I needed several surgeries as a kid and can still remember my first experience with mask induction, as it was horrific. For 20 long seconds or so before going to sleep I felt like I was drowning and unable to communicate at all. I could feel the excitement phase you described as my heart started to race and my body started to move uncontrollably. On subsequent procedures I requested the IV experience, despite hating needles, because it beat the alternative. I really think a proper study should be done to test the assumption that mask inductions are less distressing for pediatric patients, because my own experience as well as many of the comments I'm reading here might suggest otherwise.
I agree that they should look into it. I know kids will hate needles, but they can have an iv placed whilst sitting in their parents lap, with emla cream, and be rewarded with tv or cuddles afterwards. It doesnt have to happen right in the theatre, unlike the mask where you can't do the traumatic part a little ahead of time. Obviously with toddlers that may not work, but i think it should be considered for kids like aged five up.
I prefer inhalation induction, because I have what’s called collapsing veins. I had one particular surgery when I was seven, a tonsillectomy, in which case I lost count of how many times they tried to find a a suitable vein. I kept begging for the mask, I remember that much they said I was too big. The stress I went under just to put me under, made my blood pressure spike uncontrollably on the table, and I had to be sedated for two days, following my surgery to get my blood pressure back down. Ever since then, I tell doctors about my experience, and it seems to fall on deaf ears. I have had two surgeries since that one, and both of them were traumatic as they tried to find a vein, but to no avail before finally just living with one, and then I wake up to a blown out vein, and a huge bump on my hand or arm. Every induction I’ve had, for total, using the inhalation method were pleasant, and not as stressful.
So far I’ve been given both options (for context I’m 20). I tried a mask once and it felt like I was being smothered or suffocated so never again. The iv feels natural, like ur eyelids feel heavy and u fall asleep. It wasn’t traumatizing bc it was my choice, it wasn’t forced on me.
Masking is only done for kids or mentally challenged adults. If you were an adult during surgery it was an IV anesthetic. But everyone gets oxygen via a mask before going off to sleep and they easily believe they had a mask induction but that is not accurate.
Same! They didn’t warn me that nothing would be flowing before placing the mask on my face so I started breathing like normal which caused me to feel like I was being suffocated but my arms were already strapped down and I couldn’t really tell them I was starting to panic. I have had IV induction for every other surgery (I have had 7 surgeries in my lifetime) I didn’t know there was an option between the two types that could be used nor did I ever think to ask the doc before hand which on he or she plan on using. Due to chronic knee injuries I have very little cartilage left in my knee and I’m still pretty young so as I get older I will most likely have to have a partial or complete knee replacement. Next time I go in for a surgery I will definitely be talking to them about what option they plan to use. I definitely would prefer IV. Since I have to have antibiotics anyway for all my surgeries (the way it’s been explained to me is that due to some underlying health conditions I am more vulnerable to post opp infections so they always put me on IV antibiotics before I go in for surgery. So it just makes sense to use the IV method. I have no aversion to needles because I have worked in healthcare, have been giving myself injections for emergency migraine treatment for years, and was my moms practice dummy when she went through paramedic school. I have even offered to be a practice patient for any new nurses/trainees because I don’t get freaked out. And I have very easy to stick veins so I’m prefect for newbies to get their confidence up.
That might be because bad use of the anethesia or a reaction of your body, i have been induced by mask when i was 16 yo and it was fast and not unpleasant at all
As someone who's been through the ringer as far as medically. The trauma from this mask still gives me ptsd. I have awful memories of my parents holding me down at age 6 and I was screaming while the mask was over my face.
I was three when I had surgery to put pins in my elbow. Mind you, I was pretty much hopped up on pain meds so all I remember is being put on the table and the nurse saying sweet dreams and the mask going on my face and then waking up in the PACU
I remember asking if they'll put the IV in after I'm out. They did not, and still used a mask. IVs give me bad memories, so I can understand even if I prefer maks.
@@saphiriathebluedragonknight375 unfortunately IVs are pretty mandatory for safe induction. It's just not safe to not have an IV and induce, for many many cases. Some you can avoid it for sure.
Honestly when I had my surgeries at the children hospital they used to give us numbing cream and it was an excellent way to get kids to feel comfortable with iv insertion so much so that now as an adult needle iv is my preferred method and I don’t even notice that they have even put it in
I remember that part to as someone who’s also had surgeries at Children’s before it did make a difference when they installed the IV in me m so glad they have that stuff it was easier
@@Crazyreviewer123 same here and I reckon if they offered it to adults more of them would be more willing to have an iv insertion instead of being so reluctant
@@surgeon1016 I agree, the first time I donated blood I asked for the anaesthetic, stupid really as both were needles and I didn't ever again but I'd be reassured with numbing cream if needles bothered me, plus they can be brutal placing the iv!
I’ve had many surgeries, and have long been confused between why the “preference” from mask to IV suddenly changed… Now I know, it’s just because I’m an adult, and kids tend to hate needles! I used to have to BEG my pediatric doctors to let me get anesthesia through an IV because of a terrifying experience I had with the mask as a toddler (I’m still afraid of ALL masks). I really appreciate your videos, Max!
I've had a few surgeries, some as a kid, yet never offered mask induction. Guess they thought the chronically ill kid whose had dozens of IV blood draws can handle a poke for a surgery. I always wondered why they stick you if it isn't needed. Turns out the alternative isn't unambiguously better. Masks seem a wee bit horrific, in addition to being a wee bit dangerous. I don't like needles, but if I need to get a poke, I'll do it.
2:50 In the majority of non-emergent cases, rapid induction of anesthesia is NOT NECESSARY. As for patients who become combative when undergoing induction of anesthesia but who were cooperative when they arrived, Benzodiazepines such as Valium can be administered orally in the Pre-Op ward to prevent these episodes from occurring. We must also consider the emotional and mental welfare of the patient. For those patients with Aichmophobia, the fear of needles, mask induction may be the only option. If patients with Aichmophobia are forced to undergo invasive procedures such as IV placement they may not be willing to seek out medical care in the future which could be dangerous to their safety. Further, children and those with developmental deficits may not tolerate an IV Placement, which could be dangerous to them as well as the medical professional(s) Performing the IV placement procedure. Finally, you could always place an IV once the mask induction is complete. MASK INDUCTION IS ONE EXTRA STEP. TAKE THE TIME TO CARE FOR YOUR PATIENTS MIND AS WELL AS THEIR BODY.
As someone with sensory and auditory processing disorders (both autistic spectrum disorders) as well as anxiety I’m so glad you made this video because the thought of anesthesia being induced by a mask has been absolutely terrifying to me in the past and was one of the biggest reasons why I was afraid of needing surgery but hearing that IV induction is a much more preferred option was a huge relief to me! I’m actually one of those people for which IV/needle insertion is sort of a euphoric experience and I love watching when possible as a result so I’d absolutely love that option for surgery. I have deep veins but they’re really good veins for giving blood so I can imagine that they’d also work quite well in the opposite direction (provided that they don’t infiltrate like they did whenever I tried giving platelets). Great video!
Wow! I have ASD too, but I HATE needles, and the thought of being awake as they put a nylon needle into my veins was terrifying. When the anaesthetist asked me, I said "I hate IVs, can you gas me and stick me?"
@@realdanpatterson yeah, it’s weird to me that I love it because for the most part I’m a sensory avoider with everything as apposed to a seeker but for some reason that one is the opposite for me and I’m guessing it has something to do with my proprioception and/or high pain tolerance that makes the deep pressure more pleasurable for me whereas with people who are more sensitive to pain usually have a harder time.
Still remember mask induction as a kid for dental, it was a horrible experience that's made me dread anaesthetic as an adult. I think the idea of the mask scares kids less than a needle, but based on experiences here, it's actually much scarier in practice… they just can't do anything about it at that point.
@bruh Not exactly. An IV is just put in after you are out. That happened to me a few times. Another time they put in an IV before going in, but still used a mask.
@@saphiriathebluedragonknight375 Monkey perfume… I like that! I’ll have to remember that one the next time I have to go to surgery. Even though I get an IV for anesthesia, the whole OR floor smells like that gas to me. Even at 47 I have a pretty good imagination… Maybe if I take my stuffed monkey, I can’t convince myself it’s his B.O.! LOL!
Several years ago (was considered an adult at the time…. I think), I had a procedure where they put me to sleep with mask (and I’m guessing iv anesthesia). I STILL have traumatic memories from that induction. I don’t know if they didn’t dose it right or what, but it took forever to actually go to sleep, and in the mean time, I felt completely out of body, but awake. Thankfully it did take effect fully before the procedure so I didn’t have memory of that. The next surgery I had awhile after that (I have had a lot of surgeries), I just remember getting iv anesthesia. No mask. It was almost immediate that I was out. SO much better.
