Liver transplant anesthesia - operating room tour
ฝัง
- เผยแพร่เมื่อ 1 มิ.ย. 2024
- Anesthesia for liver transplant requires extensive preparation and advanced equipment, including central lines, multiple vasopressors, and transesophageal echocardiography. In this video, I show you the components of the liver transplant anesthesiologist's operating room setup.
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0:00 Start
0:39 IV pole #1
1:09 Anesthesia machine
2:15 Defibrillator
2:32 Drugs
3:21 Echocardiography
3:45 IV pole #2
3:57 OR table
4:15 Rest of the OR
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Find Max Feinstein, MD online:
Instagram: @MaxMFeinstein
Twitter: @MaxMFeinstein
Website: www.MaxFeinsteinMD.com
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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.
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#Anesthesiology #Residency #MedicalSchool - วิทยาศาสตร์และเทคโนโลยี
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I had a liver transplant at Mount Sinai Hospital in NY on March 16, 2016. There's a chance I had it done in the OR featured in this video. As I was being rolled into the OR I was very scared. I didn't know if I was going to die or not. The last thing I remember I told the anesthesiologist that I was very worried. He said to me in the kindest way possible, "Alan we're going to take good care of you. "
Those words meant everything to me and they put me at ease. The next thing I know I woke up in the recovery room and I am ok 7 years later. Thank you to that anesthesiologist, the transplant surgeon Dr. Arvelakis and all those kind professionals that helped me at My Sinai.
beautiful story
Fascinating stuff. I underwent a liver transplant in October of 2019. The anesthesiologist is the last person I remember speaking to before I woke up two days later. He must have done a good job because I did wake up and I'm doing fine.
I hope 🤞 your recovering well, I’m awaiting a Liver transplant atm
@@jamesgreen3417 Good luck! I wasn't happy when I was going through the process, but I feel fantastic now. Just keep moving forward.
@@jamesgreen3417 liver disease sucks hope u find a donor soon!
@@verykittypretty thank you 🙏🏼
My mother died after 16 days of liver transplant for wound debridement in ot due to medical negligence by anaesthetists
All this reminds me of the DEDICATION it takes to be a Doctor as well as specializing in any field. Smart, hard working people all of you !
There are a LOT more medical staff involved in liver transplants than just the surgeons and anaesthetists. Think of the scrub nurse for instance, standing there for the length of the procedure. Keeping track of all the sutures used, the swabs and instruments etc. If something gets left in the patient it can be fatal.
Also don’t forget all the backstage people. Those who maintain the filtered ventilation system, those who ensure that blood and blood products are available, Those who maintain the O.R. medical gas supply. The lab technicians who do all the tests the patient needs perioperatively. The team who procure the new liver. Etc. etc. etc.
They are also smart and hardworking and vital to the liver transplant team.
Just had a liver transplant on March 31, still in hospital, feeling great. Have been following you for a while. Thank you for helping me be prepared!
I just donated the right side of my liver to my bestfriends future daughter-in-law this past April 17, 2023. This whole experience has been so Amazing and life changing for me and the recipient. My Anesthesia team and the Transplant surgeon team were so thorough and kind. Definitely a once-in-a-lifetime opportunity to help save someone's life... And, thank you so much, Dr. Feinstein, for all of your videos-I watched a lot of them pre-surgery to mentally prepare myself. Thank you for all of your knowledge and skill.
I’m a liver transplant recipient, 2018, so glad i found this video, gives me more insight into what happened that day. I had acute liver failure my liver died in 12 hours. I was listed right away with a meld score on 48, was put into a medically induced coma on sept 3, 2018 had my transplant sept 8th 2018 everything happened so fast i woke up and didn’t know what happened i just woke up with a new liver, talk about scary.
Same thing happened to me.
@@emmaleary3767 kid you don’t mind me asking, what happened?
@@Kristen_michelle0515it was a virus.
After recently having a liver transplant, I'm thankful at least one of those machines, specifically the defibrillator weren't required. Although my surgery went well and I'm doing fantastic considering what I've gone through, it was really nice getting an overview of the room from this view with everything being explained. Thanks Dr. Feinstein for this video. Shoutout to Dr. Selvaggi, Dr. Shah, and Dr. Venkatasamy for my transplant surgery at Jackson Memorial Hospital in Miami.
