Fentanyl and other opioids given during surgery?
ฝัง
- เผยแพร่เมื่อ 20 ก.ค. 2024
- The opioid epidemic is a huge problem, but these pain-killing medications are frequently administered during surgery. In this video, I highlight the reasons why an anesthesiologist would be inclined to give opioids to patients during surgery. Featuring special guest @ABCsofAnaesthesia
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0:00 Start
0:38 Introduction
1:50 Why opioids?
5:33 Opioid epidemic
6:23 Alternatives?
8:04 Guest anesthesiologist!
Music:
Subtle Swagger by Ron Gelinas: / atmospheric-music-portal
The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional.
#Anesthesiology #Residency #MedicalSchool - วิทยาศาสตร์และเทคโนโลยี
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Seriously. I have been a practicing anesthesiologist for almost 30 years. Giving appropriate doses of narcotics to patients in pain does not cause addiction.
As a social worker, I have had patients who became addicted to narcotics after major surgery and injury.
Did you ever follow up on your cases?
I am the one who follows up and I know about this!
@@cindyhalpern3187 did they become addicted from the narcotics during surgery or the Opioids given for recovery?
Because I think the person above was taking specifically about narcs during surgery 🤷♂️
The opioid subject is tough. Some people actually need them and use them correctly but the drug seekers and abusers make it that much more difficult for docs and people on chronic pain
@@cindyhalpern3187 The people you are talking about, didn't get addicted because of the drugs given during surgery. They get addicted during the recovery phase. And it's very often because they don't take the drugs as prescribed, or because they have a predisposition to addiction. You also don't get addicted to these drugs by taking them once, like during a surgical procedure.
I'd bet my life (literally) at least 90-99% of overdose deaths were researched they would not be on PMP databases and prove once and for all its street drugs stepped on with fentanyl that absolutely NOTHING to do with Doctors or their patients and stop the two bit political witch hunt.
The irony of it is unless they're cancer patients they can't be prescribed anything other than virtually tamper proof duragesic patches that I'm prescribed for UC and fentanyl accounts for next to 100% of opioid deaths. It's more like addicts being poisoned than overdoing though I wouldn't trust an addicts self dosing not spiking it a bit as well..... 🤔 Idk that they've ever found a single overdose victim with a patch 😆 (what a joke this all is)
Limiting drug availability to those who really need them just because some idiots abuse them is insanity. My mother died of liver cancer, her death was assured, she was in severe pain and we weren't too worried about her becoming addicted.
Robin, as a recovering alcoholic, I can well appreciate your situation. Medications to relieve pain and improve quality of life (whatever remains) in a terminal patient is an absolute necessity. I am truly sorry to hear about your Mom's situation and the situation brought about by drug abuse and the medical communities' continued support of that abuse. Those who really need pain relief should have it made available.
100% agree. That is is practically criminal what happened to your mom and sadly thousands of others. If you only have a year to live why in the hell would anyone (doctor included) care if they got addicted in hospice to drugs they totally need and deserve?
That’s ridiculous
That never should happen
Some people truly are in chronic pain and use the meds as prescribed (me) but the abusers and drug Seekers make it so difficult for the chronic pain patients and the drs. they are so worried about getting in trouble from the D.E.A and losing their medical license.
And I completely get that but it shouldn’t be so hard for us patients
I've given hospice care to friends suffering from cancer, one of the liver cancer.
The problem is that opioids are metabolized in the liver and if the liver is failing then no amount of them will help. That's why methadone is swapped out for morphine in some cases, depending on the liver's ability to metabolize at all. It's not as strong as morphine but may have a more desirable impact.
But I agree that once a terminal diagnosis has been issued, pain management barriers should disappear.
God Bless you child
I am a pain patient, one of those that is being victimized by the 'war on opioids'. I only take what I'm prescribed, and only take it how it's prescribed, meaning I don't OD. I can't tell you how hard this 'war' has made it on those of us who are actually in pain! I am truly blessed to have a doctor who is not afraid to take care of me.
The hard part is the number of effective drugs that have been taken off the market, and getting the ones that are left from the pharmacy... frequently they are out, and when they order the medication, it doesn't come in!
Instead of taking effective drugs off the market, and penalizing pain patients, I think they need to concentrate more on how these drugs are getting onto the streets, and whether or not they're our own pharmaceuticals, or are they manufactured in other countries and shipped here?
But to answer your question, no, I don't think the use of opioids during surgery contributes to the opioid 'epidemic'. Hospital use is brief, and hospital doctors have to abide by strict rules on what they give patients to take home.
I completely understand how you feel. This 'epidemic' has made my pain management journey hell. I'm on my 5th pain management doctor in 5 years. Thankfully this one is wonderful! But he's also really old...so I'm scared of what will come after his retirement. I'm so tired of being made to feel like a criminal at doctors offices and the pharmacy. 🙄 I've been on opioids for 17 years now, since I was 12 years old. And cannabis can reduce the amount I take (with the right kind and good enough quality, something I rarely get in an illegal state), but I'm always going to need opioids to manage the pain. It would be incredible for science to create a new, non-addictive pain killer than is just as effective. I'd gladly give it a try. I take opioids due to a skin condition that makes my skin very fragile. So the itching side effects of opioids make things worse for me... It's a vicious cycle really.
Smoke pot
@@Studio23Media Unfortunately, cannabis is a deal breaker with my pain doctor... I'd gladly take that instead! I have a wonderful pain doc, tho... he is so compassionate and understanding, and never makes me feel uncomfortable.... but I've had those in the past, and was severely undertreated by them too! I have to drive 2 hours there and back, because he closed his office in my city, which I will gladly do! I will never violate my contract, because he is a gem! I have psoriatic arthritis, fibromyalgia and chronic fatigue as well as osteoarthritis, among other, smaller complaints.... Lately the psoriatic arthritis is eating my right hand alive!
