I was an EMS nurse…this reminds me of what we did when giving emergency meds to the little ones…add panicking parents to the mix and you have a recipe for mistakes…I drew my meds if I knew it were a kid before we even rolled out…and it was a cardiac or respiratory emergency…or required sedation or anesthesia…I was Captain so I had a separate vehicle and could take a little time to get out to support my crews…pediatrics scared me a little since EMS calls for kids were rare…
I was an EMT / FireFighter for 8 years . My Wife was a paramedic and my mother in law was a charge nurse at Children’s National Hospital till she passed away last year . My mother in law had lots of friends that did what you do and when we use to sit at the annual crab fest my mother in law threw when they would tell there story’s everything always kind of went over my head 😂. You must be a great teacher as I kind of followed along your reasoning and how you did things . I’ve always had respect for your position as you guys and gals where always the ones who’s our life’s where really In the hands of when we go under the knife . Becuase one slip and that’s it . I have to say I always kind of enjoyed being put to sleep by you guys always when I woke up you all where getting lots of laughs out of what I said when (the lights where on but nobody was home) as I was being put to sleep . Thanks !
I had several eye surgeries as a baby and young cguld. I never thought about how different anesthesia is for children. I remember being seven and a nurse anesthetist me to sleep. I breathed into a tube. It smelled of nedicine. After a few breaths I was asleep. I was the only kid who wasn't sick afterwards. She really knew what she was doing. I learned something new. Your videos are great!
Max, granted kids won’t be watching your vids but for the adults that do you give a huge service. Through you people understand the huge amount of knowledge and training that is required to give anesthesia. People know little about the world in which you work and that it is only because of your work that surgeries can happen. In essence you are almost like a guardian angel of surgery, from induction to waking up, your vigilance thru surgery maintaining life support has helped miracles happen. You are the unsung hero’s of the OR.
im an anesthesia technician from libya, & a fun fact: did you know that we as anesthesia technician in libya we have a bachelor's degree in anesthesia & ICU & our job is to prepare all the needed drugs for each operation & we also prepare the aneathesia machine for each operation, our protocol is completly difrent from USA & the rest of the world i think 😅, anyway i love ur videos, & if you would like that we make a video togather discussing the difrence in our culture i would be happy & up for it 😄.
I had my first major surgery at just 48 hours old, in the form of Open Heart Surgery to repair a VSD,ASD, and IAA. It's fascinating to see just how fragile infants and Peds can be when they need to undergo General Anesthesia. Way to go Dr! Bravo to your precise explanations and reasonings as to why Peds Anesthesia is so daunting a task. Fascinating stuff!
Ps, OT, ... Woot! The kid is now a real MD! My dad was an Anesthesiologist and my mom was a phlebotimist and biochemist, both mulit PhDs. Glad to have another MD not afraid of the camera, or this new social stuff.
So awesome. M3 here and going for anesthesia. The dilution portion is very helpful to a math challenged stethoscope wielder like myself. Seems doable! Love the channel.
It’s been a minute since I’ve seen one of your videos and I just want to say as a mother, it takes a really special person/doctor to be a pediatric anesthesiologist. Kids don’t understand what’s going on and surgery is scary. I have 3 kids. My middle one (son) was born with congenital exotropia with a consistent nystagmus gaze. He had his first surgery at 6 months old, and had 3 other surgeries. We live close to Wilmer Eye so we have the BEST of the BEST surgeons and the anesthesiologist we’ve had, are AWESOME! One of them let him “SCUBA dive” to sleep. The last time he wanted to get the IV while he was awake, and the anesthesiologist said yes, and he did it once we were back in the OR! That was way less stressful for my son and this Momma!
I work for a pediatric anesthesia group as a coder. We see new student nurse anesthetists every few months on rotation. They go one of two ways after they’re done. They’re either in love with pediatrics or they hate it.