You went thru an incredible experience
Wonderfully done and I know Anesthesiologists are paid well but watching this, I think it’s fair to demand even more. Haha
Watching these videos presented by Dr Feinstein has given me an extremely heightened appreciation for Anesthesiologist. Its very rare to meet and greet an anesthesiologist let alone get to know them in the manner we would our surgeons. The last time I had surgery 10 years ago was for a 5.5 hr cochlear implant. Anesthesiologist are frick’n busy busy just prior to being taken in, so if you meet the anesthesiologist for 3 minutes, you’re lucky. I knew then that its pretty much a thankless profession. You never see them afterwards. In fact you never get to meet the surgical teams too. So on that day as the wheeled me into the OR, completely bombed out of my mind (good stuff) barely able to speak coherently, I fought to speak clearly and loud enough “in advance thank you everyone for your help today “. The last thing I remember was a few “you’re welcome(s)”. So when you first meet you anesthesiologist, thank them, its the last chance you’ll get. 👍
This was really cool 😎. I don’t remember my anesthesiologist for my liver transplant. I remember the room was large, in the Jackson building in Massachusetts General Hospital. The nurse was fun. We had a hard time getting my special earring out. I heard that things went smoothly during and after surgery. I remember my surgeons. Post op, for a couple of days, I got psychosis. I thought that I was dead and in hell being mistreated. Those meds were hard on my brain. I know that I was being taken care of by so many. I was off the pain medications by the time I made it to the transplant unit. I so appreciate everyone. ❤️❤️❤️❤️❤️❤️
Yo i just realize you subtitle all your videos. That’s not easy. Mad respect to you for doing that doctor
Thanks! Based on the stats TH-cam shows me, there are way more people who use subtitles than I would have imagined. TH-cam also makes it super easy to caption the videos because it can auto generate subtitles and is usually pretty accurate, so I just need to make a few tweaks and that’s it.
As a person that is headed down that road, that is extremely informative, thank you for that video.
Thanks for the video! It brings back memories of the first automated anesthesia record I ever saw, at Baylor Hospital, Dallas, in about 1987. I forget the Anesthesiologist's name but he was an early pioneer in liver transplant anesthesia in Texas. In the first transplants done at Baylor he had been overwhelmed trying to keep up with the Anesthesia Record. Huge numbers of blood products were given because there was no cell saver and surgical techniques were still evolving.
This was before useful desktop computers so he had a terminal installed from the Hospital main-frame. He developed transducers from his monitors (A-line, SG, CVP, EKG, etc.) which, via the terminal, fed to an X-Y plotter, which drew out the record. He also hooked up a barcode reader. (BTW, he also had to write all the computer code!)
He developed barcodes, in cooperation with the barcode gurus, for all the usual drugs. Tapes with those barcodes were attached to the drug syringes. When he gave a med he waved the syringe over a barcode reader. This caused the name and time of administration to be printed on the Record. He did have to manually enter the amount of drug.
All the blood products had bar codes from the Blood Bank, so he could easily enter each bag via the barcode reader as well.
At the end of the case he had a paper record of the anesthetic, accurate as to times of administration of drugs and blood products.
I was impressed...
Dr Feinstein, thank you for the tour. I underwent a liver transplant in March 2017, following an Alpha One diagnosis in 2012. My anesthesia team was awesome and I am forever grateful for how they talked me through the setup all the while reassuring me they had my back. While I don't remember their names, I do remember the face of the one as he placed the oxygen mask on me. My next memory was 3 days later.
I am fully recovered now but I have required some subsequent incisional hernia repair surgeries and your videos have help me understand and appreciate your specialty. Thank you and all the best to you as you continue your career path.
Dr Max Feinstein, what a great video. I appreciate your dedication to educating people. I'll be having surgery again in November and these videos always help put my mind at ease!
I LOVE your videos! Currently in nursing school (RN) and I love to learn more about the different machines and set ups in the OR. Please keep posting :)
Amazing and breathtaking! Thank you Dr. Feinstein for your great job at not only being a good doctor, but also being unique anesthesiology expert filming such a great, interesting videos.