I think I prefer the IV, the mask freaked me out. I had major surgery when I was a teen, I remember slowly falling asleep while having a panic attack and remember thinking "bye mom" since she was holding my hand. I recently had the IV for my wisdom teeth removal, they gave me oxygen which put me into a panic attack so I made them stop. Once they put the stuff in the IV, I blinked and the surgery was done. The only thing is I hate getting the needle on top of the hand, it hurts like mother fuka.
Ugh for my recent surgery this was the first time i was ever put under as an adult. They first tried putting the iv in my hand but it was a student nurse learning how to do it and she screwed it up so it really freakin hurt as she had to remove it and do it over the head nurse finally came over and put it in my forearm but man that hurt.
@@TheRebelAndTheGirl I think actually the forearm hurts more then the hand. I've had both for blood tests and IV's both hurt, but with they had to use a kid sized IV on me, which wasn't too bad... but man does the forearm one hurt!
Excellent video Max, thanks for making videos and increasing anesthesia awareness among the people. Next time I will suggest my patients to check out your videos if they want to know more about anesthesia.
I had terrible anesthesia anxiety due to a bad experience with a mask induction. I had a recent partial knee replacement. Having watched Max's videos helped a lot in advance and then I had a wonderful anesthesiologist. I survived without having a panic attack.
@@MaxFeinsteinMD this is slightly off the topic of this video but still medical related, have you heard of methoxyflurane ? It used to be used in very high doses for general anesthesia but was later discontinued as a general anesthesia agent because it was found to be toxic to the kidneys at anesthetic doses. Methoxyflurane is still commonly used for brief painful medical procedures and for brief temporary relief from severe pain in emergency medicine in significantly lower doses than those used for general anesthesia for example it's commonly used for the pain from badly broken bones and other traumatic injuries until paramedics can gain IV access and provide patients with longer acting pain relief. In Australia we commonly refer to the device given to patients for self administration of pain relief with methoxyflurane as the penthrox inhaler or simply the green whistle
I had a traumatic experience with anesthesia as a kid. i'd never liked masks due to undiagnosed autism/sensory issues, and the doctor told me he wouldn't use one but did at the last minute anyway. this video helped me understand why he might've done that. it makes me happy to hear how dedicated you are to children's comfort, and recognize how critical it is for them and their future treatment! my situation was an odd case, so i thought i'd talk about it so anyone here might learn from it. you can't mitigate every possible traumatic thing for a pediatric patient, but you can try your best. that's more than enough. :)
I remember the wrestling match that occurred when I had my tonsils out when I was just barely 6 years old. It took 6 large adults to hold me down in order to keep the mask over my face to put me out. And then, I got them back good. I didn't wake up when they figured I should have because they figured, with how much I fought them and how surprisingly strong skinny little old me was, they put me under way deeper than normally done. When I finally came to, I found myself with a mask on my face AGAIN (oxygen this time of course) AND my hands and feet tied down cuz they figured I was gonna go berserk again ..... which I did. Aaaaaaaand, then there was the time, 4 years later, I was gassed again when I needed some extensive dental surgery. Yet another wrestling match to put me under. So, when I had to have surgery as an adult, I told them anesthesia only by IV. I don't want to go thru the trauma of a mask on my face. IV I got to go under, but then when I woke in recovery ...... I found a full mask on my face for oxygen and the panic set in again. I just do not do well with a mask. Yeah, before you say it, I am ok with the masking for COVID.
@@tinydancer7426 jesus, i'm so sorry :( there had to be a better way to prepare you for that besides restraining you so brutally. i was held down as well, and i was already half-under so i didn't have much fight left in me. they sure as hell knew they were terrifying me though
Pediatrics would be lucky to have you, I hope you get in where you want. Not only do you have the knowledge and skill for it, but I have a feeling you've got an arsenal of cheesy jokes and fun scrub caps to get a kid smiling, laughing, and comfortable before their surgery. Thanks for another great video Max.
In the 60s, I was mask induced, twice, with ether. I was like a starfish, with five grown men holding me down 7-y.o. me. Yep, I understand the PTSD part, when anyone tries to put a mask on me now! I have vivid recollections of the post-op hallucinations, as well.
I had anesthesia through a mask as a kid, VERY traumatic for me, so much so that I was very afraid to get anesthesia 5 to 6 years later for an MRI, I got IV anesthesia for that MRI and it was so much more pleasant, I dont like needles but I cannot stand the smells from inhaling anesthesia through a mask. I feel like I can't breath and it makes me feel absolutely sick. I am speaking as someone who has cerebral palsy and autism. I have had my fair share of procedures over the years. I am now 23 years old and those bad experiences still haunt me from back when I was 10 years old 😥
Really appreciate the mention of needle phobia being a valid reason to consider mask induction in adults. I find a lot of healthcare practicioners tend to consider needle phobia an issue of maturity, and tend to not be understanding or accommodating for adults. As someone with PTSD triggered by IVs, it can be frustrating to have my issues not taken seriously as a factor to consider in administering my care. It's nice to see it mentioned as a legitimate potential concern. Also, just generally really appreciate these videos. I find them very useful, both as a student in a healthcare field, and as a patient working on desensitization therapy.
Thank you for saying all that, as someone who has had a lot of IV trauma as a child, and young adult, it is often shrugged off in the medical field as “you need to grow up. “My own daughter, that is in the medical field has even told me as such.
I've been operated on a lot. I remember distinctly being put under with a mask when I was a child. I hated the smell, the phycical sensation and it made me panic. I think I was about 8 years old when I learned that IV was an option and I asked for that instead.
As one of those extremely phobic adult patients, my friend who was my CRNA offered me mask induction. However, once she told me that she could give me a better anxiety meds through an IV, I relented and I'm thankful for that.
No need for a whole video. We simply get a new one as quickly as possible. Unless the patient’s veins are oddly difficult, it’s usually easier than getting one with the patient awaken because one of the effects of general anesthesia is venous dilation, making veins easier to spot and to advance the catheter into them.
in addition to what the other comment says, you can also administer some medication through the breathing circuit or intramuscularly while attempting to reestablish IV access!
Does IV site matter? I have almost non-visible veins on my hands and arm thus most medical staffs usually have a tough time inserting an IV needle on such sites. Can it be done on the feet or neck?
I hate the mask, it stinks and feels weird going to sleep breathing gas. Give me and if and oxygen with a nose cannula or hold let me hold the mask close to my face. Idk I must be weird but if anyone else don’t like the anesthesia mask let me know
@@mikeschulte4271 The mask used to bother me, I’ve gotten past it. If you’ve ever had an endoscopy they give you a mask with a hole and a plaice guide in it before they put you under… which is weird at first until you realize that it’s there to prevent the scope from touching your teeth.. and for some reason they have to place it before you’re sedated. Odd.
I prefer the IV in the crook of my arm , and I don't like being "slammed" into sleep. Also, I like getting something to relax me before entering the OR.
If you are going to put someone under using a mask, tell them that the medication smells horrible. Thought I was breathing vehicle exhaust so I fought it a lot.
I’ve had many surgeries in my eighteen years of being alive. I always got so nervous with the mask method and it always made me feel tingly and voices were distorted. But starting in like 2015, I started getting IV stuff and it was so much calmer and more relaxing
As a person who has gotten general anesthetic’s before. I personally do not mind both methods, but my preferred method is actually the mask. With an IV you have to find a vein and they have to put a catheter in your arm or hand. I did not really hurt. That’s when I was getting my wisdom teeth out. For ingrown toenail surgery I had the mask and this is why I would prefer the mask significantly. When the mask was on my face, I wasn’t nervous because I knew I was going to get lightheaded, and I was very familiar with feeling from when I was very little and although it freaked me out, I knew what to expect this time. So the mask is on me. And they’re just doing oxygen. No IV in my arm. And then the anesthetic slowly starts to come through and every time with that mask it calms me down, even as it starts to slowly flow through the mask. It to me smells like spray paint. And after a few inhalers, then I start getting the very strong lightheadedness. And at this point, I’m just very very relaxed. com. And with a really strong lightheadedness, losing awareness of where I was at. Voices are fading away, and my feeling is fading away, but I’m really calm through all of this. And the next thing I knew I am slowly waking up in recovery. And I’m speaking about this especially that sometimes I get seizures. I don’t know how but that mask every time has me from a little bit of shaking to really calm once the oxygen or anesthesia starts flowing through it. A big reason I’m comfortable with the mask.
I cannot do a mask the smell is a trigger and the feeling makes me anxious and have told every anesthesiologist that treats me I request IV sedation since I was 10. Last procedure nurse put a mask on for 02 and did not tell me before hand and I almost freaked out and started thrashing my head the second the mask went on. I was kinda pissed afterwards.
I had a mask induction in 1997 and had all of the terrible effects you cover. It seemed like it took forever to go out and I remember screaming and fighting to get off the table. I had a partial knee replacement last week. I shared my anxiety with the anesthesiologist. He gave the first dose of Versed in pre-op when he did the nerve block, another dose en route to OR, and started Propofol as the spinal was finished. I woke up as they moved me from table to stretcher. If I ever need another surgery I will make sure it's at a place where he is on staff.