Awesome and amazing video, I love your videos, I really enjoy donating to the anesthesiologist Foundation, since it was hard for me to go to college because of my cerebral palsy, I really wanted to be a anesthesiologist. It takes a special person to be an anesthesiologist or CRNA and you’re one of them! I donated to the anesthesiologist Foundation again on last Thursday
Max, I absolutely love your channel. I am a non-traditional student who is applying to medical schools this cycle, with a hope of going into anesthesiology. Your videos have been so interesting for someone who likes to "pre-learn" as much as possible, and your clear, calm delivery is fantastic! Any resident is lucky to learn from you.
We make a emergency drug and dose sheet made with each pts weight, each emergency med dose, in minimum dose and maximum doses, we also put thier shock bolus fluid rates and IV sedation dosing( Veterinary technician here)
paralytics don't stop the heart because cardiac muscle cells are activated in a different way than skeletal muscle cells, and most frequently used paralytics only affect the way skeletal muscle cells are activated. In particular, skeletal muscles are activated (depolarized) when the motor neuron that control them releases a neurotransmitter called acetylcholine into the neuromuscular junction; this neurotransmitter then binds to acetylcholine receptors on the surface (motor endplate) of the muscle cell and initiates depolarization and contraction. Paralytics commonly interfere with the action of acetylcholine; for example, rocuronium is a competitive acetylcholine receptor antagonist (meaning it prevents acetylcholine from activating the acetylcholine receptors) and therefore prevents depolarization, and succinylcholine works by binding to the acetylcholine receptor causing an initial depolarization but preventing repolarization and thereby blocking the action of acetylcholine. In contrast, depolarization of cardiomyocytes (heart muscle cells) is controlled by pacemaker cells, which are modified cardiomyocytes rather than neurons. These cells rely on the passage of calcium, potassium, and sodium ions between the pacemaker cells to carry the action potential from one cell to the next, and then rely on similar mechanisms to cause the cardiomyocytes to depolarize and contract. There is some neuronal control of the heart rate, but it is principally through epinephrine and norepinephrine (acetylcholine actually decreases heart rate, so blocking its action prevents the heart rate from decreasing). Because of this, paralytics that act by altering the activation of the acetylcholine have little effect on heart rate and no effect on cardiomyocyte contractility
Paralytic agents act by interfering with nerve stimulation of the muscles. The heart does not require nerve stimulation to contract. This is why, if the brain stem is obliterated or the spinal cord is severed, breathing will cease but the heart will continue to beat, at least for a while. This is grossly oversimplified but it gets the point across.
@@liamhurlburt9794 Wow. Thank you for that amazing explanation. It's dark to think about but after reading your explanation I am reminded that they use sodium pentathol (sp?) when turning someone's heart off, on purpose.
It's ok man. Just take small steps everyday towards a realistic goal. Remember there is absolutely no shame in working an entry level job such as at McDonald's or Walmart. The world is yours for the taking!
@@PaulLoveless-Cincinnati Once I am an LPN I can get hired as an anesthesia tech. LPN can also assist in the OR depending on the assignment, lots of opportunities.
I am 21 and unemployed. You could probably gain a lot of insight through this dude and similar videos. And maybe idk, you could become a healthcare professional?
Oh I'm so glad u also get to teach on site. I just know how u would stress being meticulous. Your so knowledgeable, &awesome. Peds to Mr is so scary. My question, if a pt is intubated already can u tell if there haveing a laryngeal spasm? Thank u so much for your videos. I just love them. I'm sure there so helpful to those following in your footsteps. I applaud 👏 u.😊😊😊❤❤❤
what would you use if you have a pediatric patient who's allergic to atropine. I am curious cause this was me as a child. as an adult I still have that on my allergy list for the hospital and drs I see
I love these videos and I always learn something every time you publish. Thank you for these! A few questions: Do you prepare these dilutions to prep for all surgeries? If so, are these disposed after the procedure? Again, if so, and given that you're already labeling the syringes, wouldn't it be good to write the the IM and IV doses directly on the syringes?