Thank you Dr. Feinstein! Your videos are informative and easy to understand! Knowledge helps me to understand the procedures and not be so nervous.
Excellent and informative video! You have a natural teaching ability.
Very intresting Dr.Feinstein! Keep it up, I'm sure thousands of people are very grateful for you and your sensitive work with these potentialy dealdy drugs. Your a very talented person! If i ever have a life saving surgery I would feel at ease with you in the operating room. Much love from Texas!
I'm an IONM student and HOPE he sees this. Seriously my class was supposed to get to see our first live case back in July, but the patient got cold feet. I took my first "practice" CNIM exam today and A LOT of Max's information helped me. Eventually I will get into a place for my clinicals. Its nice to get a real run down of the OR and NOT be the one on the table. Love ya Max!
Thanks for this video. I just got put onto the Liver Transplant List in England. Will have my transplant at Cambridge Addenbrookes. This was really interesting although a little unsettling to watch! Knowing I'll be in good hands though. Just amazing. Thanks for all you do for Liver patients.
Thanks for sharing this! You seem quite competent. I’m impressed!
That is something! Always looking forward to your next video
Great Job! Greetings from the UCSF Liver Anesthesia Team 😀.
I love this vid, Dr Max! One of my faves!
I attempted medical school and failed miserably the mental toll of experiencing someone loved one dying in front of me was too much! wasted 8 years only to realize it was not for me! the insane hours and stress was not worth it for me my hats off to you and everyone that survives Medical school internship residency! Cheers from Salt Lake City!
Well done!! Awesome tour! I enjoyed it! I learned a lot!!! Great job!!
I’ve watched this video a few times but this is my first since my transplant a week ago. Literally about this time a week ago I had just been stapled back up and was heading towards ICU for the standard ICU stay. The last things I remember before going under where the anesthesiologist saying I was getting a free shave with my transplant (I had a decent beard and that 1 dollar razor they gave me in my room prior to surgery both literally and figuratively wasn’t going to cut it), being slid onto the table by like 10 people as I’m kind of a bigger guy, getting strapped in and getting some oxygen. Last thing they said was the classic “Alright give us some deep breaths” and I drift off. My first memory post transplant is waking up in the ICU, not fully aware of where I was but basically knew, and I could see my wife and hear her voice. I don’t remember what she said but I could hear her and I knew it was her.
Thank you for sharing this information. It helped calm me nerves before the transplant! You do excellent work!
I donated part of my liver to a friend and I only had about 45 seconds of consciousness in the OR before they put me under. I just remember how much stuff was in there and tried to take it all in, but this really helped me understand how deeply complicated things are even though the transplant team tried to keep it simple enough not to freak me out before surgery. Very cool!
Isnt it illegal to donate liver out of family?
@@asdasdasdqwe123 nope! i don’t understand why it would be
@@disconsolator It is in most of countries atleast in INDIA where i live.
@@asdasdasdqwe123 when i donated my liver, they made sure that i wasn’t being given any money for my donation. my guess is in different countries this becomes a problem - they don’t want people selling off their organs for whatever reason, so they have to legally limit it to family. here we can donate to friends or even be anonymous. american privilege is a factor
@@asdasdasdqwe123 it seems that they don’t want people for feel pressure to donate their organs for money in other countries. in the us they make sure you are not receiving money for your organ donation. limiting it to family would be one way to prevent this
Awesome tour…. Very involved surgery. Wowza!
Fascinating and well done Thanks Dr Max !
Thank you for this video Dr. Feinstein!
Very well presented man there is a lot of equipment in that room,take care Doctor!
I'm waiting on a double lung and liver transplant. Very cool and informative to see what this room looks! Going in not knowing what all the machines are for can be overwhelming.
as an anaesthetic dr in australia, glad to see the exact same equipment are used at the other end of the earth 👍
Yes just upside down versions of everything.
Your videos are fantastic. You're providing answers to questions that so many patients want to ask. Would you devote a future video to intubation procedures, processes and different types of endotrachial tubes why each is used.... thank you
So very interesting, amazing detail. Thank you
I just like your video and the details you let us know about!