I agree with you, but in the same breadth if opioids are in use you should always have a narcan/etc type thing on hand just incase an oops ever happens. It doesn’t take a lot to OD, and one tired persons mistake could be life or death. I keep some narcan on hand as much as possible, as my mom is also a pain patient and she’s only double dosed once in nearly 15 years. Not near OD in her case tho. Stay safe 😊.
@@kaidanariko I do have Narcan on hand if my mother should find me unresponsive... but I'm more like your mom.... very high tolerance. A double dose wouldn't even make me sleepy.
I’m chronically ill/disabled and the war on opioids has severely affected my quality of life. I have severe, constant chronic pain and I’m in pain management. I, and my other chronically ill friends in pain management, take our meds as prescribed and have never abused our medications. I’ve been in pain management for 6 years now and I’m only 31. But I and other chronic pain patients are being punished even though we aren’t the ones abusing our medications.
People who are abusing opioids aren’t affected by the war on drugs because they aren’t getting their drugs legally anyways. The only people who are affected by legislation that affects healthcare are pain patients. We go to our doctors for our medications and have to deal with whatever guidelines our doctors are forced to follow. It’s absolutely horrific. I’m in almost unbearable pain every second of my life because I can’t get the correct medications at the correct dosages that I need because the people abusing the meds I need get them regardless of what the law says. And legislators know that, they just don’t give a shit about sick and disabled people.
I have flare ups where I’m in so much pain I *can’t walk* and now when I go to the ER the doctors give me toradol. Toradol is basically IV ibuprofen. I’m already in pain management, so obviously ibufuckingprofen isn’t going to touch pain bad enough that I can’t walk. I wouldn’t go to the ER if my pain could be helped by ibuprofen. But doctors won’t help me anymore because of the fucking war on drugs. When I used to go to the ER, doctors would help me, and now they can’t or they’re too scared to. I give them my pain management doctor’s name and number and everything and nothing.
I have other flare ups where I get nerve pain all over my body. It feels like my body is cold burn screaming. The first time it happened I woke up screaming out of my sleep. I’ve passed out from the pain before. And the ER rarely helps me anymore because of the fucking war on drugs.
My life is nothing. I’m in bed 24 hours a day because my pain is so bad. I’m 31. I shouldn’t have to live like this.
I am so sorry. Chronic pain is terrible and Pain Management programmes are still in their infancy. I hope they make some giant strides soon - chronic pain is a global issue, and growing every year.
I feel similarly. I'm 34 and I'm disabled in chronic pain as well. I get my care at the veterans hospital and when I got out of the service the first Dr I met said 'you're 27 you don't need all this medication' I was on oxycodone and fentanyl daily. They filled it for 1 more week and told me I'd have to deal with it. My pain came from a helicopter crash I was in when I was deployed. Now I am in pain all of the time and I've tried to kill myself 3 times. People just don't realize how debilitating chronic pain is. I'm a shadow of who I used to be and the VA just wants to keep throwing antidepressants and gabapentin etc at me and they've made me gain over 100 lbs. I just feel like I was so much better managed and had a life and family before....now I'm just...existing in spite of my reality.
Great video max! Thanks for the call ❤
Thanks for picking up, I had a great time chatting with you!
Loved the crossover episode!
Thank you! Very good information for the public. I am a retired RN. Been in OR as circulating nurse several times. However the colder environment was not for me. Went on to work many units. Toward end of career went to hospice. I loved it. Nursing was always an honor for me. My privilege to help others.
Max does a great job with his videos. It does seem that we’ve gone from an extreme in overprescribing to the other extreme where patients are left suffering because doctors are reluctant or just plain scared to dispense opioids. I firmly believe that taken as directed (not abused), patients will not become addicted and certainly with short term use, addiction just doesn’t happen. The point is, giving someone 120 oxycodone which used to happen is ridiculous except for cancer patients etc. But now there’s a fear of giving 2-5 days’ worth of opioids for post-operative pain because somehow this will cause addiction.
Spot on
It’s not easy for us chronic pain patients
@@Chi-town1369 i feel you. I got dumped from chronic pain treatment from degeneration of my intervertebral discs causing pinched nerves along with arthritis of the cervical spine and lumbar spine. Now Im trying to get by on ibuprofen and lyrica along with suboxone i had to get on so I wouldnt lose ALL my lifes things like my JOB ! Yes Chronic pain started this crisis but pill mills and people faking pain and doctors that didnt actually screen well, i.e. MRIs CT scans, ultrasounds etc atr why were here now dealing with pain that isnt well controlled or even slighty well controlled.
P.S. I was referred to another pain mgmt group by my P.C.P. and because I wasnt acting all pitiful and groaning and limping and ..... I was literally thrown out of the office, and now being sued by this clinic for fees, etc. For treatment I never received. Not even an MRI or as much as a peek into my chart. Just the Bums rush
There is also a habit of leaving Fibromyalgia patients in pain because "you will keep needing more and more"
Yeah exactly. Give your patient enough for a few days after operation and there is no chance he´ll get addicted, even if he abused the pills. Obviously there were many lifes ruined by opiates but I´d wager many more lifes were saved by them. The ability to stick needle into someone and pretty much instantly end or suppress their agonizing pain is such a great thing for humans to have. Let´s not go back to times where you got a few swigs of whiskey before they amputated your leg.
