. It was a major surgery where they had to break my jaw on both sides to move it to where it needed to be. Then they put rods and screws in it and wired my jaw shut and the bones screw back. I still have rods and screws in my jaw. I was in the hospital for one night. Thankfully that's when I started puking.
So because thalidomide caused birth defects in pregnant women, you'd want to avoid amisulpride... because it sounds similar? Even though amisulpride was first introduced in the 1990s?
@@ChrisPBacon-ok7ir Thalidimide was never approved by the FDA for use by anyone. This is not to say the FDA is perfect; there have been many missteps and there is plenty they could do better. But if you ever want to use medications, what do you propose? No Federal organization? Good luck with your next infection when there is no formal assessment for whatever you take.
Hey max, how does anesthesiology interact with regular nurses in the OR? Do you ever ask for their help or ask them to help you draw up meds. How is it decided if an anesthesia doctor is on the case versus a CRNA. It seems like crna have a very similar role.
Amisulpride is an antipsychotic and does have a psychoactive effect, I have taken it and I found it quite unpleasant. As a potential patient of an anesthesiologist at some point I would much prefer something that is not a strong anti psychotic if I can at all help it. Another concern I have with anti psychotics is tardive dyskenesia. After one dose amisulpride had my feet in a kind of spasm and curled up, I couldn't really walk on them. I am guessing the research and fda claim that this drug doesn't have these risks or a reduced risk? I have my doubts after having taken it before.
My doctor is doing a bladder stone removal with a scope. I asked if it would be done under General annesthesia he said light General Annesthesia with an LMA. Can you explain if that means conscious sedation without a breathing tube?
I recently had my first ever general anaesthetic in my late 50’s for a routine foot op………never felt so ill in my whole life. Should have been in recovery for 20 minutes max and was there 7 hours as they couldn’t get on top of my PONV. I knew I was high risk before the op because being female, non smoker, history of motion sickness etc, and I’d done my own research…..but the anaesthesiologist didn’t take me seriously or do a proper risk assessment in my view. I’ll be much more assertive next time for sure. After the op they ran out of different things to try so eventually sent someone to the ward to my case and retrieved my own anti nausea tablets I use……felt much better within an hour, they still had to keep me in overnight when it should have been day surgery. I wish you’d been my anaesthesiologist!!
I'm someone who always vomits for days after anesthesia until a wonderful anesthetist told me about scopalimine patches. I met him 2 days before knee surgery, he gave me a patch and said put it on in the morning of surgery as soon as I wake up. It was a miracle for me.
I'm an anesthesiologist resident in Spain and I love and appreciate your videos so much. This kind of information for the non medical public is so important. Thank you
Why are emesis basins so small? I get it if you're unconscious, but if I'm awake and holding the thing, can't you give me something bigger and more dignified to throw up in?
Edit: even the Wikipedia article says they're garbage for actually catching vomit and are frequently avoided for such purpose. AND YET...
Agreed!!
I had a migraine/suspected concussion when I was in a&e after falling off my bike and hitting my head with no helmet. I remember being handed a bin (might have been an open/unused sharps bin) as I was about to throw up with no warning (I was 10 years old and a bit dozy, the a&e doc had reaction senses like spider man). I think the nurses/HCAs/cleaning staff/my mum appreciated the doc’s smart move, little to nothing to clean up!
I too have never understood why the emesis basin is so small and curved. If you hit the basin with it's curved shape, it could easily go everywhere. When I was working at an imaging facility I grabbed a trash can....to heck with that little emesis basin.
inside the OR,if the patient is already lying on the operating table or bed and was anesthetized and up to few hours after the operation your not allowed to lift the patient's head up to vomit and the patient is prep not to ingest food or water few hours prior to OR so theirs no need to have a big emesis basin or even trash bin to throw up.
We usually give our patients emesis bags, they hold nearly a liter of fluid and they're a long skinny plastic thing so the vomit lands far from your face and won't spill out. I usually save the emesis basins for patients to spit in brushing their teeth if they can't get to the sink to do it.
A seasickness patch worked pretty well for me after my last spinal surgery
Same for my SI Joint fusions! Scopolamine patch and ondansetron worked well.