Love from Bangladesh 🇧🇩🇧🇩
These videos are so great! I'm aware that anesthesiology is a complex field and there's probably a lot to keep track of, but is there any chance you might be making a video about the major differences in providing general anesthesia for various types of surgeries? Hearing your thought process for specific procedures (precautions, types of things to anticipate, how you plan ahead) would also be really interesting.
Please please please make more of these types of videos
I love learning about the equipment in hospitals and especially operating rooms
There’s so much weird and complex machinery and stuff it can seem overwhelming
So these breakdowns are so awesome
Everything from big transplant surgeries down to the most simple general surgery rooms are interesting to me
and I love to learn about all the machinery and equipment in them
it’s also really helpful since I’m building some different operating rooms in Lego including general surgery emergency surgery nero surgery and more
So these types of videos are super super helpful in finding out what equipment and such needs to be in the different rooms
Working on another type of video like this! Thanks for the feedback, it's very helpful.
@@MaxFeinsteinMD of course mate
Happy to help
I am a huge anesthesia nerd/medical history nerd myself
so I’m digging your content a lot
Looking forward to that video that you got coming up
sounds like it’s gonna be really useful to me
@@MaxFeinsteinMD just a quick question: why do you use those sort of volumetric pumps instead of 50ml syringe pumps (e.g. BD Alaris Guardrails) to administer vasopressors? Is the accuracy comparable? And if you place a CVC, is there a specific reason you don't use the different lumen for vasoactive medication instead of putting it all on the same line? Kind regards, Charles, BSN at an ICU in Belgium (Europe)
What a gas, getting this info in this manner through the lens of technology. Anyone not in the profession would be awed by all this marvel yet clueless about what and how it's all used. Good stuff as usual.
Love the detail in this video, keep it up!
I'm amazed I never thought about how much medication and machinery goes into a liver transplant. I learned something new. I liked the video.
Hey Max! Really good job. You accurately portray the level of complexity of this operation and the equipment that makes it possible. I am a liver transplant anesthesiologist at one of the few private practice programs in the country. If you ever make your way to San Francisco or are interested in pursuing a career here, give me a call. Keep up the good work!
Jeffrey, I was told that it takes a couple hours to set up the patient once they are “out”. What happens between me arriving and the surgery starting??
@@drsuessl We usually have a plan accordingly to the patient as a whole. Labs, other co morbidities, other organs involved, and each patient case requirements are different. We hope for the best but prepare for the worse. It is truly a very tedious surgery. The surgery is well planned out however your dealing with coagulation, hemodynamics etc. We aren't legally able to give you advice or speak on your case. However your surgeon, anesthesiologist and transplant team should be able to break everything down to you in great detail. Best of luck!
I have a history of high BP, currently on 3 meds and it's still up there. Would I be difficult to have a transplant? Just curious because I was told by many medical professionals that the liver is highly vascular and maybe I would be tricky to operate on?....If you can't answer due to legalities I understand! THX!
Thank you for taking us on this tour. I will be getting a liver transplant and it is nice to know what is there
Great video! My dad had a liver transplant at Mount Sinai in 2000.
Woahhhh this is so cool, thanks for the tour!
THIS IS WONDERFUL AND I LOVE YOUR VIDEOS 😘
I am Liver Transplant Donor ! (18-09-2023) From Pakistan Kidney And Liver Institute Lahore !
The team was So Genius ! May God Give Them Higest Reward!
Fascinating I’m a double organ transplant (SPK) this year will 32 years.
This was really interesting! I had a triple organ transplant, including liver, and the anesthesiologist had me out before I got to the OR so I didn’t see any of it!
Beautiful work !
The machine that recaptures the blood and gives it back to the patient is fascinating!
When I got to watch a surgery everybody called it the washing machine 😂
Cell Saver
Yes Cell Saver is another brand
Those machines are great. They used one on me during trauma surgery ( broken rib got my splenic artery...ouch!). I'd like to put in a thank you for all blood donors too. While I didn't need any outside blood, I'm grateful to the six people who donated a pint had there not been a machine.