Hi Max, Great and informative video as always. 🙂 Five years ago, I had a ruptured appendix and about 8 cm of my small intestine had to be removed too. Is this considered a smooth or complicated surgery from anesthesia perspective? I know it depends on the individual, weight....any medical issues. I'm an average guy with no medical issues. What are the types of medications that could have been used during my op?
How do you make sure the liquids are properly mixed in those syringes with such tiny doses? I feel like even shaking wouldn't 100% ensure that the concentration is equal in every single drop of solution.
Diffusion mixes everything on its own. Since it is pre-prepared, the time will be enough for the solution to mix well before the need to use. At least that is what I think happens.
Hi my name is Stuart. I am using my wife's TH-cam channel. I live in Naples Florida Dr. Max. Here's a fun fact for you. If you remember watching the movie series television series actually Highlander. Remember the character mythos the oldest immortal in the world. Well he is currently 60. I think 5 years old or whatever he is and he actually a few years ago became a anesthesiologist I believe in the state of California. Yep, me post the longest living TV. Immortal is a literal anesthesiologist doctor in California and he still looks pretty good. Have a great day! Dr. Max oh and here's another fun fact Dr. Max! I was born and you're very hospital on August 10th. 1964 Believe it or not, I think you're at the Mount Sinai on 97th and the Central Park West I believe. Just curious. Have a great day!!!!!!!
Brian, the thing to consider is that the person giving the paralytic fully understands the actions and effects of the drug and is trained on its usage and actions to follow if there is an adverse effect of the drug. If you look back to Michael Jackson and now Matthew Perry you see the importance of this education and training along with the necessity of additional drugs and equipment.
@@brianredban9393 yes, that is something of concern. But fortunately tech has produced anesthesia monitors that display the anesthesia level to help prevent that. It comes down to the person doing anesthesia, how good they are at their job. Make it a point to have a conversation with your anesthesia person, chatting with them at any chance on entering the OR, express your concerns and get a chance to get a feel for them. Check their sense of humor. I told my one anesthetist that I knew people that envied her. That made her curious and I got to explain that she has the easy way to shut me up. That broke the whole staff up and her and I joked a bit before I was out. Our brief conversation said a lot about her and I had total confidence in her. If there is a next time for surgery, be adventurous and engage your anesthesia provider, there are many like Max that want to make the procedure less stressful for you.
Push lots of Versed and Keppra. Pheno-barb if refractory. Consider Ketamine. Manage the airway appropriately. If paralytic used, EEG monitoring in the ICU is best practice.
@jakesolar-bassett6619 it still isn't an anesthetic, and it's still linked to increased post-operative pain. There's also good evidence that it increases the amount of anesthetic that's required for surgery as well, which could be the mechanism that causes increased post-operative pain.
I was an EMS nurse…this reminds me of what we did when giving emergency meds to the little ones…add panicking parents to the mix and you have a recipe for mistakes…I drew my meds if I knew it were a kid before we even rolled out…and it was a cardiac or respiratory emergency…or required sedation or anesthesia…I was Captain so I had a separate vehicle and could take a little time to get out to support my crews…pediatrics scared me a little since EMS calls for kids were rare…
I was an EMT / FireFighter for 8 years . My Wife was a paramedic and my mother in law was a charge nurse at Children’s National Hospital till she passed away last year . My mother in law had lots of friends that did what you do and when we use to sit at the annual crab fest my mother in law threw when they would tell there story’s everything always kind of went over my head 😂. You must be a great teacher as I kind of followed along your reasoning and how you did things . I’ve always had respect for your position as you guys and gals where always the ones who’s our life’s where really In the hands of when we go under the knife . Becuase one slip and that’s it . I have to say I always kind of enjoyed being put to sleep by you guys always when I woke up you all where getting lots of laughs out of what I said when (the lights where on but nobody was home) as I was being put to sleep . Thanks !