I have absolutely ZERO interest in becoming an anesthesiologist and as far as I know have no surgeries coming up. However your calming demeanor and delivery of your video are bringing me much peace (or escape) during a turbulent time for me. Thanks max.
I had a hysterectomy three weeks ago and after surgery I have been dealing with really bad nausea, a complicated uti, antibiotics, and weekly iron infusions. I finally decided that I needed my Doctors help. Thankfully, now have Zofran on board at least until I can get over three more weeks of recovery. Thank you for your time and this video!
Dr. Feinstein, I enjoy your channel, Im in school right now for my BSN and on the way to becoming a CRNA. I think it would be amazing if you did a video talking about the role of a CRNA with the anesthesiologist.
I’m super prone to PONV as we discovered after my first surgery as a child….puked like the exorcist. 😂 Now, I make sure to tell my anesthesiologist that I need EVERY single anti nausea med in my anesthesia cocktail and I also request the Scopolamine patch to be placed behind my ear before I go under. Even then, when I wake up, I’ll still feel nauseous and need an extra dose of Zofran. Last surgery I had was a total hysterectomy a couple years ago and I still needed a dose of Zofran plus a dose of Tigan after waking up. Thankfully, it did the trick. Nausea disappeared, I never threw up, and I was able to take in broth and jello.
Ever since a surgery where a method referred to as TIVA (Total Intravenous Anesthesia) was used by the anesthesiologist, I've never gotten PONV ever again. Upon asking about it, I was told that the gases that are often used, are most often the cause of PONV.
That is correct. However there are some circumstances where using inhaled gas instead of TIVA provides an overall more favorable risk profile. It depends on the circumstances of the patient and the surgery.
Thank you for providing your insight into that. I always like to understand why something is done in a particular way vs another. I love the videos you make. You're a really good educator as well as an anesthesiologist.
In the past I always ended up with a raging headache and then would throw up after surgery. The last major surgery I had, I got off caffeine before having it so I wouldn't end up with a caffeine headache after surgery. I was thrilled to not throw up. I can't prove being off caffeine helped because I know the anesthesia might have been a different type, but my next surgery I plan to do the same thing.
Great video! I’ve been hesitant to have post weight loss skin removal surgery for multiple reasons regarding my sensory and auditory processing disorders being the biggest because of their effects on the entire experience but your videos have answered so many questions that have helped me understand that it’s actually possible for me to have it sometime in the future when I have the time and money to and I really appreciate them, keep up the great work!
I'm a real puker, so that was interesting. I feel so bad for all the PACU nurses who have been in my trajectory. I had 3 surgeries in 2020 and they seemed to figure me out by the 3rd one. I have vague memories of them putting little gauze pads with peppermint oil in my oxygen mask to help with the nausea. It was a really nice complement to the drugs.
We have come a long way with treatments for nausea and vomiting. Back in the 80s there was little they could do. I remember any family members that woke up after surgery had issues with it. I work in a hospital and reguarly walk through PACU and rarely see anyone vomiting or complaining about nausea. I have been put under twice for outpatient procedures and had no issues. Same with children and adults that are dealing with stomach issues. Back in the day you just had to deal with it, now there are medications that are very effective for most people. My brother went through chemo the year before last and only vomited twice. Zofran worked well for him.
After I'd had several surgeries, one day it just popped in to my head that if I get gas I end up vomiting after I wake up, but if I go to sleep through IV meds I'm fine, so I now point this out when I'm going in and it's been working out for me.
Same here, only had 1 surgery on the gas and puked for a good long while. as someone with emetophobia thats really amazing... but when i get the magical white syringe i go under and wake up basically ready to go home. as if i just took a short powernap. amazing stuff
Have you heard of ClearFast? I had surgery at a Scripps facility in 2020. They had recently started a new system-wide protocol that worked wonders for me. They have the patient drink a bottle of ClearFast at midnight, and another one right before leaving for the hospital. The liquid passes so quickly from the stomach (it’s gone prior to surgery) that there is no danger of aspiration during surgery, but the additional carbs, proteins, and hydration significantly cut down on the need for additional anti-emetics (and decrease required nursing minutes posy-operatively). I have a long history of vomiting after surgery despite prophylactic meds - this drink is such a game changer. I actually felt good afterwards. (The protocol also has you drink a bottle once you wake up.) The drink was developed by someone connected to Scripps, and they’re trying to spread the word that clear, colorless liquids are demonstrably safe a few hours before surgery, but adoption has been slow - I think there’s hesitancy around changing long-standing safety protocol. But the benefit to patients (and the reduction in nursing time required) is significant.