I've always said, taking an addictive drug doesn't turn you into an addict. Having a regular source for it and taking it on a routine basis will turn you into an addict. Being prescribed 2 or 3 weeks worth of oxycodone because of some bad injury might leave some people wanting more. But unless they can find a heroin dealer at the drop of a hat, it's not going much further. Of course that's not to say there aren't some people who don't find other means. Where there's a will there's a way. Doubly so with addiction.
Max, I love this. I’m a severe chronic pain pts with failed several spine surgery as well as my mom we have genetic components and opioids have improved our quality of life and have used opioids for quite sometime and this not a problem for chronic pain pts we take our meds as prescribed and are now able to live our lives. Due to cdc guidelines it ruined the quality of care for those in severe chronic pain.
This is me too. My Mom passed on Degen Disk disease have had 2 major surgeries and so many injections I lost count. Hardware out the wazoo. I wear a back brace, cane. I do not sleep at all. I am a walking zombie. I had a pain mngt doc for 10 years and it all just so crazy I decided to leave. I am a disabled Vet and decided to go talk with VA docs. After a 3 month wait I was very frustrated by VA docs.
@@jasonwickens0813 I’m so sorry!!!! You’re not gonna get the pain care you need with the VA I’m so sorry you’re going through this. I’ve heard such awful stories. Pain care within the VA changed. And they don’t take care of pain pts they way they should anymore. I hate this for you. If there’s anyway look for an outside Dr. That’s the only thing I can think. Good luck and wish you the absolute best!
@@jasonwickens0813 just know you can get Releif you just need the right doc.
I'm right there with you sister-I actually had a doctor that had been in practice over 30 years when I went to the emergency and I was in pain ask her he could give me a hug because he feels that people that really need pain medications are not getting them now because of the opioid epidemic and the pill Mills are running for people that actually need that pain medication doctor is so resistant to prescribe anything now because they're afraid of lawsuits-I had a total hip replacement and ended up with palsy and drop foot and numbness from above my knee down on the same leg I had my surgery so I'm in constant pain and they're so reluctant to give me any kind of pain medication that will help me-they gave me two 7.5 lortabs to take A Day but it's not enough I mean that's one every 12 hours and you know that the life expectancy of opioid narcotics prescribed narcotics is 4 hours
@@cindibarton1167 omg this is awful!!! I hate that you’re being treated this way. You need to find another doctor!! They’re hard to find but they’re out there and they will give you something better than that you just gotta search. You should most likely be on a long acting opioid as well as a short acting one. I’m not a Doctor so you need to talk to one. But most ppl who have pain around the clock that’s how their pain meds are usually done. However all pain care should be individualized for the pt being treated. Wish you luck. Search, girl!!!
I remember reading that fentanyl was preferred by anesthesiologists because it had the same half-life as naloxone, making it extremely easy to manage. With other opioids, the half-life is much longer than naloxone so you may have to re administer naloxone several times to counteract one dose of opioid.
And... the half life matches well with the length of most surgeries. Also, the duration of action can be increased by giving a larger dose or incremental doses. Also the time to onset of action is much shorter than that of most opioids so valuable OR time is not lost waiting for the med to act, e.g. morphine.
In the OR, the half-life of fentanyl actually depends on how much has been administered and for what duration (if it's a continuous infusion). And actually the term we use more is the "context-sensitive half-time" which refers to the clinical effect time based on how long the medication has been infused. The context-sensitive half-time of fentanyl can be significantly longer than the clinical effect time of naloxone if the fentanyl was infused for multiple hours. However, you do have the right idea that the timing of fentanyl is important for anesthesiologists-- the maximum effect time is relatively quick at about 4-6 minutes, making it a drug that can be easy to titrate (ie. change the dose to get to the desired clinical effect) which has advantages for surgeries with large hemodynamic changes that occur unpredictably.
@@MaxFeinsteinMD isn’t it also true the half life of Fentanyl also depends on how it’s formulated. For example the “t1/2” for a iv derived medication vs a fentanyl dermal patch vs Actiq vs sublimaze vs subsys. And they’re toleration is different by each route of admin? Do yall still use opioid titration to analgesic effect? That’s what we used when I was in school.
@@MaxFeinsteinMD I prefer sufenta.
@@0BRAINS0 Same. Much easier to manage.
I am a operation theatre and Anesthesia technology student .This videos are very helpful for medical students . Thankyou Sir for making this videos ❤️
I had a 10 hr bilateral latissimus dorsi flap surgery with capsular contracture due to radiation fibrosis. I had intravenous fentanyl during and after surgery and I just want to say to you and all of the other anesthesiologists out there…. Bless you! The after care team’s always get the credit, and thanks, but I’m here to say thank you. It was an extremely painful surgery. It was my 10th surgery due to chemo & radiation complications. And my body was tired. The dr sure helped make that surgery much easier,and no complications with pain meds in 10 days I was off all pain meds and doing great. 😊
How long did it take to wake up?
Norwegian here. Just had my first time under general anesthesia last week as a I was admitted with a burst appendix and peritonitis and underwent emergency surgery.
Last thing I remember from the operating theatre was "Just administered 150mg of Fentanyl." - "Give him 50 more!". Felt extremely warm and like my mind was drifting away from my body and I was out. Woke up what felt like a fraction of a second later with no pain or nausea.
Spent total of 6 days in hospital.
Surgeon described my procedure as a "real sea battle" and it took over 2 hours under the knife (well, laparoscope).
Had zero (serious) pain or nausea after surgery and refused any medication against it.