Very cool! I had a kidney transplant 17 years ago so this video is very interesting 😃👍
Great video as always. 🥰
As a physical therapist, who loves all things ICU and other complexities in a hospital setting, it was a real privilege to witness how the medical team works together in a complex operation. I myself got to witness a CABG x3.
Fascinating! And hopefully something I'll never experience. Of course, now I want to see the liver transplant.
I appreciate the 4K quality content!
Thank you thank yooooou i swear its help me allllot more than your imagine thank you
I love your videos. Very interesting.!!!!
Knowledge seems such a small word to use when, one becomes aware of how far we have come in healthcare provisions, that transform &
Extends lives. In the1800's it was a Bottle of alcohol, a surgeon, & an amputation. Now Look! To those who truly
Study & Love this work, Thank
You is also a heartfelt, yet small word.🌷
I hope to work one day in this room even it cost my life.
You are lucky Dr.
your voice is like Propafal- puts me to sleep, very calming
I have donated my liver to my dad 6 months ago.. Thanks for this video got to know what all I went through for the first tym .!!
Hello, I'm going to donate my liver to my mum. May I please know how are you doing now and is there anything I need to know before going for the operation? How long did you rest after the operation? I'm quite nervous. Thanks in advance
I have biliary atresia (a liver disease in which I was born with a bad bile duct) and I underwent a Kasai surgery when I was 2 months old. I’m 19 almost 20 now and I am doing great, but it’s still possible I may have to get a liver transplant at some point in my life. Really interesting to see the equipment they use for the procedure. Hopefully none of it will ever have to be used on me fingers crossed 🤞
I am both fascinated and terrified at the same time😳
Great video!!!
Hi Max, love the channel! I didn’t see a video on anesthesia for trauma surgery and would be very interested in learning more! Also, I saw it discussed briefly when you were interviewing the Chief of Neuro Anesthesia, but would love to hear your thoughts on TIVA vs. Inhaled Anesthesia. And finally (sorry) would love to see a video on MAC Sedation vs. General Anesthesia for minor procedures (I realize it depends on the procedure and a host of other factors, however, I’m assuming the Anesthesiologist would make the final call if they believed it was in the best interest of the patient to convert to full GA even if MAC Sedation was planned for and even started…I think it would be an interesting topic for you to discuss anyway). Thanks!
Awesome video. I'm the head of the biomedical engineering department is South Africa's biggest private hospital. Very informative
that’s fascinating
I never forget this room ...in my life
This was so cool to see!! I am getting a liver transplant soon and am really glad I get to know more about the behind the scenes of it! - ps love the channel!!:)))
So so happy for you🥰🥰 I’m a post kidney transplant patient of 17 years. I wish you all the best!!♥️
Glad you enjoyed! Best wishes for your upcoming surgery.
Best wishes!!! Your life will become amazing. My 'borrowed' kidney will be twenty years old soon.
Do more video like this
Thanks for the feedback, I will try to do more specialized OR tours as I go through my subspecialty rotations!
@@MaxFeinsteinMD please do A video of The anesthesia supply cart toI want to be a orthopedic surgeon when I grow up
Awesome video! More wires than my tv setup! 😂
So interesting!!
I play pipe organ. Then I worked for a a CDL. I thought that was complicated. Then I looked at a pilot's license later and perhaps will skip that. Then I see this. Keeping humans ALIVE is the most complicated thing ever and always will be! Those that take up the call and do this. WOW. Much respect.
Amazing
Oh id been thinking about making filyer blood putting it back in also for other things.interesting, my. Mum worked at guys hospital once then Nottingham as teacher a clinical teacher of nursing.
Wonder if can use this on injured soldiers to stop blood loss. Some kind filter in field that gets blood back up instead on floor.
So cool! Also I live very close to a Grifols plant!
Wow that’s awesome! I’d love to tour a Grifols plant haha.
That last little bit was fascinating! How do they collect the blood for filtration?
The auto transfusion system was so cool!0
Love your videos! My interest in anesthesia is growing. How do you defibrillate when a patient is in active surgery? Where do you place the defib pads?