My mom had this protocol used for her colonoscopy and she's 69. It was a breeze for her. She was walking and upright completely fine right after surgery, although I obviously monitored her. I'm hoping if I ever have to go under again they will use ClearFast.
I get horrible (albeit dose-dependent) PONV, so this was a really interesting video for me.
Interesting video. I'd love to see more anti-dopaminergic drugs for nausea/severe vomiting without the bad side effects such as dystonic reactions. Curious to see how this drug works out as an overall anti-emetic for non-PONV cases.
I almost died 15 years ago when I aspirated after having cervical neck surgery. I was left in recovery room and my sister came in to see me and found me unresponsive. I don't remember much on my recovery but I was in CCU for over a week and spent another week in regular hospital room. I am terrified now of ever having any general anesthesia because of this experience.
WOW. you're supposed to be monitored! How did the doctors react to this happening to you? Sounds like negligence
@@bioshawna They sluffed it off as something that "routinely" may happen. My sister spoke with a nurse when in was in ICU and she admitted that I should have been monitored while in recovery. Unfortunately we never saw a lawyer after my experience as I was just happy to know I survived. I still am hesitant of anesthesia even when I have had twilight anesthesia for colonoscopy, I let the doctor know about what happened to me before.
Thank you very much for the information on this topic. While I'm no fan of puking, if it's the worst thing to put up with after surgery, life could be much worse.
I'm one of the fortunate ones. Since diagnosis of kidney disease in 20202 and since requiring semi annual bilateral ureter stents as an outpatient procedure at hospital with anesthesia, I've never had a problem with Ponv.
I get nauseous from anesthesia so the last time I went under, I asked for some antiemetic and I was up and walking very fast. If anyone gets nauseous post op, def tell your anesthesiologist and they will do what they can to help.
I get terrible PONV and unfortunately require a lot of surgeries, both GA and Twilight. My most recent GA following a moderate back surgery the Anaesthesiologist told the nurses to bring me a lemonade ice block as he suspected low blood sugar was makings me feel sick also (not diabetic). The nurses in recovery were very hesitant, but due to allergies I had maxed out anti nausea drugs. They got me the ice block and it was the most helpful thing ever. I was watched like a hawk eating it. I usually have the same Anaesthetist and didn’t on this occasion so I appreciated a new idea. I will let the others know in future that helped immensely!
I tend to get violently ill after surgery from anesthesia. My wife said she is never going to let me do another outpatient surgery again, she said she will insist I only do in-patient from now on.
Me too. I get very sick from anesthesia. Even after pain shot they gave me for cervical spine and lumbar spine. Really don’t want too repeat those as they don’t help much at all for my pain and not worth side effects and hassle it takes too do the shots as neither my husband or I drive and don’t want too inconvenience anybody else having to pick us up after anesthesia
I have always had terrible PONV! But when I had the heart surgery in 2005 I was so surprised that I didn't have nausea!! I didn't vomit once!! Thank you Dr. Feinstein for this information. I have a very good idea now about why I didn't throw up or vomit after the ❤ surgery!! I was so grateful to the medical staff for not vomiting!! 😊
I had a partial knee replacement 4/5. I did my pre-surgery drink to reduce gastroparesis. I had nerve block, Versed, spinal & propofol. I was mildly queasy when I sat up before trying to walk and had IV Zofran. I walked. I peed. I was getting discharge instructions and out of nowhere threw up -- had only had water so that's what it was. Then I was fine and had no more nausea or vomiting.
OH THANK GOD. Meds have gotten to the point that I'm still very nauseous but I don't throw up. If you get rid of the nausea that'll take like 50% of my anxiety in terms of surgery. It's THAT unpleasant for me.
Yup , agree.especially if you have a tendency to have this problem
I always get sick after surgery. They have not yet found the perfect cocktail for me to prevent it. This makes me even more anxious about having surgery.