I have been patiently waiting for one on pediatric anesthesia, AND I GOT IT!!! WOOOOOOOOOOO!
I had several eye surgeries as a baby and young cguld. I never thought about how different anesthesia is for children. I remember being seven and a nurse anesthetist me to sleep. I breathed into a tube. It smelled of nedicine. After a few breaths I was asleep. I was the only kid who wasn't sick afterwards. She really knew what she was doing. I learned something new. Your videos are great!
Max, granted kids won’t be watching your vids but for the adults that do you give a huge service. Through you people understand the huge amount of knowledge and training that is required to give anesthesia. People know little about the world in which you work and that it is only because of your work that surgeries can happen. In essence you are almost like a guardian angel of surgery, from induction to waking up, your vigilance thru surgery maintaining life support has helped miracles happen. You are the unsung hero’s of the OR.
im an anesthesia technician from libya, & a fun fact: did you know that we as anesthesia technician in libya we have a bachelor's degree in anesthesia & ICU & our job is to prepare all the needed drugs for each operation & we also prepare the aneathesia machine for each operation, our protocol is completly difrent from USA & the rest of the world i think 😅, anyway i love ur videos, & if you would like that we make a video togather discussing the difrence in our culture i would be happy & up for it 😄.
Same in Pakistan
I had my first major surgery at just 48 hours old, in the form of Open Heart Surgery to repair a VSD,ASD, and IAA. It's fascinating to see just how fragile infants and Peds can be when they need to undergo General Anesthesia. Way to go Dr! Bravo to your precise explanations and reasonings as to why Peds Anesthesia is so daunting a task. Fascinating stuff!
Ps, OT, ... Woot! The kid is now a real MD!
My dad was an Anesthesiologist and my mom was a phlebotimist and biochemist, both mulit PhDs.
Glad to have another MD not afraid of the camera, or this new social stuff.
So awesome. M3 here and going for anesthesia. The dilution portion is very helpful to a math challenged stethoscope wielder like myself. Seems doable! Love the channel.
It’s been a minute since I’ve seen one of your videos and I just want to say as a mother, it takes a really special person/doctor to be a pediatric anesthesiologist. Kids don’t understand what’s going on and surgery is scary. I have 3 kids. My middle one (son) was born with congenital exotropia with a consistent nystagmus gaze. He had his first surgery at 6 months old, and had 3 other surgeries. We live close to Wilmer Eye so we have the BEST of the BEST surgeons and the anesthesiologist we’ve had, are AWESOME! One of them let him “SCUBA dive” to sleep. The last time he wanted to get the IV while he was awake, and the anesthesiologist said yes, and he did it once we were back in the OR! That was way less stressful for my son and this Momma!
Another great video! You do such a good job of explaining the reasoning behind everything you discuss.
I work for a pediatric anesthesia group as a coder. We see new student nurse anesthetists every few months on rotation. They go one of two ways after they’re done. They’re either in love with pediatrics or they hate it.
Awesome and amazing video, I love your videos, I really enjoy donating to the anesthesiologist Foundation, since it was hard for me to go to college because of my cerebral palsy, I really wanted to be a anesthesiologist. It takes a special person to be an anesthesiologist or CRNA and you’re one of them! I donated to the anesthesiologist Foundation again on last Thursday
Max, I absolutely love your channel. I am a non-traditional student who is applying to medical schools this cycle, with a hope of going into anesthesiology. Your videos have been so interesting for someone who likes to "pre-learn" as much as possible, and your clear, calm delivery is fantastic! Any resident is lucky to learn from you.
Dr, am greatly grateful as was always confused about epinephrine dosage preparing nd usage..
Thanks again for making things clear.
We make a emergency drug and dose sheet made with each pts weight, each emergency med dose, in minimum dose and maximum doses, we also put thier shock bolus fluid rates and IV sedation dosing( Veterinary technician here)
Why does the heart muscle not stop when using paralytics?
paralytics don't stop the heart because cardiac muscle cells are activated in a different way than skeletal muscle cells, and most frequently used paralytics only affect the way skeletal muscle cells are activated.