@@TurboSpeedWiFi Technically the knee replacement was "spinal with sedation and nerve block". But I was out as soon as the laid me down from the spinal and didn't wake up until they were moving me to the stretcher (and barely at that). However having seen TH-cam videos of partial knee replacement surgeries I really didn't want to remember anything.
I'm 28 and I just got my first general anesthesia surgery a month and a half ago, and I more or less got both. the actual anesthetic was administered through IV, but they also gave me oxygen through the mask which apparently is common practice, I think it was called "pre-oxygenation". honestly if I didn't ask how they'd put me under before surgery, I wouldn't have known it was IV, because when they put the mask on me I was focused looking at the rebreather bag while the anesthesist administered the anesthetic in my arm on the other side which I couldn't see. all I remember was feeling lightheaded and next thing I know I woke up in the recovery like nothing happened. either way I'm really glad they put the mask on me because I literally didn't feel the induction until lightheadedness kicked in.
Maybe this is what I had too? I had major abdominal surgery a few years ago. I know the anesthesiologist had put a needle in my back, which was the local anasthetic to keep the majority of my torso numb even after the surgery. I had another needle too, in my arm. They injected some sedative/calming medication, which felt pretty nice to be honest. When I had laid down on the operating table I was given oxygen in a mask. Then they took it away and I think someone said that I was going to fall asleep now, then they gave the mask back and told me to breathe normally. I always thought that was the anasthesia, but maybe it was oxygen and they actually used an IV to put me to sleep. Then there was a very slow blink and when I opened my eyes again it was very bright and the surgery was over. Someone probably told me at some point what was going to happen/what exactly they were going to do but I was so nervous, I think I missed all of it. I was so cunfused when I watched this video and saw there were all these drawbacks to using a mask for anasthesia induction, I thought "Then why would they do that with me?"
The last thing I remember during TIV induction is the smell of the anaesthetic exiting my lungs just before I pass out. I did catch one doctor in a lie, tho. Just before I went under, I commented that I could smell the anaesthetic coming OUT through my lungs. "Strange", I thought, since O2 is mostly or practically odorless. Next thing I know, he said "we're giving you a little nitrous, too". Caught him in a lie just before I went under. Niiiiice! I have been induced prior to pre-ox, via IV, and didn't know about the mask. And the nurse, THAT TIME, told me the truth. It was oxygen, and pre-ox generally isn't necessary with Brevital, since it's a fast-acting and short-acting anaesthetic, and is suitable for light to moderate sedation, as well. Diprivan didn't exist back then, or it would have been a good choice for a pediatric anaesthetic.
I've been under anesthesia 4 times, twice with a mask when i was younger and twice with IV. With IV its basically like your there and then you wake up finished, all sudden with mininal feelings while going under. However with a mask you feel yourself slowly loosing consciousness to the point you cant move anything or even talk and then finally fully unconscious. I still remember it very clearly, even the "taste" of the gas :P
I made a post above, but I had one surgery with the mask that I remember. It was several years ago, but I still remember the trauma of slowly going to sleep, still feeling wide awake, but out of body and it took FOREVER. I couldn’t say anything. Had IV the next time (I don’t remember if I said anything about the previous experience) and I was OUT
The gas tastes horribly bitter and makes me feel like I am suffocating. On the EMS squad where I have worked, they also can put someone to sleep with intranasal sprays of midazolam and ketamine. I would love to learn more about that method if Dr. Feinstein offers info on it.
I was put under anesthesia using the mask induction up until I was 16 years old and got sick to the stomach almost every time but the last surgeries I had an I.V. put in and the mask was 100 percent oxygen and didn't get sick when waking up
Just a quick comment to say that you're a very good youtuber. You can keep a layperson glued to your videos. I'll assume you don't get the glory of a trauma surgeon or a ER doc, but you do a hell of a job explaining the ins and outs of anesthesia. I wish all doctors were as informative as you are. I wish you the best of luck in your career, and I sure would feel at ease with you as my anesthesiologist. I grew up kinda in the area. Colts Neck NJ so I've heard of your hospital.
My veins suck so bad I usually don’t have a choice. I’ll be put to sleep with the mask so they can place an iv in my neck or groin or when that fails a central line without me being awake whenbeing poked 20 times or more (last surgery I counted 21 sticks/tries and I was so happy I didn’t feel any of them 😅)
I am also a difficult stick person. I vividly remember the anesthesiologist taking one look at my arms and going nope we’re doing that when she’s under. I would much prefer the mask honestly.
Another very important benefit of mask induction is that the patient does not lose spontaneous ventilation, thus making it a safe choice to "take a look" at a patient airway without commiting to a full iv induction. I have used this technique in environments where there is not an appropriate difficult airway equipment like endoscopy or radiology rooms. Also, induction with sevoflorane provides a lesser degree of hemodynamic drop, which makes it a reasonable alternative for sedation procedures in elderly patients or patients with ventricular disfunction.
Interesting! A patient can certainly become apneic and no longer spontaneously ventilate with an inhalation induction. I also wouldnt want to "take a look" while they're spontaneously ventilating but with gas onboard because they could be in stage 2 and suffer a laryngospasm.
A very long time ago, I was anesthetized with ether. I told you it was a long time ago. I was about five years old. It was not a pleasant experience. First there is the awful nauseating smell and the sense of suffocating. Then there were the hallucinations along the way. I don’t recommend it. Thank goodness they don’t do that anymore. A funny part of it is the way the anesthesiologist got me to breathe it. I was struggling and pulling away, I am sure. He said,”Don’t you like that smell? Just blow it away as hard as you can.” I did. What is the next thing you do after you have blown all the air out of your lungs? Right.
5:52 one thing I will note: while pediatrics has its own issues (different physiology), the simple concern of avoiding medical trauma exists in adults as well. I also like that you mention the discomforts of a mask induction. I personally prefer IV, simply because that's what I remember getting and I don't remember anything going wrong. I also have a very high pain tolerance (courtesy of unrelated chronic health issues), and have needed a lot of blood tests growing up (for still-more unrelated health issues that have since resolved without incident), so for as long as I can remember I simply haven't given a crap about just having one IV (as long as it comes out or gets relocated *before* the vein it's in gets completely borked).
Yeah, I hear you. Some prefer ether - the bottle or the hammer - but I prefer neither. Always opt for local, whenever possible. I've even had a couple of knock-out docs tell me I made a wise choice. Hospitals will sometimes lie to their patients - especially in the ER - to wit: there is no local that we can give you to set a Colle's fracture. Bullshit. I've had other doctors offer me the option, even oral surgeons for advanced orthodontic procedures which required cutting and suturing the gumline. If I ever need a root canal, I will choose the dentist with prudence. I always joke: "What??? No Diprivan?", or "no local doc, give me Propofol!". Michael Jackson would have been proud...
@@MaxFeinsteinMD Good thing your wife is a doctor. $70k isn’t getting you far in NYC rent… I mean if you think about it… your take home probably covers the rent.
I remember my first experience with needing an IV. I was giving an oral medication and about 30 minutes later I was ready to put the IV in myself, lol. I've since gotten over the fear of needles. As per the usual, another great video! You're going to be great working with kids!
As a little kid I would’ve freaked out over the IV but if I need surgery now as a young adult I wouldn’t mind an IV. If a patient of any age had an IV started at the scene of an emergency and later needed surgery, it makes sense to use anesthesia through the IV
Mask anesthesia caused me claustrophobia!! It was a terrible experience. At one point, I almost got up from the table. Took me several mins to go under. I also had a super loud ringing as I went under. The second time around I got a procedure, the anesthesiologist put me under via IV which was INCREDIBLY LESS STRESSFUL
I have really bad anxiety around IV's and while getting my wisdom teeth out, I'm so thankful they gave me IV anesthesia. I was out like a light and didn't even realize until they were waking me up. It was definitely helpful to me to not be able to remember anything that happened besides the 5-10 minutes of just having to sit there with the IV in my arm prior to the surgeon coming in
Great info! I always ask for a I.V to put me to sleep, I don’t like the mask over my face lol! I really enjoy donating to the anesthesiologist Foundation, since it was hard for me to go to college to be a anesthesiologist physician, I really wanted to be a anesthesiologist physician! I’m working on becoming a patient advocate for Anesthesiologist! I think it takes a special person to be a anesthesiologist or CRNA! I look up to all anesthesiologist and CRNA! I have had 14 surgeries because of my cerebral palsy! I’m 33
I also have cerebral palsy and loved working in emergency and acute care medicine as an EMT-B // RN. I am awaiting a pancreas transplant, but would love to consider CRNA or AGACNP school even as a 41 year old.