I had my appendix removed a few yrs ago and was vomiting blood after surgery. It turns out my throat has narrowed a fair amount as I’m aging, so I now need a much narrower intubation tube. 😊❤️🇨🇦
I’ve been under anesthesia 3 times and luckily had NO post operative symptoms , just felt a little run down or tired.
Hey Max thanks for your videos, I had sedation for my endoscopy today and had a nice chat with the anesthetist about the drugs he was using and dosage, he asked if I'm in the medical field because I knew so much from your videos :) PS propofol is awesome
what's propofol like?
@@TheRagingWookie From my own experience: I felt REALLY happy after I got propofol. Like, unnaturally happy. It was like the best sleep ever. I don't remember anything about the procedure itself. After I woke up, I was laughing and telling some weird jokes to the doctors. Then I had to wait until these effects passed. Felt ok afterwards, except for a minor vertigo. Had no other side effects.
@@TheRagingWookie Michael Jackson's contributing factor of death
My last surgery I had horrible nausea and vomiting post op. Which was very unfortunate for me because it was after a 7 hour abdominal surgery. And I don't think I have ever felt so much pain in my life. I had literally every risk factor for it which sucked. I have a rare metabolic disease that means propofol is off limits and volatile anesthestics are our only maintaince option which sucks for me because there's nothing we can change to lower the risk. As least I now know that compazine works way better than Zofran for me. If I ever have abdominal surgery again they are defiently going to know that!
When I had oral surgery in 1987, I received the anesthesia by mask and I vomited several times following the surgery. When I had a hernia repair surgery in 1993, I received the anesthesia by IV and I never got sick once.
In 2008, I had a sigmoid resection (not laproscopic), and was very concerned about PONV. During my pre op consult, I was assured that with new powerful meds, it shouldn't be a problem, and happily, I had zero PONV issues. That was the last thing I wanted after having abdominal surgery.
The patch works wonders for me.
Amisulpride on the other hand can have quite dangerous side-effects, like malignant neuroleptic syndrome, QT prolongation, stroke, venous thromboembolism, leukopenia, neutropenia, agranulocytosis, hyperprolactinemia (various tumors), liver toxicity and it, like flumazenil, lowers epilepsy threshold. So it’s really a risk-benefit analysis.
Just subscribed to the newsletter.
Thank you and please keep up the great videos!
What a great video! I usually get sick from general anesthesia. I can't even have premeds before surgery because they make me sick. At one point, the right cocktail was found but I haven't had general anesthesia in over 24 years.
I understand the importance of having an empty stomach before surgery! It has been preached to me for decades. I have always followed the rules. I have always wondered how this issue is dealt with regarding a trauma patient who may just eaten before a need for surgery. I guess that is where an anesthesiologist really shows there talent! You may have patient history. or knowledge of what you can or cannot give. I would guess that in these situations you are more concerned about just keeping the person alive at any cost.
I came in as a trauma patient who had recently eaten.....they pumped my stomach to get out as much as possible. That was in the 1990's.
Thank you for the video, Dr. Feinstein! I just had my 6th ortho surgery on my left hand yesterday, thankfully all 6 was done with nerve block and sedation, so I didn’t get much ponv ( nothing a dose of zofran can’t fix)
Marezine and Zofran together really nip the PONV in the bud when I have surgeries.
wait what are the side effects of dexamethasone that he is referring to? Is it the psychiatric ones, like anxiety and agitation? Also why wouldn't it be appropriate for him to say that?
It makes you itch in places you’d rather not itch.
@@royquitterA real pain in the arse.
Thanks...I was wondering that too
Yeah just say what it is. This an informative video after all. No reason to be embarrassed.
My great uncle created the ASA guidelines at Rhode Island Hospital he had a twin brother that was an anesthesiologist too. Meyer and Elihu Saklad I enjoy all your videos 7:35
Dr. Feinstein, I enjoy yoiur channel and find it very educational and enlightening. As a kid back in the early 50's, I had surgeries for Spina Bifida, Clubbed feet and other birth defects.. Back then they used ether. Whew...talk about nausea and vomiting..that stuff was rough! I've had more surgeries since that time and waking up was so much easier without the N/V. Thanks for an interesting topic.