I love that he used a nautical metaphor, as a Norwegian. =) Hope you're getting better
150mg sounds a bit much tbh :) Good thing it impairs memory
I have never seen 150mg of Fentanyl in a German OR. What's up with Sufenta ?
@@andreaslindenau1190 Microgram...not milligram!
In cardiac anaesthesia often huge amounts of fentanyl are given to the patients.Till. they are warm enough and they are able to breathe on their own you can stop the respirator--therapy. Some doctors do not use fentanyl but sufenta because it is stronger and the patients will undergo a respiratory therapy for a few hours anyway.. They shall not feel pain or shiver or feel stress. Beeing stable and to have good vitals means the extubation for the patient.
So many people think that the Fentanyl a doctor gives for serious conditions is the same as the fentanyl on the streets, witch is so far from each other! And I don't think you do anything wrong giving people opioid during surgery.
On a molecular level they're identical, but yes, different in the sense of potency, purity and contaminants
You are wrong they are the same one is just controlled by the government the other you don't no what type of dose your going to get and ends up being lethal. Both are very addictive and both can kill you. This medication is a necessary evil so to speak. Even if taken as directed from a doctor it can still be lethal. I believe fent should only be taken under strict observation by a doctor or nurse in end of life situation or in surgery or post surgery for a very short period of time.
The biggest issue with street Fentanyl is dosing consistency and people not knowing they’re taking it.
If you buy a 100 tabs of pharmaceutical grade medication and each tab is supposed to have 50mcg. Every tab will have 50mcg. If you buy a 10mcg tab from your dealer than he made from smashing up a bunch 50mcg tabs then cutting with 40mcg of what ever some of his tabs will 10 but some will have 0 and others will have the entire 50. So you buy what you think is 5 10mcg tabs. Take 1 and nothing happens because suprise it’s actually a 0. So you decide to take 4 more because why not the 1 did nothing and get a total of 165mcg and then you’re laying face down not breathing.
It is completely not addictive to receive a narcotic during surgery...... but in my educated opinion that was and is the only place fentanyl and its analongs should be used. Opioids should be legal or at least decriminalised and the DEA is a terrorist organisation whom single handedly created the fentanyl epidemic as well as causing untold deaths from the pressures the put on Drs to remove patients from semisethetic opioids like Hydrocodone and oxycodone to fentanyl patches which are the same dang fentanyl that sublimaze is in surgery. They dont care about peoples safety they care about money and power.
@@aroyce4 The bad fentanyl comes for dirty clinics in China and other places in the world, with one goal, earn the most money.
I really enjoyed this. I had a liver transplant . I woke up in discomfort. For a couple of days they had me on morphine. It made me comfortable enough to sleep. Once I was back on the transplant floor I was off the pain killers. I took everything slowly. After a could days there I was getting around the unit like a little old man half bent over. I was sent home encouraged to use the pain killers to continue being ambulatory.
I healed well, and have no I’ll effects from those meds ❤️❤️. Approaching 10 years post of.
Good that you dare to talk about things like this. You are the real kind people, not those pretentious ones. Most doctors will not do this kind of really important topic because it's controversial.
Great collaboration!
Please, more videos on opioids (I also suffer from chronic back pain and appreciate the education.
Thanks Max !!! Such an informative and thorough description/explanation, as usual !!! Much appreciation for you and to you !!!!!
The bells that you make go off in my mind on the administrative compliance side of anesthesia are invaluable. You explain it very simply and I cannot thank you enough Dr. Max.
Yay! A Max Feinstein video! Good to see you back on TH-cam! I had been messaging you on Instagram about my experience with anesthesia over the past year. I saw my doc a couple days ago, and he said I’m doing well! Hope all is well with you!
Great video man!! I learned a lot! I have a operating room tour coming up soon, since I donate to the anesthesiologist Foundation, since it was hard for me to go college to be a Anesthesiologist after I graduated high in 08 because of my cerebral palsy! You rock man
In the United Kingdom, where opiates were relatively expensive, I had been used to administering "Balanced Anaesthesia" using a mix of IV somnants, amnesics, volatile inhalants, opiates, muscle relaxants, etc. However, when I worked in Saudi Arabia, where opiates were cheap, they practiced Opiod Anaesthesia, where the patient was kept anaesthetised with continuous high doses of fentanil, rather than propofol, barbituates, or volatiles. Scary to see at first.
When working in France, and Switzerland, the emphasis was on using local anaesthesia, continuous infiltration with LA agents, regional blockade, or the use of spinal, epidural, or epi-spinal blockade.
Your lessons and others helped me understand one very important part of surgeries I have had. I understand how to communicate and share with my anesthesiologist before and after surgeries. Thank you.
Max, thank you so much! I’m on a chronic pain management! I’ve had 36 surgeries for my Chrons disease and I have severe chronic pain that along with fibromyalgia, MCAS, and Adrenal insufficiency so using a narcotic for my pain has been the only life saver. I’m grateful for what they have done for me. I have received narcotics during surgery and I’m thankful for my anesthetist/anesthesiologist who helped me.
Very good points. Great job explaining this Dr.
Loved how u did this video. Man I agree u surely need something to lesson the amt of post op pain when pt awakens. Have a great week. I pray 🙏 once your all done with your training u continue doing videos
❤❤❤❤❤
I nearly died on the operating table because they gave me Propofol for emergency surgery which contained Sulfites as a preservative. I listed my allergies but sulfites was over looked as a possible preservative , but some Propofol is preserved by sulfites which I am deathly allergic too and my heart freaks out when a dentist tries to freeze my gums to remove a tooth . I have half a broken tooth still in my gum due to my hearts reaction to the freezing, the dentist said he could not continue so he just filled the open gap with a cement like substance.
propofol is for the induction and maintenance of general anesthesia but does NOTHING to relieve pain which is why it is always given with an opioid like Fentanyl. Propofol Is not an opioid.