Have had several general anesthesia surgeries. Getting IV is hardest part but thankfully the surgery teams are pretty good at it. I’m usually pretty chill until last minute- then I want the happy juice 😅
Hi, Dr. Feinstein Thanks for this video, I have been waiting gor this topic for a long time, I always enjoy your videos. I had a needle broke off in me when I was 13, we got our shots at school in those days, I have had an extreme needle phobia ever since and loose all control at even the sight of a needle. When you showed those needles in your video, it caused me to panic attack even though I closed my eyes the second I saw them. I also have a mask anxiety really bad, I'm ok, though, if I hold the mask while the Doctor turns the gas on. How do you handle patients like me who have extreme phobias, I also loose all control if I see restraints anywhere near me as well, sadly, I injured a nurse real bad about 6 years ago when she tried to sneak up on me to give me a needle for a bone scan. Thanks for taking the time to read my comment, your feed back is appreciated.
In 1982, I had gall bladder surgery/removal. I woke up on the table for some unknown reason. I couldn’t move my body except I could move my eyes and blink. I felt no pain. I was surprised and looked down at my body. My torso was cut open with many sponges etc and apparently I was in the middle of surgery. I could hear the doctor and nurses talking. No one was looking at me. Suddenly I heard the anesthesiologist behind me shout, “She’s coming out of it!” I felt pressure on my face by the mask then passed out. I guess they ramped up the gas. Very weird thing to have gone through. I hope it never happens again. 😬
As a 6 year old kid I was offered the choice: syringe or "the balloon". I knew what a syringe was, and that balloon sounded definitely more fun, so I opted for that. That was 42 years ago, I still remember the panic and the screaming, the nurses/assistants/whatever holding my arms and legs (while a 5th one kept the mask on) as I was suffocating in that sh*t. Never. Again. I had another surgery a few years later, I didn't hesitate.
Hi. I'm loving following your videos and learning new things. I am a Registered Nurse in Australia and I'm interested in and looking into becoming an anaesthetic technician. Could you do a video of what an anaesthetic techs role involves? Thank you so much.
Hey Max. In one of your videos about what happens before anesthesia, I thought you said the mask was used for every patient regardless of age to give them 100% oxygen since they’re apneic under Propofol. Even at 31, I’ve never liked the mask. I’m obviously not asking for medical advice, but when I’ve requested IV anesthesia instead of the mask technique, Anesthesiologists get a little irritated with me.
Pre-oxygenation is not the same as inhaled induction. Even though it’s more efficiently achieved by tightly adjusting the mask over patient’s face, we can let it be a little looser for comfort. During induction with an inhaled anesthetic it’s critical to tighten it effectively to avoid leakage, which would prolong the process and also pollute the OR air.
@@henriquelaydner4080I understand the difference between pre-oxygenation and inhaled agents. However, I thought that mask was needed regardless of which method is used, since the patient will likely not be breathing on his or her own in the induction phase
Dr Max, I see at time line 1:17 there are 7 syringes on the cart, one on the left & 6 on the right, why so many? What are they and are ao many typically required during a surgery? I understand one will be the anaesthesia used right at the start the induction I think you called it, I guess one may be the maintenance anaesthesia and one the emergence agent, what are the rest? BTW, My veins are crap, with several attempts every time to have a successful cannulation. Insertion isn't the painful part, I don't feel the prick most times, it's when they start wiggling the cannula that it hurts. Paramedics, Nurses, Doctors in ER, Anaesthesiologists all have difficulty. They have even called in Nurses from Oncology who are used to dealing with difficult veins, all same result, a number of attempts, with or without the light the shows veins or using ultrasound to guide the needle. I wish the would give me an injection of something to sedate me, then insert the cannula. I have sleep apnea, and use a machine, so probably will have no issue with a mask, though my preference is an IV for the actual anaesthesia because of the speed at which I am "knocked out".
Propofol for induction Succinylcholine for paralysis Fentanyl for pain relief Midazolam for anti anxiety Atropine for cardiac stability (avoidance of bradycardia during intubation) And I believe the yellow one is epinephrine also for cardiac regulation I don’t see it here but Sugammadex and neostigmine can be used for emergence and reversal of the paralytic. If I’m wrong on any of these then I hope Max could correct me. I’m starting medical school soon and want to be an anesthesiologist.
Left to right (colors are part of an internationally recognized labeling system): 1- 10cc syringe to inflate the endotracheal tube cuff; 2- orange is for benzodiazepines, probably midazolam, which is the most common in an anesthesia context; 3- fentanyl (blue is for opioids); 4- saline solution, used to push medication previously given (aka “wash the IV line”); 5- propofol (as an induction agent it could be labeled yellow, like etomidate and ketamine, but given it’s unique white color we usually don’t label it); 6- a neuromuscular blocking agent, probably succinylcholine, usually diluted in a 10cc syringe; 7- methadone (another opioid, hence the blue cap, but it is also labeled because the cap colors are not part of the international labeling system). Atropine and other muscarinic anticholinergic agents are labeled green. Epinephrine, ephedrine and other sympathomimetic agents are labeled violet. Reversal agents get a white label with diagonal strips colored accordingly to the drug class they’re supposed to reverse.
A sedative could be given orally or intramuscularly, but this would ensue the risk of hypoventilation, specially in a patient who already suffers from sleep apnea. This could be life threatening would the care givers not be able to ventilate your lungs properly. Safety always trumps comfort.
@@henriquelaydner4080 I understand, I just put up with the many cannulation attempts till one works. I deal with it, doesn't mean I am excited by it. IV induction of the anaesthesia is far quicker as far as time to loose awareness goes and will always be my first option if given a choice. Thanks for the previous post re the meds on the cart.
I once told a doc I'd like to self-administer the Propofol. He said "go right ahead! Knock yourself out!". It is rare, but a few docs will actually allow this today, as the dosage is already pre-meted. Sadly, I haven't had that luxury yet myself. But some docs are really cool, especially the more savvy anaesthetists. Rare today, even, as we are in a litigious society here in the USA. Cheers.
My 7 year old got gas to sleep and i was very grateful. She was prepared to get a needle as i had spoken with her to prepare her. I've only been put under with medication but I've had the mask on to administer o2 prior to rsi.
Its oddly comforting seeing people in the comments speaking about their feelings about having the mask vs. having IV induction. Being a cancer survivor, I've definitely been through many procedures that required me to be put under. I was mortified by mask-induced anesthesia because of the scent of the mask, the taste of the fumes; it made me panic every time! Even as a child, I vividly recall asking to get poked so that they can use IV induction--a LOT faster and more comfortable! Even to this day, if I think deeply enough, I can STILL smell the scent of those masks!
Hey Max, how about something quite exotic, effective, safe (and *very* expensive), namely Xe / O2 induction and / or anaesthesia? You may even go open circuit and charge the patient for the xenon gas wasted 😁.
I wish you’ve not missed the opportunity to show that, no matter how big is the needle, only it’s tip brakes the skin so the IV catheter can be introduced into the vein.
It blows my mind how nice of a doctor you are because i as a kid i hated doctors because in my country pretty much every doctor(specialist) dosent give a shit about how comfortable you are.
would love to see a IV insertion guide Max! I heard anesthesiologists are the best at starting IVs. it would be a blessing to the world to see how you approach it with your own insights
I wouldn't let a Doctor stick me with ANY needle, EVER. Once my primary care Physician said " I can give you the injection if you like" I said, " That's all right, the nurse will do it" Nurses are the ones who give the best injections.
Paramedics are 😁 as a former medic I did 15-20 ivs a day while the ambulance was moving then became a nurse I do ultrasound sound guided IVs and on my for CRNA
I have had both IV and mask. I also have terrible needle phobia. The mask induction worked wonderfully. Nice drift to sleep with IV taking over after I'd never notice. No complaints. Then I had IV conscious sedation with propofol. Some sadist knocked out the real anaesthesiologist and decided it was time to crank it to 11. Apparently I'm one of the few lucky people who don't get along with propofol and get the burning sensation. He came in, did the flush (which hurt) and snarked at my reaction. THEN began the push with "This is propofol. Most people tolerate it fine, but there are a select few who experience a burning sensation. If you're one of them, you'll feel that... NOW." Cue panic. I'm sure the nurses were so much happier when I stopped fighting and went down. AND, despite being warned I don't stay down, stopped the meds for too long during the procedure so I woke up. Not a great time.
That hat looking like brain surface makes Dr. Feinstein look like an invader from Mars! (I like my doctor to be literally open minded)😀😀😀 Jokes aside, I believe that the sight of it would make me freak out before having an operation.. I prefer hats with teddy bears or something like that.. Anyway, another great video!!
Great video. I’ve had a lot of surgery due to spina bifida. I’m 52. As a child, general anaesthesia was always induced with a mask, which I detested (I felt like I was suffocating and there was a distinctive taste). As soon as I was able, I requested iv induction and found it SO much easier. Personal preference I suppose.