I vomited up a bunch of green bile the day after my surgery in March. Ironically the vomiting was triggered by dissolving Zofran on my tongue. It wasn’t pleasant but I felt so much better afterward.
I know, it's ironic that Zofran ODT tastes like the nastiest grape flavor and usually makes me more nauseated before it gets better.😅
I am extremely prone to PONV and don't tolerate most opioids as well as gas anesthesia; which means that for me to get the best surgical outcome possible, I need everything you can throw at me. I usually request TIVA and a prophylactic dose of aprepitant about 2h before induction. And then anesthetists give me ondansetron and dexamethasone during anesthesia AND a dose of either haloperidol/droperidol + dimenhydrinate before emergence.
Hey Dr. Feinstein, I've watched many of your videos and this one is going to serve me very well for my next surgery in June. I drew a "NO PONV" sign on a piece of paper and held it up to the anesthesia team before my last procedure. We had a nice laugh. Must have worked because I didn't have ANY PONV afterwards.
Thank you.
What was the dexamethasone side effect he was talking about? I can't figure out what it was, if it was so bad that he couldn't say it on TH-cam
Groin dyscomfort (and I am not kidding)
not sure either
"Ants in the pants" sensation
Look up 'Advisory 18-02 Dexamethasone Dilution'
Thank you! I got lots of dexamethasone during my cancer treatment, but I always got it in a diluted bag over like 45 minutes. I was curious but I couldn't find it on Google.
Dr. Feinstein, you were born to be a physician and more specifically an anesthesiologist. All those years of medical school drudgery and even O. Chem before that clearly paid off, because IMHO you clearly know ur stuff! When it comes time to sit for the Boards, you should be given a pass. Just show ‘em your impressive YT body of work….instantly Boarded!
I feel like the only person that Zofran just doesnt work very well for. I have better success with it if i have right when nausea starts but if I've been nauseous for while or have made it to the active vomiting phase, it does nothing for me. Phenergan though....has never let me down 😂 i fought for 3 years with gallbladder issues before javing it removed and the amount of Phenergan i got through iv's ruined my veins, but boy was it my best friend for a while.
Zofran does nothing for me either. Phenergan or Combazine work for me.
Im a post op vomiter. Last time i had surgery i remembered to tell them that and they gave me zophran before i woke up and other nausea meds after i woke up.
I always feel awful after anaesthesia. 24h nausea, but because of you have to be sober for surgery, there is nothing in your stomach to throw up
Thank you for the information "Amisulpride"
I've been under anesthesia before for endoscopy and cholecystectomy, never puked once.
This brings back memories. I was diagnosed with gallstones at 16 and while on the year long waiting list I ate Ondansetron for breakfast. First thing I wanted post op was more anti emetics!
I only get nauseous when volatile anesthesia is used. I make sure to let my anesthesiologist know before surgery and they've been great about controlling my nausea. Great video, Max. Get some more humor in there like your older ones 🙂
Vomiting is a nasty thing, but especially after anesthesia it is horrific I had it big time after surgery back in 2010. It still haunts me to this day even though it was 13 years ago. The inhaled anesthesia is disgusting. That smell, taste and feeling will be in my memory forever absolutely horrible 🤢🤮😭
Hey Dr F, Veterinary technican here, and Mom of a child that had an anesthesia Event, Can you do a video on Pediatric Laryngospasm upon extubating in asthmatic children, (or just maybe Anesthesia concerns in asthmatic kids) My Daughter was extubated after a T&A and when into a Laryngospasm, they had to push Succs and intubate her again then she started having retractions and wheezing back under anesthesia, she was 2 years old, we had to wait about 5 min before trying to extubate her then she was on Q2 Albuterol admitted into PICU and had aspirated, BTW i was not told any of this until on of the nurses came and got me 45 min after it happened, her O sats where very low, and I was told to get a MRI or CT if she ever had any symptoms of Hypoxia its been about 8 months since then and I have noticed some speech delays or regression, and occasion odd behaviors that I am considering Getting her that MRI, anyway
To prevent PONV, make sure you administer dontpyookitol to the patient after surgery is complete.