I am So Sorry
That's awful I'm glad your okay
I’m allergic to sulfa, but not sulfites. So it’s common for them to use a med with sulfites, as they do not metabolize the same way. Please make sure your chart lists sulfites not just sulfa, to keep you out of harms way in the future. Also, if you have an egg allergy, especially to egg yolks, that also could have been part of the problem, as propofol contains it. Best wishes to you in the future.
What do you mean by freezing your gums? I just usually get novacain for any dental work other than cleaning. Is that what you mean?
Your channel is so interesting. U make things easy to understand. And throw I'm some humor too. Thanks for everything.
As an epidemiologist specializing in pain and opioids: the opioid epidemic is no longer driven by rx or clinically used opioids, though it once was. That aspect is of historic interest only.
My pharmacist concurs, and told me: “it’s a street drug problem”. Apparently availability (of nearly anything!) is very widespread now.
I am having neck surgery in 3 weeks. You have set my mind at ease. Thank you.
I love your vids! Last year I had ovarian cancer surgery, and they used fentanyl as part of the anesthesia, which made me so sick afterward. The whole rest of the day and the next day, I couldn't eat and could barely hold even a sip of water. Well, the surgery took at least 2 hours and was more extensive than they originally thought, so I probably got quite a bit. I was prescribed 20 oxycodone or whatever for pain, and they had me write down when I took them on a form and return it to them! There is a certain amount of pain you have to bear if you don't want to become dependent on opioids or have liver, kidney, or stomach problems from NSAIDS.
😮 I learn much more from your videos than sitting down to read any book! 😅😅😅
Thanks for the video - have often wondered about this - especially re the fentanyl.
Great collaboration! 👍
Brilliant! Thank you! Love from London!! x
Favorite opiates were Sufenta and Dilaudid. Occasionally, Demerol. So much less intraop opiod use could be had by doing a spinal with Buprenorphine or placing an epidural catheter and administering small amounts of local anesthetics along with opiates...preferably Sufenta.
Awesome vid, Max!!
Consider Ketamine drips. I'm a veterinary technician with anesthesia training. Ketamine is wildly used in vetmed for induction, intra and post op analgesia and sedation. Ketamine is one of my favorites for it has a wide dose range(in animals) and short action time with less chance of forming dependence, from my understanding.
We also commonly use fentanyl and sufentanyl. We also use dexmed, but sparingly for it's consider hazardous for patients with heart Dz. Although dexmed is reversible we are causious with its implalmentaion for we don't always know cardiac function due to client expense.
Im fascinated by similarities and difference between human and vertrinary medicine. Thank you for your wonderful insight!
Animals, like people, wake up miserable after ketamine, with emergence delirium, nausea, not fun. Propofol is much preferred
@@rgfan12345 Thats true, they can wake up delirious. This is why we keep them on continuous micro doses of Ketamine at 3-5mcg/kg/hr for 8 to 12 hours post op. Then slowly wean them off. We utilize propofol and acepromazine typically for emergence delirium or a micro doses of dexdom. Most of the time it's the opioids that cause nausea in animals, which a dose of ondansetron or meropitant usually mitigates.
I've gone through surgery 2 times the last 3 years (one was a minorsurgery managed under local anesthesia, and the other was a larger surgery under general anesthesia) and both times I got Fentanyl. Let me tell you: it was the most awful experience and worst feeling ever. Headache, not thinking clearly, blurry vision, and of course the vomiting afterwards... the worst. I hope alternatives are developed soon, because it is just awful.
Thanks for making this video it was a great idea
The first half of the presentation was excellent. Then he brought in a doctor from Australia and things got weird. It became a technical conversation between doctors which left us laymen in the dust.
Max thanks for your video and your effort to educate people on anaesthesia... As a german resident in anaesthesisoligy it's interessting how you guys abroad are looking/dealing with these issues..actually concerning opiods we don't have these problems yet. The american opiods crisis is farer away, therefore we as anaesthesiologists don't have to thinks of theses "side-effects" that much.
Following your videos, I wonder what you guys (anaesthesiologists) are doing beside being in the OR? In Germany anaesthesiologists also work on ICUs, Pain medicine, palliative care and in the pre-hospital field (emergency medicine) . Would be interessting to see othe parts of anaestsia besides OR.. Greetings from Germany
Hey Max, I just discovered your channel and you are doing a great job! Here in Germany we don't really use Fentanyl anymore. Instead Sufenta is used.
I knew an ex-anesthesiologist who was an addict. Had stimulants, opiods, benzos, and others on his waistband at work. All connected to an IV to his leg. Like the checkers girls change slots they wear on their belt is how he described it, all types of drugs at a push of a button straight to the blood stream. How do anesthesiologists resist this urge? Best drugs in the world right at their fingertips; sure there are measures to prevent misuse but there's always a way around if you want it enough. Have you ever heard of a fellow anesthesiologist with an issue like this? Anesthesiology is the field of choice for high functioning addicts for obvious reasons
@@Newlife-ol6pk anyone who wants drugs will find them; it's very easy to order them online if you dont know anyone in person. It'd be even easier to take them from an overstocked hospital. So no, I'm not making that assumption. That doesn't even make sense lol
@@Newlife-ol6pk you ever have an interaction with someone using your brain, rather than saying "So yOu ArE aSsUmInG.... something fucking retarded"?
Maybe try it some time mouth breather, exercising a smidge of common sense really isn't that hard.