I'm unsure of pediatrics encompasses, but I imagine perhaps for the older children/teenagers, explain what the differences are and what they would prefer. I always preferred to just be stuck with the iv and be done with it, rather than having the nasty tasting gas mask. ( since the iv was gonna be done with anyway, and i preferred the poke to the mask. )
I was born with a defective heart, so had lots of surgeries as a baby. Then I was okay for a few years. So when I was about 6 or so, needed a procedure done. They told me about the mask to give me sleeping gas, and let me chose the "flavor". I asked for strawberry and bubble gum mixed together, and they said sure. Nope! Noooo...I have no idea what happened, but that smell was NASTY!!! Like old, stale rubber. I happily accepted IVs after that!
I’m 19 and have been under anesthesia 12 times. The first 3 times was when I was 2 and 3 so I really only remember the last 9 times I was put under. When I was 10 I was put under laughing gas for dental work. The 8 other times I’ve been under have been for surgeries. 2 iv sedations and 6 mask sedations. The two times I was put under via iv the anesthesia going in my arm hurt extremely bad, it felt like my arm was on fire. When I woke up both times I had a massive headache and felt extremely uncomfortable. No matter what I did I couldn’t get comfortable, I couldn’t even get comfy in my own bed when I got home. When I was put to sleep via the mask, I felt really relaxed and when I woke up felt extremely sleepy but comfortable. The last few times I’ve been put under have been through both mask and iv at once, but it still turned out much better than just the iv sedation for me. It’s interesting reading all these comments about people doing better with iv sedation rather than mask sedation, but everyone’s different. For me when I wake up from a mask sedation I feel really relaxed and sleepy, when I wake up from an iv sedation I feel like I got hit by a truck.
I've done both. I was born with a bi-lateral cleft lip & palate. The mask does feel odd, and you start to overthink when the mask is on you about when you will fall asleep. The IV is seamless. I hate IV's, but if you had to choose one or the other; it would be IV.
When it comes to general anesthesia with the mask vs. IV, when I was a kid, masks felt pretty heavy. And I felt I couldn't breathe. So then I opted for the IV type of the anesthesia. But as time progresses, the people who make the masks have found a way to make them lighter and softer so that way, the patient can be put to sleep and hardly notice that the mask is even there. When I went in for the colonoscopy, they put the mask on, and turned the operating lights off. And within less than a minute, I was out like a light.
i had mask induction when i had major surgery they told me to take a deep breath the first deep breath i literally felt myself fall out of the world. Everything lost focus and i was instantly fatigued. they said "good" and told me to relax and said try my best to take another deep breath. I'm pretty sure i took a half breath and the next thing i know i had a nurse smiling at me in the recovery room. I saw no major downsides.
Are there any kind of Antianxiety gases that one can give to “take the edge off” with a mask first, then insert the IV without risk of airway compromise?
i am now a teen and have a condition hypochondra plasia and have had about 20 surgeries including 10 hour long ones and i have really hard veins and my most recent surgery and the nurses started poking me with needles about 10 time at the same time i love the mask because for me i dont need to worry about the iv this has never been a problem. please dont hate on my condition thanks
I prefer the mask. I’ve had so many procedures and surgeries in my life. I don’t like getting poked. I always try to ask if we could do the IV after I’m asleep but they always say no now.
I've had both the mask and the IV. I've gone under anaesthesia several times (I've disability since birth) and I've never had a bad experience yet. Most of the times it's been the mask and this video helped me understand why most anaesthesiologist chose to. Personally both the mask and the IV are fine. I'm more familiar with the masks so I'm not intimidated by them as I know what will happen to me. IV's are however quicker way to go to sleep. Masks are okay but the smell gets pretty strong and you can smell it even hours after the surgery. Again it all depends on the situation and the doctor. For anyone who hasn't had a anaesthesia yet, don't be scared you'll be fine. By the time you wake up you'll won't remember half of it anyways. Side note: Remember not to panic. Whenever I got under the mask the doctor would always say that if I'm feeling uncomfortable I could raise my hand to let them know, this however depends on the doctor ig
Disclaimer I’m not a medical professional so all I say may be complete bollocks. But I’m pretty sure that in some regions of the world you can actually get midazolam as a oral solution. I’m not from the states so I don’t know if it’s a thing there or not At least in my part of the world I believe it’s a pretty common practice. sevofluran is also used if you have had any signs of hypersensitivity to propofol I think
@@MaxFeinsteinMD good to know my memory didn’t fail me completely. Hihi I don’t know if it’s true But I’ve heard it’s actually just the IV solution that you drink So it’s supposed to taste really bitter because it’s not really meant for oral consumption But it does work
I'm always afraid that if I go under anesthesia, that I won't wake up, even though I've had 2 pretty serious surgies, a hysterectomy ( not the bikini cut kind ) and had my gallbladder removed. But yet I still am afraid if I have to have another surgery, that I won't wake up. Which doesn't make for an easy procedure, I will fight tooth and nail. I can't help it.
I had AFIB surgery ayr ago and need to have more surgery. I told all 3 residents and the the anesthwsia doctor not to give me opiates because I have a receptor that stops the opiates from working. I gave them all the info from the Harvard study explaining it and told them what drug to use. They all asked me questions, some read the article, and told me fine. When I woke up, later that night I was in pain and asked for pain medication. I was told they had to give me huge amounts of opiates during surgery, and couldn't have any other medication. What can I do? I have to go to the same hospital, and I did everything I know to do, (my surgeon knew) . Do you have any ideas? This surgery is much more extensive and will be more painful.
The first step is just an anaesthetic, like a surgical anaesthetic. Both have the same goal, to avoid the following procedure being torturous. It's intended to be a pain free death, at least in theory. The main issue is that a medical professional cannot carry it out. This means it's not unheard of for it to go horribly wrong, which can result in essentially torturing the victim.
Had to have an operation once for some oral surgery. Had propofol by injection, no problem. Fast forward 5 years later and now I needed an operation in Germany (US citizen). Went to a german hospital and they decided that mask/gas was the way to go. Getting knocked out went fine, but when I came out of it I have never had such a nausea and vomit fest as that afternoon. Oh well. Over now.
I can tell you I honestly have no idea if the anesthesia gas or IV meds put me to sleep 3 weeks ago. I have no idea when they even gave me Versed, but it was billed so I assume I got it. They had me taking breaths with an oxygen mask, then I recall them complaining about new monitors, the BP wouldn’t read and I was helping trying to fix it. It started working, they showed me they were putting a Peds Pulse Ox monitor on me and joked about me being a Peds RN, I saw them put my right foot into stirrups and was out. Totally fun…not. But I like the No dreams sleep 😂 Just not any of the post op stuff like ureteral stents.
If I ever match into anesthesia, I'll offer my patients a third option for being put asleep: hearing my life story 😴
LOL!
Don't worry you'll match😂
😂😂😂😂😂
It can't be that bad 😮
😂
I needed several surgeries as a kid and can still remember my first experience with mask induction, as it was horrific. For 20 long seconds or so before going to sleep I felt like I was drowning and unable to communicate at all. I could feel the excitement phase you described as my heart started to race and my body started to move uncontrollably. On subsequent procedures I requested the IV experience, despite hating needles, because it beat the alternative. I really think a proper study should be done to test the assumption that mask inductions are less distressing for pediatric patients, because my own experience as well as many of the comments I'm reading here might suggest otherwise.
I HATE the mask. I am petrified of them even on the doctors. I am hearing impaired so it's terrible
I agree that they should look into it. I know kids will hate needles, but they can have an iv placed whilst sitting in their parents lap, with emla cream, and be rewarded with tv or cuddles afterwards. It doesnt have to happen right in the theatre, unlike the mask where you can't do the traumatic part a little ahead of time. Obviously with toddlers that may not work, but i think it should be considered for kids like aged five up.
As a frequent pediatric patient, I agree with you 100%; mask induction was literally the stuff of my nightmares.
I prefer inhalation induction, because I have what’s called collapsing veins. I had one particular surgery when I was seven, a tonsillectomy, in which case I lost count of how many times they tried to find a a suitable vein. I kept begging for the mask, I remember that much they said I was too big. The stress I went under just to put me under, made my blood pressure spike uncontrollably on the table, and I had to be sedated for two days, following my surgery to get my blood pressure back down. Ever since then, I tell doctors about my experience, and it seems to fall on deaf ears. I have had two surgeries since that one, and both of them were traumatic as they tried to find a vein, but to no avail before finally just living with one, and then I wake up to a blown out vein, and a huge bump on my hand or arm. Every induction I’ve had, for total, using the inhalation method were pleasant, and not as stressful.
So far I’ve been given both options (for context I’m 20). I tried a mask once and it felt like I was being smothered or suffocated so never again. The iv feels natural, like ur eyelids feel heavy and u fall asleep. It wasn’t traumatizing bc it was my choice, it wasn’t forced on me.
Masking is only done for kids or mentally challenged adults. If you were an adult during surgery it was an IV anesthetic. But everyone gets oxygen via a mask before going off to sleep and they easily believe they had a mask induction but that is not accurate.