In particular, skeletal muscles are activated (depolarized) when the motor neuron that control them releases a neurotransmitter called acetylcholine into the neuromuscular junction; this neurotransmitter then binds to acetylcholine receptors on the surface (motor endplate) of the muscle cell and initiates depolarization and contraction. Paralytics commonly interfere with the action of acetylcholine; for example, rocuronium is a competitive acetylcholine receptor antagonist (meaning it prevents acetylcholine from activating the acetylcholine receptors) and therefore prevents depolarization, and succinylcholine works by binding to the acetylcholine receptor causing an initial depolarization but preventing repolarization and thereby blocking the action of acetylcholine.
In contrast, depolarization of cardiomyocytes (heart muscle cells) is controlled by pacemaker cells, which are modified cardiomyocytes rather than neurons. These cells rely on the passage of calcium, potassium, and sodium ions between the pacemaker cells to carry the action potential from one cell to the next, and then rely on similar mechanisms to cause the cardiomyocytes to depolarize and contract. There is some neuronal control of the heart rate, but it is principally through epinephrine and norepinephrine (acetylcholine actually decreases heart rate, so blocking its action prevents the heart rate from decreasing). Because of this, paralytics that act by altering the activation of the acetylcholine have little effect on heart rate and no effect on cardiomyocyte contractility
@@liamhurlburt9794 Thanks for the detailed answer!
Paralytic agents act by interfering with nerve stimulation of the muscles. The heart does not require nerve stimulation to contract. This is why, if the brain stem is obliterated or the spinal cord is severed, breathing will cease but the heart will continue to beat, at least for a while. This is grossly oversimplified but it gets the point across.
@@johnopalko5223much more succinct answer, thank you 😂
@@liamhurlburt9794 Wow. Thank you for that amazing explanation. It's dark to think about but after reading your explanation I am reminded that they use sodium pentathol (sp?) when turning someone's heart off, on purpose.
Took 8 years to figure that one out, but it works!
I have been waiting for this exact video
I also happen to be 18 and unemployed
It's ok man. Just take small steps everyday towards a realistic goal. Remember there is absolutely no shame in working an entry level job such as at McDonald's or Walmart. The world is yours for the taking!
@@PaulLoveless-Cincinnati Once I am an LPN I can get hired as an anesthesia tech.
LPN can also assist in the OR depending on the assignment, lots of opportunities.
I am 21 and unemployed. You could probably gain a lot of insight through this dude and similar videos. And maybe idk, you could become a healthcare professional?
Oh I'm so glad u also get to teach on site. I just know how u would stress being meticulous. Your so knowledgeable, &awesome. Peds to Mr is so scary. My question, if a pt is intubated already can u tell if there haveing a laryngeal spasm? Thank u so much for your videos. I just love them. I'm sure there so helpful to those following in your footsteps. I applaud 👏 u.😊😊😊❤❤❤
You’re amazing doc
such a great informative video, thanks for making these. ❤
An additional consideration for succinylcholine is its prolonged effect on patients with pseudocholinesterase deficiency.
0:50 peds nurse here… this part triggered my PTSD lol
what would you use if you have a pediatric patient who's allergic to atropine. I am curious cause this was me as a child. as an adult I still have that on my allergy list for the hospital and drs I see
Thank you max
I love these videos and I always learn something every time you publish. Thank you for these!
A few questions: Do you prepare these dilutions to prep for all surgeries? If so, are these disposed after the procedure? Again, if so, and given that you're already labeling the syringes, wouldn't it be good to write the the IM and IV doses directly on the syringes?
I wonder how much the concentrated epi in the needle annulus throws off the dilution?