That ex anesthesiologist was lying. There's NO WAY they could get away with an IV hooked up to his leg during surgery lol
This video is absolutely fascinating and now I am wondering if I was given fentanyl during the removal of an old VP Shunt for Hydrocephalus? I also had a new VP shunt inserted. As soon as I woke up in recovery, I was experiencing horrific pain inside my brain and outside my scull. One of the surgeons said the old shunt tubing and valve had fused to my scull and literally needed to be dug out. The recovery nurse kept giving me Fentanyl injections over about a 90 minute period, until the horrific pain subsided. Each dose didn't last very long at all. If I am remembering correctly, I had about 15 doses, which sounds like a lot. I also remember the nurse saying that different patients respond differently to fentanyl and there is no "standard" dose.
As living with chronic pain due to several spine surgeries and neuropathy I've been denied the fentanyl patch for quality of life due to some people abusive use! I have used the fentanyl patch and was able to have at least some quality of life but now doctors are afraid to prescribe it and malpractice is making it cost prohibitive. Thanks to those people who made it prohibited for me!! Including the insurance companies!!
I loved the video! You explain this so well. What is sugammadex used for? I'd also be interested to know if the European anesthesiologists are all doing what you are doing. I believe we do get the same opioids during the surgery but tend to get far less for controlling pain afterwards, even for chronic pain (I don't mean cancer, obviously, but other types of chronic pain that I know some Americans get opioids for). Would just be interested in whether that is actually true or just my guess. Your videos are great, I had surgery a bunch of times and was really interested in how it all works.
Years ago When I went in for my spinal epidural for back pain. They gave me a lil fentanyl so I would not jump while doing the injection which could result in paralysis if I moved.
A few weeks back I had an ablation and next day I got a permanent pacemaker installed. The Dr gave me a couple shots locally to numb me before the surgery. I wasn't quite numb and they gave me fentanyl to knock me out.
@Max Feinstein, MD : thank you for all your videos! May we have your opinion on Xenon anesthesia, please?
Good information in today’s video. ✌️
I have had the occasional opioid following c-section and breast cancer surgery but the uses were well monitored and prescribed for only the length of time usually given for such recovery from those surgeries. Ive never felt the need to have more than prescribed.
Not sure if you have done this video, but can you make one about hownyou knew anesthesia was right for you and what made you do it? I'm a current nursing student and anesthesia has always interested me. How the brain reacts, how the body reacts, helping comfort people in possibly the most stessful moment in their life. I would love to be a crna but I just don't knownif it's "right". I'm currently a cna in the icu and help with certain procedures with the nurses and doctors and love it.
Well if you basically love what an anesthesiologist does then yeah you could go for CRNA, CRNAs does similar work like them with supervision of their teacher anesthesiologist, he did a video before saying why he wanted to become an anesthesiologist in pretty sure he was saying like how he loved the life style and “anatomy” of how anesthesia works because originally I think he said he wanted to be a dermatologist but changed his mind just because he favored anesthesiology more
You’re my favorite doctor youtuber!! 🥳🥳🥳
In Australia general anaesthesia is widely used; where as in China, none major surgeries usually only use local. I had surgeries in both countries, hence I know
Such an interesting video, and very good points. I was given morphine and oxycotin (sp?) during my time in hospital after falling 20ft (6 meters) and breaking my face/jaw into 11 pieces, shattering my wrist, and puncturing a lung. I was worried I would become reliant on the pain meds (I didn't, yay!) but I was on such a low and infrequent dose they didn't help much at all.
I have woken under anesthesia 3x. Once a complicated oral surgery, a wrist surgery and with cataract surgery I was given drops and a medication yhat was to relax me but was stimulating instead. For reconstruction on my foot I was given fentanyl. It helped tremendously. I also had an opiod for recovery. Not addicted.
Max- the spicy comment I remember reading on that other video was not so much a critique of the anesthesia meds you chose, but more so a critique of how much the cost gets inflated down the line by the time the patient gets the bill. Something about ‘adding a few zeros’ to the cost you quoted, LOL. The problem isn’t the meds chosen by the anesthesiologist; the problem is the overhead of the American healthcare system after the insurance companies and hospital admin gets their cut.
Really cool video. Tks!
Very interesting Video. I enjoy all of your videos.
I remember when I came out of a major surgery in 2022 that I was given Fentanyl, Ketamine and one other opioid during the course of my surgery. My recovery for almost a week in the hospital, and going forward, the only pain management I was given was Tylenol and Ibuprofen. No opioid addiction.
Thank you Max 🌻
so the Governments position on this issue is to just cut it all out. The patients who follow the rules are the ones who get screwed period. There is no gray area. Its all too easy to go after the patients who do follow the rules to the letter. It has always been this way. The DEA has threatened the pain docs so much hell I would not want to prescribe meds either. So when the day comes, and it coming fast I can no longer function with my cane and brace, and the neuropathy becomes so painful. I will have to get a lawyer and file for full disability. My Mom had to at age 50. I am 53 I figure by next year my L3 will be next to be operated on. My L4, L5 and S1 have already been surgically repaired.
I have had three knee revisions, this past Christmas I got pneumonia an the sepsis and staph! I ended up in the hospital getting my knee hardware replaced, an the entire knee scraped to remove the infection! There are holes eaten in my leg a various places from the infection. After the surgery an 2 weeks in the hospital I was discharged, with a pic line for antibiotics an a nurse that comes to my house to take care of me! I was given 5 mg Acetaminophen, 10 total! This is crazy after a week I was told to take motrin! This is exactly why people buy it from dubious sources! There are people that do not get high, like me just needed some relief from the pain! God bless my biker friends!