For me I just suddenly went black for 3 seconds
Same! They didn’t warn me that nothing would be flowing before placing the mask on my face so I started breathing like normal which caused me to feel like I was being suffocated but my arms were already strapped down and I couldn’t really tell them I was starting to panic.
I have had IV induction for every other surgery (I have had 7 surgeries in my lifetime) I didn’t know there was an option between the two types that could be used nor did I ever think to ask the doc before hand which on he or she plan on using.
Due to chronic knee injuries I have very little cartilage left in my knee and I’m still pretty young so as I get older I will most likely have to have a partial or complete knee replacement. Next time I go in for a surgery I will definitely be talking to them about what option they plan to use. I definitely would prefer IV. Since I have to have antibiotics anyway for all my surgeries (the way it’s been explained to me is that due to some underlying health conditions I am more vulnerable to post opp infections so they always put me on IV antibiotics before I go in for surgery. So it just makes sense to use the IV method. I have no aversion to needles because I have worked in healthcare, have been giving myself injections for emergency migraine treatment for years, and was my moms practice dummy when she went through paramedic school. I have even offered to be a practice patient for any new nurses/trainees because I don’t get freaked out. And I have very easy to stick veins so I’m prefect for newbies to get their confidence up.
That might be because bad use of the anethesia or a reaction of your body, i have been induced by mask when i was 16 yo and it was fast and not unpleasant at all
It could perfectly be that they didn't give you enough Oxygen
Always straight and to the point and always educational.
As someone who's been through the ringer as far as medically. The trauma from this mask still gives me ptsd. I have awful memories of my parents holding me down at age 6 and I was screaming while the mask was over my face.
Totally 💯 agree. I have major PTSD as well
I was three when I had surgery to put pins in my elbow. Mind you, I was pretty much hopped up on pain meds so all I remember is being put on the table and the nurse saying sweet dreams and the mask going on my face and then waking up in the PACU
I remember asking if they'll put the IV in after I'm out. They did not, and still used a mask. IVs give me bad memories, so I can understand even if I prefer maks.
@@saphiriathebluedragonknight375 unfortunately IVs are pretty mandatory for safe induction. It's just not safe to not have an IV and induce, for many many cases. Some you can avoid it for sure.
Honestly when I had my surgeries at the children hospital they used to give us numbing cream and it was an excellent way to get kids to feel comfortable with iv insertion so much so that now as an adult needle iv is my preferred method and I don’t even notice that they have even put it in
I remember that part to as someone who’s also had surgeries at Children’s before it did make a difference when they installed the IV in me m so glad they have that stuff it was easier
@@Crazyreviewer123 same here and I reckon if they offered it to adults more of them would be more willing to have an iv insertion instead of being so reluctant
I agree although mask is better for people that can’t deal with a Iv needle
@@surgeon1016 I agree, the first time I donated blood I asked for the anaesthetic, stupid really as both were needles and I didn't ever again but I'd be reassured with numbing cream if needles bothered me, plus they can be brutal placing the iv!
I’ve had many surgeries, and have long been confused between why the “preference” from mask to IV suddenly changed… Now I know, it’s just because I’m an adult, and kids tend to hate needles! I used to have to BEG my pediatric doctors to let me get anesthesia through an IV because of a terrifying experience I had with the mask as a toddler (I’m still afraid of ALL masks). I really appreciate your videos, Max!
Totally agree
I can totally relate. I had to leave work because of the mask 😷 issue with the pandemic
I've had a few surgeries, some as a kid, yet never offered mask induction. Guess they thought the chronically ill kid whose had dozens of IV blood draws can handle a poke for a surgery.
I always wondered why they stick you if it isn't needed. Turns out the alternative isn't unambiguously better. Masks seem a wee bit horrific, in addition to being a wee bit dangerous.
I don't like needles, but if I need to get a poke, I'll do it.
Exactly, I can take a poke, but I still dislike it.
Find the mask freaky and the feeling of closeness on the face makes me feel panicky.
2:50
In the majority of non-emergent cases, rapid induction of anesthesia is NOT NECESSARY. As for patients who become combative when undergoing induction of anesthesia but who were cooperative when they arrived, Benzodiazepines such as Valium can be administered orally in the Pre-Op ward to prevent these episodes from occurring. We must also consider the emotional and mental welfare of the patient. For those patients with Aichmophobia, the fear of needles, mask induction may be the only option. If patients with Aichmophobia are forced to undergo invasive procedures such as IV placement they may not be willing to seek out medical care in the future which could be dangerous to their safety. Further, children and those with developmental deficits may not tolerate an IV Placement, which could be dangerous to them as well as the medical professional(s) Performing the IV placement procedure. Finally, you could always place an IV once the mask induction is complete. MASK INDUCTION IS ONE EXTRA STEP. TAKE THE TIME TO CARE FOR YOUR PATIENTS MIND AS WELL AS THEIR BODY.
As someone with sensory and auditory processing disorders (both autistic spectrum disorders) as well as anxiety I’m so glad you made this video because the thought of anesthesia being induced by a mask has been absolutely terrifying to me in the past and was one of the biggest reasons why I was afraid of needing surgery but hearing that IV induction is a much more preferred option was a huge relief to me! I’m actually one of those people for which IV/needle insertion is sort of a euphoric experience and I love watching when possible as a result so I’d absolutely love that option for surgery. I have deep veins but they’re really good veins for giving blood so I can imagine that they’d also work quite well in the opposite direction (provided that they don’t infiltrate like they did whenever I tried giving platelets). Great video!
unfortunately you still get to breathe through a mask to oxygenate your blood that they have more time to start the artificial respiration.
Wow! I have ASD too, but I HATE needles, and the thought of being awake as they put a nylon needle into my veins was terrifying. When the anaesthetist asked me, I said "I hate IVs, can you gas me and stick me?"
@@realdanpatterson yeah, it’s weird to me that I love it because for the most part I’m a sensory avoider with everything as apposed to a seeker but for some reason that one is the opposite for me and I’m guessing it has something to do with my proprioception and/or high pain tolerance that makes the deep pressure more pleasurable for me whereas with people who are more sensitive to pain usually have a harder time.
@@realdanpatterson I also have autism, and hate needles. Be glad you're not on dialysis. Two needles, three times a week. IF you're lucky.
Still remember mask induction as a kid for dental, it was a horrible experience that's made me dread anaesthetic as an adult. I think the idea of the mask scares kids less than a needle, but based on experiences here, it's actually much scarier in practice… they just can't do anything about it at that point.
@bruh Not exactly. An IV is just put in after you are out. That happened to me a few times. Another time they put in an IV before going in, but still used a mask.
@bruh That it does! I remember one nurse called it monkey perfume. I can still smell it!
@@saphiriathebluedragonknight375 Monkey perfume… I like that! I’ll have to remember that one the next time I have to go to surgery. Even though I get an IV for anesthesia, the whole OR floor smells like that gas to me. Even at 47 I have a pretty good imagination… Maybe if I take my stuffed monkey, I can’t convince myself it’s his B.O.! LOL!
Several years ago (was considered an adult at the time…. I think), I had a procedure where they put me to sleep with mask (and I’m guessing iv anesthesia). I STILL have traumatic memories from that induction. I don’t know if they didn’t dose it right or what, but it took forever to actually go to sleep, and in the mean time, I felt completely out of body, but awake. Thankfully it did take effect fully before the procedure so I didn’t have memory of that. The next surgery I had awhile after that (I have had a lot of surgeries), I just remember getting iv anesthesia. No mask. It was almost immediate that I was out. SO much better.
I think I prefer the IV, the mask freaked me out. I had major surgery when I was a teen, I remember slowly falling asleep while having a panic attack and remember thinking "bye mom" since she was holding my hand. I recently had the IV for my wisdom teeth removal, they gave me oxygen which put me into a panic attack so I made them stop. Once they put the stuff in the IV, I blinked and the surgery was done. The only thing is I hate getting the needle on top of the hand, it hurts like mother fuka.
Ugh for my recent surgery this was the first time i was ever put under as an adult. They first tried putting the iv in my hand but it was a student nurse learning how to do it and she screwed it up so it really freakin hurt as she had to remove it and do it over the head nurse finally came over and put it in my forearm but man that hurt.
@@TheRebelAndTheGirl I think actually the forearm hurts more then the hand. I've had both for blood tests and IV's both hurt, but with they had to use a kid sized IV on me, which wasn't too bad... but man does the forearm one hurt!
Excellent video Max, thanks for making videos and increasing anesthesia awareness among the people. Next time I will suggest my patients to check out your videos if they want to know more about anesthesia.
Thank you Dr. Masapu!
I had terrible anesthesia anxiety due to a bad experience with a mask induction. I had a recent partial knee replacement. Having watched Max's videos helped a lot in advance and then I had a wonderful anesthesiologist. I survived without having a panic attack.