Well hello there Dt. I must say ,not cool to wake up vomiting 🤢 after surgery
Great topic 😊❤
What works for me is Phenergan. For some reason drs refuse to give Phenergan after surgery anymore so I throw up violently for hours after any surgery. My drs argue with me and tell me Zofran will help me or that patch behind the ear but none of these help. I wish drs would listen to their patients and just give me what works ie. Phenergan
Agree. Zofran doesn't do much for me either, however, IV Phenergan (which works!) caused blood clots in 2 veins in my arm. Was on blood thinners for 3 months.
Marezine (Cyclizine) and Zofran (Ondansatron) (IV) together really nip the PONV in the bud when I have surgeries.
Thanks for the video!! I had bad motion sickness( POMV) after i wake up from my minor procedure. For sure it was not fun after received Phenergan...yes, nausea and vomiting stopped, but HR dropped, BP dropped and felt quite dizziness for 2 days..
Thats a very informative video on PONV, thanks for such an amazing video.
For anyone who wants to answer, when I was a child (in the 70s &80s) I had a few surgeries and always experienced severe nausea and vomiting for at least 24-36 hours. Now that I’m an adult, I’ve had 3 surgeries and have never experienced any nausea or vomiting. Do you believe this is most likely due to improvements in medications used or more likely related to my adult system handling it better? I tend to think it’s more related to changes in medication protocol.
It could be both. Newer meds and our bodies change. I went through the same thing. Had my tonsils out and was given ether. Threw up for hours. Had a very bad headache for four days also.
Yup,I'm one of those people...After one procedure,I was still in the hospital and went longer than eight hours before dinner..And halfway through dinner...Guess what...I was very annoyed.
Curious, when a patient comes in to the er as a trauma patient and is unconscious etc. and needs to go to emergency surgery, do you still give general anesthesia? If so, how do you know the patient is "asleep" and unable to feel anything if the patient is already unconscious and not responding? Could you do a video explaining an anesthesiologists job during trauma situations?
I don't feel nauseated or vomit afterwards, I feel bone deep cold. I always request a warm drink (water, tea, coffee, etc.) but rarely get it, though they usually bring warm blankets.
I've been premedicated with scopalamine patch, Zofran and Reglan before.
I looked up the side effects of dexamethasone and nothing there seemed inappropriate to say on here. I'm confused.
I had my jaw rebuilt after a head on motorcycle accident destroyed it. My mouth was wired shut afterwards and I wore a pair of wire cutters on a chain around my neck. Years later I thought...If I had gotten sick by the time I got the wires cut which would ruin the recon I just had, I would have aspirated. There isn't any time to say oh hang on there a minute, need to cut those wires. They need to come up with a better way to stabilize jaw fractures and recons without wiring ppl mouth shut
From ambulance to post operative care why is etomidate not use more often. Seems to have some great advantages of propofol.
Dehydration is /was always the issues Ive had after surgery. I recently underwent surgery for a complex shoulder break (proximul humas) and I was denied water for two days before the operation. I wa heaving up the medication given.. I'm in Euroize by the way.
I have severe emetophobia so my main fear with any surgery is that I might throw up due to anesthesia, almost to the point where I didn't get a tonsillectomy for a cyst. Surgery?? In my throat?? BY MY GAG REFLEX???? Zofran was my friend
Why can’t you tell us the side effects of dexamethasone in your video which necessitate it being given post-induction?
I'm not sure. It's an injectible steroid that has all the implications of steroids: mood, hormone regulation, increased blood sugar, skin conditions, depressed immune system...and it can affect growth in children. Most of these are from prolonged use though, not from the single dose you get during surgery.
2:17 Waking patients up - A nurse had said when she woke up a patient that had received . anesthesia . They had unfortunately attacked her from the after effects and disabled her . I suppose she came up to their side and ? I would suggest that you touch or jiggle a patient's toes / feet to get them to wake up . This way you are obviously far away from their hands and arms ,
I received doperidol for an antiemetic and it was wildly uncomfortable.
I saw Haldol in the emesis basin. Do you use this for PONV? That's a new one on me, PACU RN of 25 years. 2nd dose of Zofran, Reglan, diphenhydramine, promethazine are great choices for PONV.