Great content.Thanks.
Thanks for this video. Really good information. To me when people give their opinions on what meds are ok and what are not ok, talk is cheap. What would they want to be used if they were having major surgery---or their spouse or child was having major surgery. Would they want whatever is the best for pain and for no new memories created, even if those drugs were ones they were against?
I like this video. Thank you so much.
Mt Dew is far harder to get off of then fentenyl. Morphine isn't easy but the Dew is totally addictive and 3 years later I'm still trying and failing. Love that stuff.
Take good care of your teeth while you are addicted to Mountain Dew. Brushing your teeth with xylitol will help keep them cavity-free. I don't want your teeth to rot out.
What is mountain dew?
@@Swan-rb4yg A better-tasting version of Mellow Yellow.
My experience with 'talking to the anesthesiologist' has been perfunctory--she or he appears minutes before surgery with little time to ask questions. I have found that the type of anesthesia is often driven by the surgeon's preference.
I sympathize with you completely. Anesthesia is commonly assigned the night before, making a conversation challenging to say the least. Ask the surgeon's scheduling person for the number they call to schedule surgery. Then call the number and ask to speak with the anesthesiologist the night before your surgery, preferably the one that routinely uses a brain monitor to avoid over medicating you..Please download your free copy of my patient information book, Getting Over Going Under, @ my nonprofit Goldilocks Foundation.
I've had 2 surgeries and both times the anesthesiologist came and talked to me about what was going to happen. they never mentioned which medications they would use though
Excellent video.
Great video! Thanks. I had part of my colon removed under general anesthesia. I received no opioids(narcotics) post surgery. They did such an amazing job of keeping ahead of my pain with other options. I was impressed. About 10 days later, I had an outpatient procedure to remove a bone in my thumb. I am not sure what level of sedation I received, but there is little attention paid to my pain plan post op. Perhaps the abdomen needs little pain treatment. Thoughts on why little attention was paid to my pain after my seemingly minor outpatient procedure?
I would be interested to hear about propofol. It seemed to help with my mood coming off it.
I was in enormous pain once and went to the emergency room for relief. I didn't get any help because the doctor thought I was only looking for drugs. I've never been a drug user.
The narcotic crisis is from the streets
Good morning... keep up the content
I had surgery in 2008, and one night I had some pain. The nurse called my surgeon, and he had them give me one dose of Oxycontin (I think). When I was discharged, I asked if I would get that as it worked very well, and he said "oh no! You'll get tylenol 3. Its too addictive"
Given that knee arthroplasty is the most common surgery it would be very interesting to see your plan
Dr. Feinstein thanks for making this videos. Like yeah there's going to be influencers but like isn't better to have more doctors make videos like its so much more information and like if were all going to mars at least when you're in a doctors operating room people are at least keeping in mind the science network in real time.
Great video guys
Excellent video. Learned something.
Calling the ABCs is a little hokey, though.
Just had my gallbladder out on Friday. Was given Fentanyl, Dilaudid, and Oxycodone. The Oxy was for home use, twelve pills. I haven’t needed any yet today, but man, did I need them Friday and yesterday.
Did it help when you woke?? A heard they give fentanyl during surgery
@2:36: I honestly had no idea the body would still react to stimuli like that even if the patient is under anesthesia. I guess it makes sense. The body has no idea what's going on so it's tensing itself up for a potential fight, I'm guessing?
Thank you!
Great video. Loved the collaboration with ABC. Here in Ohio we're hit hard with the opioid crisis. While the problem has many facets, one step our state pharmacy board has taken is that prescriptions for narcotics now must be issued electronically between the doctor and the pharmacy. I believe the goal is to reduce the manufacture of bogus prescriptions. Hope it helps. Curious if other states have adopted this practice.
studies show that almost 99% of the overdoses are not from people taking these drugs under a doctor's care. The media wants to scare everyone because they ignore that there are BOTH rapidly growing numbers of OD's from these while also the number of RX's written has dramatically fallen in the last several years. The FDA does not want you to know that. These are street addicts dying from ILLEGAL fentanyl. Not saying they do not matter just saying the government is looking at the wrong place to try and fix the issue.
All my prescriptions in general have been electronic for a while here in California, I would assume it's just the natural step and is a lot more secure.
Interesting. So in the cases where FDA approval processes for you know, double blind studies are unilaterally predetermined? As opposed to .. ethical dilemma
I had a total hip replacement a year ago April-when I woke up in the recovery they had given me a couple milligrams or however it's distributed of fentanyl-they also gave me a morphine shot and then a few more milligrams of fentanyl-I finally got to my room after the surgery I didn't crave anything just once pain to stop-so they started on some morphine shots gave me Percocet gave me ultram-every time the physical therapist would come to my room I would say ask the nurse if I can have a shot of morphine easy before or after we're done because I was so much pain. Never did I want at show any signs of withdrawal after I went to the rehab center-never die show but I needed more medication what they would give me-I never asked for anything more once I got to the rehab center-physical therapist while I was in the hospital told me well you're not going to be getting these shots I'm working when she get to the rehab center they don't do that-I said fine but while you are making me get up here and walk around and do things on my own I need that extra shot cuz I would be in too much pain-but I never did withdrawal-this goes to show that not everybody gets hooked on pain pills and it's a shame I have to drive 2 hours and 20 minutes to even see this pain in the management DR-I've actually went the past 4 or 5 weeks without it because they would only prescribe my medication for 2 weeks and I called them and I told him that's a long journey for me but 6 to 7 hours just to go to the appointment-doctors are just so reluctant to prescribe proper medications people that are in chronic pain need-my first appointment with this "doctor"-it was actually a PA-the first thing she said to me is we don't prescribe OxyContin-I explained to her I've never had oxycontin and I didn't even asked for oxycontin but 2 7.5 lortabs a day is not enough-it takes a lot out of me to ride that far as I can't drive anymore so I'm under the real liability of somebody driving there through my insurance company. I think it's like 198 mi or 168 MIles from my house to the pain management doctor. It's A hard life dealing with chronic pain and knowing that these doctors won't give you what you need but you do miss your amount it's still collect on the insurance payments whatever insurance you're under
That actually sounds like you became addicted very quickly.