@@MaxFeinsteinMD this is slightly off the topic of this video but still medical related, have you heard of methoxyflurane ? It used to be used in very high doses for general anesthesia but was later discontinued as a general anesthesia agent because it was found to be toxic to the kidneys at anesthetic doses. Methoxyflurane is still commonly used for brief painful medical procedures and for brief temporary relief from severe pain in emergency medicine in significantly lower doses than those used for general anesthesia for example it's commonly used for the pain from badly broken bones and other traumatic injuries until paramedics can gain IV access and provide patients with longer acting pain relief. In Australia we commonly refer to the device given to patients for self administration of pain relief with methoxyflurane as the penthrox inhaler or simply the green whistle
I'm also going to specialize in pediatric anesthesia. So great to have you among our ranks, you're gonna be awesome. Caring for kids is the best!
I had a traumatic experience with anesthesia as a kid. i'd never liked masks due to undiagnosed autism/sensory issues, and the doctor told me he wouldn't use one but did at the last minute anyway. this video helped me understand why he might've done that. it makes me happy to hear how dedicated you are to children's comfort, and recognize how critical it is for them and their future treatment! my situation was an odd case, so i thought i'd talk about it so anyone here might learn from it. you can't mitigate every possible traumatic thing for a pediatric patient, but you can try your best. that's more than enough. :)
They often still use a mask to give oxygen even if they do iv
I remember the wrestling match that occurred when I had my tonsils out when I was just barely 6 years old. It took 6 large adults to hold me down in order to keep the mask over my face to put me out. And then, I got them back good. I didn't wake up when they figured I should have because they figured, with how much I fought them and how surprisingly strong skinny little old me was, they put me under way deeper than normally done. When I finally came to, I found myself with a mask on my face AGAIN (oxygen this time of course) AND my hands and feet tied down cuz they figured I was gonna go berserk again ..... which I did.
Aaaaaaaand, then there was the time, 4 years later, I was gassed again when I needed some extensive dental surgery. Yet another wrestling match to put me under.
So, when I had to have surgery as an adult, I told them anesthesia only by IV. I don't want to go thru the trauma of a mask on my face. IV I got to go under, but then when I woke in recovery ...... I found a full mask on my face for oxygen and the panic set in again.
I just do not do well with a mask. Yeah, before you say it, I am ok with the masking for COVID.
@@tinydancer7426 jesus, i'm so sorry :( there had to be a better way to prepare you for that besides restraining you so brutally. i was held down as well, and i was already half-under so i didn't have much fight left in me. they sure as hell knew they were terrifying me though
My bad experience at age 5 was they used ether . I still remember trying to pull the cloth or whatever off my face
I had several surgeries due to chronic medical conditions as a child. The worst part was screaming bloody murder because of mask inductions.
Pediatrics would be lucky to have you, I hope you get in where you want. Not only do you have the knowledge and skill for it, but I have a feeling you've got an arsenal of cheesy jokes and fun scrub caps to get a kid smiling, laughing, and comfortable before their surgery. Thanks for another great video Max.
I still have PTSD from mask induction several times as a child. I feel so much better anytime there’s an IV induction.
Absolutely agree
In the 60s, I was mask induced, twice, with ether. I was like a starfish, with five grown men holding me down 7-y.o. me. Yep, I understand the PTSD part, when anyone tries to put a mask on me now! I have vivid recollections of the post-op hallucinations, as well.
Luckily the iv only hurts a second while placing it.
I had anesthesia through a mask as a kid, VERY traumatic for me, so much so that I was very afraid to get anesthesia 5 to 6 years later for an MRI, I got IV anesthesia for that MRI and it was so much more pleasant, I dont like needles but I cannot stand the smells from inhaling anesthesia through a mask. I feel like I can't breath and it makes me feel absolutely sick. I am speaking as someone who has cerebral palsy and autism. I have had my fair share of procedures over the years. I am now 23 years old and those bad experiences still haunt me from back when I was 10 years old 😥
Really appreciate the mention of needle phobia being a valid reason to consider mask induction in adults. I find a lot of healthcare practicioners tend to consider needle phobia an issue of maturity, and tend to not be understanding or accommodating for adults. As someone with PTSD triggered by IVs, it can be frustrating to have my issues not taken seriously as a factor to consider in administering my care. It's nice to see it mentioned as a legitimate potential concern.
Also, just generally really appreciate these videos. I find them very useful, both as a student in a healthcare field, and as a patient working on desensitization therapy.
Thank you for saying all that, as someone who has had a lot of IV trauma as a child, and young adult, it is often shrugged off in the medical field as “you need to grow up. “My own daughter, that is in the medical field has even told me as such.
As bad as the stuff burns, I still prefer I.V. induction. I freak out with the mask.
I've been operated on a lot. I remember distinctly being put under with a mask when I was a child. I hated the smell, the phycical sensation and it made me panic. I think I was about 8 years old when I learned that IV was an option and I asked for that instead.
As one of those extremely phobic adult patients, my friend who was my CRNA offered me mask induction. However, once she told me that she could give me a better anxiety meds through an IV, I relented and I'm thankful for that.
@@TurboSpeedWiFi I didn't remember anything after that, so sure?
Here is a video about putting the child to sleep.
I’ve been waiting for this video !
Thank you so much 😊 ❤
Can you do a video on what you do if you lose IV access during a procedure?
No need for a whole video. We simply get a new one as quickly as possible. Unless the patient’s veins are oddly difficult, it’s usually easier than getting one with the patient awaken because one of the effects of general anesthesia is venous dilation, making veins easier to spot and to advance the catheter into them.
in addition to what the other comment says, you can also administer some medication through the breathing circuit or intramuscularly while attempting to reestablish IV access!
Does IV site matter? I have almost non-visible veins on my hands and arm thus most medical staffs usually have a tough time inserting an IV needle on such sites. Can it be done on the feet or neck?
I hate the mask, it stinks and feels weird going to sleep breathing gas. Give me and if and oxygen with a nose cannula or hold let me hold the mask close to my face. Idk I must be weird but if anyone else don’t like the anesthesia mask let me know
I don’t like the mask either it smells awful
@@surgeon1016 yea facts 😂. It stinks and I wanna go to sleep with good easy medication rather than stinky stuff.
@@mikeschulte4271 The mask used to bother me, I’ve gotten past it. If you’ve ever had an endoscopy they give you a mask with a hole and a plaice guide in it before they put you under… which is weird at first until you realize that it’s there to prevent the scope from touching your teeth.. and for some reason they have to place it before you’re sedated. Odd.
@@JimAllen-Persona yea that is odd. Never had that hopefully I don’t need that would probably freak me out a bit at first not gonna lie
It's terrifying
Cousins used to hold my nose and mouth making me pass out.
Don't give me a mask
I prefer the IV in the crook of my arm , and I don't like being "slammed" into sleep. Also, I like getting something to relax me before entering the OR.
If you are going to put someone under using a mask, tell them that the medication smells horrible. Thought I was breathing vehicle exhaust so I fought it a lot.
I’ve had many surgeries in my eighteen years of being alive. I always got so nervous with the mask method and it always made me feel tingly and voices were distorted. But starting in like 2015, I started getting IV stuff and it was so much calmer and more relaxing
As a person who has gotten general anesthetic’s before. I personally do not mind both methods, but my preferred method is actually the mask. With an IV you have to find a vein and they have to put a catheter in your arm or hand. I did not really hurt. That’s when I was getting my wisdom teeth out. For ingrown toenail surgery I had the mask and this is why I would prefer the mask significantly. When the mask was on my face, I wasn’t nervous because I knew I was going to get lightheaded, and I was very familiar with feeling from when I was very little and although it freaked me out, I knew what to expect this time. So the mask is on me. And they’re just doing oxygen. No IV in my arm. And then the anesthetic slowly starts to come through and every time with that mask it calms me down, even as it starts to slowly flow through the mask. It to me smells like spray paint. And after a few inhalers, then I start getting the very strong lightheadedness. And at this point, I’m just very very relaxed. com. And with a really strong lightheadedness, losing awareness of where I was at. Voices are fading away, and my feeling is fading away, but I’m really calm through all of this. And the next thing I knew I am slowly waking up in recovery. And I’m speaking about this especially that sometimes I get seizures. I don’t know how but that mask every time has me from a little bit of shaking to really calm once the oxygen or anesthesia starts flowing through it. A big reason I’m comfortable with the mask.
I cannot do a mask the smell is a trigger and the feeling makes me anxious and have told every anesthesiologist that treats me I request IV sedation since I was 10. Last procedure nurse put a mask on for 02 and did not tell me before hand and I almost freaked out and started thrashing my head the second the mask went on. I was kinda pissed afterwards.
I had a mask induction in 1997 and had all of the terrible effects you cover. It seemed like it took forever to go out and I remember screaming and fighting to get off the table. I had a partial knee replacement last week. I shared my anxiety with the anesthesiologist. He gave the first dose of Versed in pre-op when he did the nerve block, another dose en route to OR, and started Propofol as the spinal was finished. I woke up as they moved me from table to stretcher. If I ever need another surgery I will make sure it's at a place where he is on staff.