I have noticed this very often and am just going to put it here: In Germany we do not use midazolam regulary. We did, but since it does not prevent delir and aggrevates Awarness from an explicit to and implicit experience it is now actualy fraund apon. There has to be specific reasoning in prescribing it. Ít is used in children and if patients explicitly ask for an anxiolitic. Even if you suspect intraoperativ awarnes we do not use it. Reasoning being that we want the explicit memory to be able to go into talking about it and if needed psychotherapy. Same thing goes for unpleasent experiences being made prior to general anesthesia. Midazolam makes psychotherapy close to impossible.
Doc what are the side effects of dex that you didn't want to say?
Made the mistake of pushing Dexamethasone too fast while in emerg and let's just say my patient complained of "fire crotch". Never again.
I get so sick waking up after my Hydrocephalus surgeries
Compazine is also an antipsychotic and causes insomnia and horrible dreams.
your'e stomach is meant to be empty prior to surgery so cant see how you could be vomiting after surgery ??
Droperidol works wonders
Thank God i've never felt what PONV feels like, after going under general probably more than 15 times. However i do feel urgent need to smoke after emergence and i got wrecked by medical staff multiple times for doing it 😅
Hey everyone, ever since I got an appendectomy five years ago I’ve had nausea every day. What I don’t get is why i seem to be getting used to all the usual anti-nausea medications. Has anyone else had this problem?
Oh no... Possible tolerance? Something has to be out there that will work for you. Nausea is awful so I am so sorry for you 😢🙏🏻
Gonna watch this during dinner
I had my jaw wired shut too for one of my surgeries as a teenager. Before everyone knew that i was a post op puker. They had to cut some of the wires.
Why was it wired?
@@madi4481 my jaw was malformed as a kid and when I was fully grown, at 17, they needed to fix it so I would have full function of my jaw. It was a major surgery where they had to break my jaw on both sides to move it to where it needed to be. Then they put rods and screws in it and wired my jaw shut and the bones screw back. I still have rods and screws in my jaw. I was in the hospital for one night. Thankfully that's when I started puking.
After the Thalidomide horror I'll go with the vomiting.
So because thalidomide caused birth defects in pregnant women, you'd want to avoid amisulpride... because it sounds similar?
Even though amisulpride was first introduced in the 1990s?
@@alex-ty8zr "a drug that was recently approved by the US Food & Drug Administration"
@@ChrisPBacon-ok7ir 1990 is recent?
@@ChrisPBacon-ok7ir Thalidimide was never approved by the FDA for use by anyone. This is not to say the FDA is perfect; there have been many missteps and there is plenty they could do better. But if you ever want to use medications, what do you propose? No Federal organization? Good luck with your next infection when there is no formal assessment for whatever you take.
I was so nauseous and sick after my ceasarians! They gave me a jab to stop it but I still felt ugh!
Couldn't find that dexamethasone side effect. Could someone enlighten me?
Itchy perineum.
@@jarls5890 wow. I wonder why it's so specificly localised
@@sjcwoor Good question! I have no idea!
Maybe a neurologist (or dermatologist?) reads this and can answer.
Hey max, how does anesthesiology interact with regular nurses in the OR? Do you ever ask for their help or ask them to help you draw up meds. How is it decided if an anesthesia doctor is on the case versus a CRNA. It seems like crna have a very similar role.
I vomited when I had a surgery for the first time
Amisulpride is an antipsychotic and does have a psychoactive effect, I have taken it and I found it quite unpleasant. As a potential patient of an anesthesiologist at some point I would much prefer something that is not a strong anti psychotic if I can at all help it. Another concern I have with anti psychotics is tardive dyskenesia. After one dose amisulpride had my feet in a kind of spasm and curled up, I couldn't really walk on them. I am guessing the research and fda claim that this drug doesn't have these risks or a reduced risk? I have my doubts after having taken it before.
Would pheneran or Zofran or haldol with Benadryl or Compazine.
Why can you have POV if you are just having a HOLEP done for a prostate?
just had this issue last thursday after my pcnl surgery. they failed to give me zofran while pumping me full of pain meds
My doctor is doing a bladder stone removal with a scope. I asked if it would be done under General annesthesia he said light General Annesthesia with an LMA. Can you explain if that means conscious sedation without a breathing tube?
I projectile vomited the day after my surgery I was under for 5 hours does being under longer make you more prone to being sick after?