Great question! We try to anticipate when defibrillation may be necessary, so in those cases we place pads on the chest and back before a patient goes to sleep. Then if we need to defibrillate during surgery, we make sure nobody's touching the patient and then go ahead. If pads aren't already placed, we quickly try to get them on, but as you can imagine that's more difficult when the patient is already draped for surgery.
Good. For. You. Fam
Dr. Feinstein can you please do a video talking about anesthesia during heart surgery - especially during a heart transplant. Thank you for these wonderful videos.
Working on that exact video right now! Will post in the next week or two
Amazing.
I had a liver transplant 5 years ago but, I was so sick and in and out of consciousness, that the only thing I remember was the pain from being moved onto the cold operating table. I’m guessing the anesthesia was top notch 🤭
Hey! Maybe a little bit dumb question but how many sockets does this OR have and where is the coagulation machine? Because from shadowing surgeons in my home country at one of the best hospitals here in every OR where I’ve to they have special stand(bench) with maaany sockets, laparoscopic equipment and coagulation tools as well. This sockets are also being used by anaesthetists as well (its like 20 of them) and also there are multiple monitors. This construction can be easily moved and put aside, it can be adjusted for every hight and seems incredibly comfortable to use. How do you survive without this in your ORs? 😮
I am on an anaesthetics rotation right now and this is so much crazier than all the stuff i’ve seen so far
Yeah liver transplant is just about as crazy as anesthesia can get.
@@MaxFeinsteinMD I think I know what I am going to organize my taster week in! (in UK foundation training (2 years of being an intern) we can take a week out of our study allowance and use it to work in a speciality we are interested in)
This is so similar to the room I was taken when I was donating part of my liver to my son
I miss doing my Liver Transplants at Houston Methodist Hospital In Houston. The fluid warmer and Bair hugger was not mentioned as it is two of the most important devices to have as patient's Temps are highly monitored. Great video. WOULD LOVE TO COME JOIN 😍
I loved that Bair hugger when I was in SICU post-transplant, those things are wonderful!
You're right, I did not mention the fluid warmer or Bair hugger but they're both very important! I'll point these out next time I do an OR tour video.
@@MaxFeinsteinMD no problem. Team work..
That’s my Runner label! 😎
Thank you 🙏🏼
isn’t there usually an “airlock” room in between the hallway and the surgical suite so the doctors can scrub in and to equalize the pressure since the or is kept at above ambient pressure?
Are normothermic perfusions machines commonly used before the transplantation, like Transmedics or OrganOx?
Wonderful Video. I live in NYC and know about Mount Sinai Hospital. Do they also do Kidney Transplants? Please keep making more of these Wonderful, Educational Video's💖
Hi Carla, yes Mt. Sinai is a high volume kidney transplant center! Thanks for the nice feedback.
Just curious what the med with the brown cap in the upper left is- it looks like Omnipaque 300- I have never seen another medication in the same vial size with a brown cap before.
What are the emergency medications specifically and what would they be used for?
How long is this surgery and how do breaks happen? Thank you.
ABSOLUTELY AMAZING 👍🏻👍🏻. EVEN MORE IMPRESSIVE ARE PHYSICIANS LIKE MAX FEINSTEIN WHO WENT TO MEDICAL SCHOOL TO LEARN HOW TO OPERATE ALL THIS WHILE HAVING THE PATIENT IN A CONTROLLED INDUCED COMA ( if you will ) AND BRINGS THE PATIENT BACK FROM THAT STATE OF COMA TO AWAKE AND CONSCIOUSNESS, AMAZING !!
Could you perhaps do one of these for major spinal surgery (like a multi-level fusion with instrumentation for scoliosis/kyphosis), please?
I'm an IONM student and HOPE he sees this. Seriously my class was supposed to get to see our first live case back in July, but the patient got cold feet. I took my first "practice" CNIM exam today and A LOT of Max's information helped me. In the mean time if your craving spine stuff. Dr. Scott Blumenthal our the Texas Back Institute has a GREAT Cervical ADR, Jack E Zigler Anterior Lumbar Fusion. I usually watch these for fun, but mostly pre op research.