Hi Max, Great and informative video as always. 🙂 Five years ago, I had a ruptured appendix and about 8 cm of my small intestine had to be removed too. Is this considered a smooth or complicated surgery from anesthesia perspective? I know it depends on the individual, weight....any medical issues. I'm an average guy with no medical issues. What are the types of medications that could have been used during my op?
How do you make sure the liquids are properly mixed in those syringes with such tiny doses? I feel like even shaking wouldn't 100% ensure that the concentration is equal in every single drop of solution.
The principle of diffusion works pretty dang well.
Diffusion mixes everything on its own. Since it is pre-prepared, the time will be enough for the solution to mix well before the need to use.
At least that is what I think happens.
Great video!
Hi my name is Stuart. I am using my wife's TH-cam channel. I live in Naples Florida Dr. Max. Here's a fun fact for you. If you remember watching the movie series television series actually Highlander. Remember the character mythos the oldest immortal in the world. Well he is currently 60. I think 5 years old or whatever he is and he actually a few years ago became a anesthesiologist I believe in the state of California. Yep, me post the longest living TV. Immortal is a literal anesthesiologist doctor in California and he still looks pretty good. Have a great day! Dr. Max oh and here's another fun fact Dr. Max! I was born and you're very hospital on August 10th. 1964 Believe it or not, I think you're at the Mount Sinai on 97th and the Central Park West I believe. Just curious. Have a great day!!!!!!!
Watching these videos scare me more than before about having surgery. Having someone administer a paralytic to me is really really anxiety-provoking
You are put to sleep before the paralytic is pushed. You won’t even know.
Brian, the thing to consider is that the person giving the paralytic fully understands the actions and effects of the drug and is trained on its usage and actions to follow if there is an adverse effect of the drug. If you look back to Michael Jackson and now Matthew Perry you see the importance of this education and training along with the necessity of additional drugs and equipment.
@@genepatterson4375 I just worry about waking up wile paralyzed during a surgery. I know it's extremely rare but it has happened.
@@brianredban9393 yes, that is something of concern. But fortunately tech has produced anesthesia monitors that display the anesthesia level to help prevent that. It comes down to the person doing anesthesia, how good they are at their job. Make it a point to have a conversation with your anesthesia person, chatting with them at any chance on entering the OR, express your concerns and get a chance to get a feel for them. Check their sense of humor. I told my one anesthetist that I knew people that envied her. That made her curious and I got to explain that she has the easy way to shut me up. That broke the whole staff up and her and I joked a bit before I was out. Our brief conversation said a lot about her and I had total confidence in her. If there is a next time for surgery, be adventurous and engage your anesthesia provider, there are many like Max that want to make the procedure less stressful for you.
@@genepatterson4375 Micheal Jackson OD’d on propofol, that is not a paralytic
My spelling is off. I meant A young child.. Lol
Can you please do a video covering status epilepticus? Thank you. Also IO's?
Push lots of Versed and Keppra. Pheno-barb if refractory. Consider Ketamine.
Manage the airway appropriately.
If paralytic used, EEG monitoring in the ICU is best practice.
So can acetylcholine reverse a cocaine overdose?
Interesting question. Can you post about why you think that? I don't have a solid enough understanding of the chemistry.
No. Cocaine is a reuptake inhibitor of Dopamine, Serotonin, and Norepinephrine.
Has nothing to do with acetylcholine at the neuromuscular junction.
How do you feel about using cannabis as an anaesthetic agent?
Cannabis is not an anesthetic agent. There is good evidence that patients who regularly use cannabis have worse post-operative pain.
What about using cannabis as an anaesthetic agent for patients who are cannabinoid naiive
Keep in mind in Israel we have injectable cannabis
@jakesolar-bassett6619 it still isn't an anesthetic, and it's still linked to increased post-operative pain. There's also good evidence that it increases the amount of anesthetic that's required for surgery as well, which could be the mechanism that causes increased post-operative pain.
I was thinking... A massive dose of the injectable we have in Israel could potentially achieve deep sedation like Midazolam