HELLO MAX! I LIKE YOUR VIDEOS! THEY ARE REALLY GROOVY! MY QUESTION TO YOU IS HOW DO WE KNOW THAT GA ACTUALLY PREVENTS PAIN, AS OPPOSED TO JUST MAKING YOU NOT REMEMBER PAIN? ...LOOKS LIKE I HAVE CHRONIC APENDISITIS, AND THIS QUESTION KEEPS ME UP AT NIGHT
I was given fentanyl on my ambulance ride for a torn and dislocated meniscus. They talked back and forth between 50 to 75 units(mcg?) of fentanyl. After the gave the 75mcg(?) dose, I felt a brief sensation like I had a shot of Everclear and then it was gone after probably 20 seconds. Literally didn’t last through the gurney ride. I was discharged from the hospital with no pain medication or prescriptions.
RE: CYP2D6 poor metabolizers (individuals with no CYP2D6 activity) I was told that I may lack this enzyme because I have no response to opioids. This was talking with an anesthesiologist before one of my back operations. Admitted for severe back issues which needed surgery I was given IV morphine, dilaudid etc and would just laugh because they do zero to take away the pain. After care at home I had oxycodone which did nothing also causing upset stomach and vomiting. In fact the first surgery they had a hard time waking me up and again vomiting. Opinions please.
Very informative.
So interesting.. I love watching you
Last time I had an opioid was as a kicker they gave me for my back and headache as I was leaving the hospital. Small dose of oxycodone straight through the IV. Immediately I felt amazing, I could move my body like I was a kid again, no pain, I couldn't stop smiling. About 5 minutes later I suddenly felt like I was in an oven, I was burning, soaking in sweat so bad it was dripping down my arms and legs, running to the restroom by the time I got to a toilet from the sudden intense nausea my head started spinning like never before, I didn't move in fear that I would just immediately fall over. This lasted for 10 minutes, and the shakes didn't go away for another 2 hours, still I was pain free, and it was nice. Well that was 4 years ago, I don't have any desire to do that again, even if it makes me feel great.
From the UK here, I recently had surgery and was given a dose of fentanyl before being put under. I was quite suprised that it was after asking, since it was not pleasureable at all. My head was extremely light to the point of uncomfort and it was much harder to breath. Not something I'd want to repeat, so giving the correct dosage is important.
Similiar experience. I also had blurry vision and vomiting afterwards. I really hope they come up with something better
8:35 : coming from a hospital Operator, we wouldn’t know wtf to do with that request 🤣 Very interesting vid tho! Great job 😊
Many years ago I watched a distinguished cardiac surgeon perform a CABG on a pt. I asked the anesthesiologist what he was using for anesthesia and he said, "nitrous oxide and morphine". I thought that was a little odd but he commented on the safety of his protocol. Post op. the pt. did very well, was quickly extubated and had an uneventful course.
the study that abc cites about more people dying from prescription opioids than heroin is a bit misleading - it includes opiates that were never supplied with a prescription but were made by some dude in his basement with a pill press. a large number of the deaths attributed to prescription opioids were not legally obtained, though abc seems to have interpreted it that way. part of why people die so often from consuming them.
it also doesn't account for the paracetamol contained in some pills, where the paracetamol is responsible for the death. or poly drug abuse - the majority of deaths in that study were due to multiple substances, which would include, for eg, people who took counterfeit oxycodone that was laced with fentanyl. Finally, one of the stated limitations of the study was that heroin deaths may have been undercounted and miscounted as morphine due to difficulty interpreting toxicology data.
Anesthesia use in China is still pretty limited due to the paranoia from the opium wars. So it is definitely different in other countries. I still remember when I was 2, I cracked my head open, and the doctor gave me 4 stitches in the ER without any anesthesia, not even lidocain. I still have PTSD from it.
Wow so sorry
Please I'd love to see a collab with an anaethestist in the UK. Very different conditions with the NHS and lower fentanyl abuse in the population.
We use very rarely fentanyl in France, remifentanyl a lot though
For the example for the appendectomy - What agent/opioid would be your choice for postoperative pain management (since fentanyl is rather short-acting)? And at what point of the surgery would you give it?
Post op pain management is usually handled (in the US, at least) by the surgeon. In the case of my appendectomy, it was five to ten milligrams of hydrocodone every four hours for five days. I felt it was appropriate and adequate, with no need for more opiates at day six.
I had a nerve block on my left knee (first one) but not second. Second knee (right) much worse, but it was delayed for a year (even if for legitimate reasons) first i had hives (allergic to thyroid medicine) and then i had to have colon resection first, that thankfully wasnt cancer but could have been.
Ngl I feel like a much bigger question should be what post operative pain plan do we have for these patients, if you are wanting to reduce the risks of subsequent opioid addiction. The connection between a one time hit whilst unconscious and later addiction feels almost irrelevant unless the patient has previous addiction issues.
Had three Caesarians and very grateful for the drugs.