@@TurboSpeedWiFi Technically the knee replacement was "spinal with sedation and nerve block". But I was out as soon as the laid me down from the spinal and didn't wake up until they were moving me to the stretcher (and barely at that). However having seen TH-cam videos of partial knee replacement surgeries I really didn't want to remember anything.
You were blessed with a wonderful anaesthesiologist. I'll bet he was a real knockout, too!
I'm 28 and I just got my first general anesthesia surgery a month and a half ago, and I more or less got both. the actual anesthetic was administered through IV, but they also gave me oxygen through the mask which apparently is common practice, I think it was called "pre-oxygenation". honestly if I didn't ask how they'd put me under before surgery, I wouldn't have known it was IV, because when they put the mask on me I was focused looking at the rebreather bag while the anesthesist administered the anesthetic in my arm on the other side which I couldn't see. all I remember was feeling lightheaded and next thing I know I woke up in the recovery like nothing happened. either way I'm really glad they put the mask on me because I literally didn't feel the induction until lightheadedness kicked in.
Same for me
Maybe this is what I had too? I had major abdominal surgery a few years ago. I know the anesthesiologist had put a needle in my back, which was the local anasthetic to keep the majority of my torso numb even after the surgery. I had another needle too, in my arm. They injected some sedative/calming medication, which felt pretty nice to be honest. When I had laid down on the operating table I was given oxygen in a mask. Then they took it away and I think someone said that I was going to fall asleep now, then they gave the mask back and told me to breathe normally. I always thought that was the anasthesia, but maybe it was oxygen and they actually used an IV to put me to sleep. Then there was a very slow blink and when I opened my eyes again it was very bright and the surgery was over. Someone probably told me at some point what was going to happen/what exactly they were going to do but I was so nervous, I think I missed all of it.
I was so cunfused when I watched this video and saw there were all these drawbacks to using a mask for anasthesia induction, I thought "Then why would they do that with me?"
The last thing I remember during TIV induction is the smell of the anaesthetic exiting my lungs just before I pass out. I did catch one doctor in a lie, tho. Just before I went under, I commented that I could smell the anaesthetic coming OUT through my lungs. "Strange", I thought, since O2 is mostly or practically odorless. Next thing I know, he said "we're giving you a little nitrous, too". Caught him in a lie just before I went under. Niiiiice! I have been induced prior to pre-ox, via IV, and didn't know about the mask. And the nurse, THAT TIME, told me the truth. It was oxygen, and pre-ox generally isn't necessary with Brevital, since it's a fast-acting and short-acting anaesthetic, and is suitable for light to moderate sedation, as well. Diprivan didn't exist back then, or it would have been a good choice for a pediatric anaesthetic.
I've been under anesthesia 4 times, twice with a mask when i was younger and twice with IV. With IV its basically like your there and then you wake up finished, all sudden with mininal feelings while going under. However with a mask you feel yourself slowly loosing consciousness to the point you cant move anything or even talk and then finally fully unconscious. I still remember it very clearly, even the "taste" of the gas :P
I made a post above, but I had one surgery with the mask that I remember. It was several years ago, but I still remember the trauma of slowly going to sleep, still feeling wide awake, but out of body and it took FOREVER. I couldn’t say anything.
Had IV the next time (I don’t remember if I said anything about the previous experience) and I was OUT
The gas tastes horribly bitter and makes me feel like I am suffocating. On the EMS squad where I have worked, they also can put someone to sleep with intranasal sprays of midazolam and ketamine. I would love to learn more about that method if Dr. Feinstein offers info on it.
I was put under anesthesia using the mask induction up until I was 16 years old and got sick to the stomach almost every time but the last surgeries I had an I.V. put in and the mask was 100 percent oxygen and didn't get sick when waking up
Just a quick comment to say that you're a very good youtuber. You can keep a layperson glued to your videos. I'll assume you don't get the glory of a trauma surgeon or a ER doc, but you do a hell of a job explaining the ins and outs of anesthesia. I wish all doctors were as informative as you are.
I wish you the best of luck in your career, and I sure would feel at ease with you as my anesthesiologist. I grew up kinda in the area. Colts Neck NJ so I've heard of your hospital.
My veins suck so bad I usually don’t have a choice. I’ll be put to sleep with the mask so they can place an iv in my neck or groin or when that fails a central line without me being awake whenbeing poked 20 times or more (last surgery I counted 21 sticks/tries and I was so happy I didn’t feel any of them 😅)
Fellow difficult veins person, hello! I wrote my experience in a comment but wanted to reply and let you know you're not alone ❤️
I am also a difficult stick person. I vividly remember the anesthesiologist taking one look at my arms and going nope we’re doing that when she’s under. I would much prefer the mask honestly.
My veins are so bad that I have a mediport. I've had IO'S 7 times. Those really suck. I would definitely see if you can get a port.
Another very important benefit of mask induction is that the patient does not lose spontaneous ventilation, thus making it a safe choice to "take a look" at a patient airway without commiting to a full iv induction. I have used this technique in environments where there is not an appropriate difficult airway equipment like endoscopy or radiology rooms.
Also, induction with sevoflorane provides a lesser degree of hemodynamic drop, which makes it a reasonable alternative for sedation procedures in elderly patients or patients with ventricular disfunction.
Interesting! A patient can certainly become apneic and no longer spontaneously ventilate with an inhalation induction. I also wouldnt want to "take a look" while they're spontaneously ventilating but with gas onboard because they could be in stage 2 and suffer a laryngospasm.
You're right on both counts, great points.
A very long time ago, I was anesthetized with ether. I told you it was a long time ago. I was about five years old. It was not a pleasant experience. First there is the awful nauseating smell and the sense of suffocating. Then there were the hallucinations along the way. I don’t recommend it. Thank goodness they don’t do that anymore. A funny part of it is the way the anesthesiologist got me to breathe it. I was struggling and pulling away, I am sure. He said,”Don’t you like that smell? Just blow it away as hard as you can.” I did. What is the next thing you do after you have blown all the air out of your lungs? Right.
I'd prefer ether the bottle or the hammer. Even nitrous is no laughing matter. I prefer TIA.
This is interesting. If I wanted to become a doctor I’d go for being an anesthesiologist
5:52 one thing I will note: while pediatrics has its own issues (different physiology), the simple concern of avoiding medical trauma exists in adults as well.
I also like that you mention the discomforts of a mask induction. I personally prefer IV, simply because that's what I remember getting and I don't remember anything going wrong. I also have a very high pain tolerance (courtesy of unrelated chronic health issues), and have needed a lot of blood tests growing up (for still-more unrelated health issues that have since resolved without incident), so for as long as I can remember I simply haven't given a crap about just having one IV (as long as it comes out or gets relocated *before* the vein it's in gets completely borked).
Yeah, I hear you. Some prefer ether - the bottle or the hammer - but I prefer neither. Always opt for local, whenever possible. I've even had a couple of knock-out docs tell me I made a wise choice. Hospitals will sometimes lie to their patients - especially in the ER - to wit: there is no local that we can give you to set a Colle's fracture. Bullshit. I've had other doctors offer me the option, even oral surgeons for advanced orthodontic procedures which required cutting and suturing the gumline. If I ever need a root canal, I will choose the dentist with prudence. I always joke: "What??? No Diprivan?", or "no local doc, give me Propofol!". Michael Jackson would have been proud...
So glad to hear you are specializing in pediatrics, you will be great!!
Sir do you earn 700k dollars a year as an anesthesiologist? Plz reply. Thanks a lot.
No. I earn about 1/10 of that as a resident.
@@MaxFeinsteinMD sir after residency how much do you expect to earn as an attending doctor? Plz reply. Thanks a lot.
@@MaxFeinsteinMD Good thing your wife is a doctor. $70k isn’t getting you far in NYC rent… I mean if you think about it… your take home probably covers the rent.
You can look up the Medscape survey on anesthesiology compensation.
I remember my first experience with needing an IV. I was giving an oral medication and about 30 minutes later I was ready to put the IV in myself, lol.
I've since gotten over the fear of needles.
As per the usual, another great video! You're going to be great working with kids!
As a little kid I would’ve freaked out over the IV but if I need surgery now as a young adult I wouldn’t mind an IV. If a patient of any age had an IV started at the scene of an emergency and later needed surgery, it makes sense to use anesthesia through the IV
Mask anesthesia caused me claustrophobia!! It was a terrible experience. At one point, I almost got up from the table. Took me several mins to go under. I also had a super loud ringing as I went under. The second time around I got a procedure, the anesthesiologist put me under via IV which was INCREDIBLY LESS STRESSFUL
I tell the team, do not use a mask period if I am aware. I will fight it
I have really bad anxiety around IV's and while getting my wisdom teeth out, I'm so thankful they gave me IV anesthesia. I was out like a light and didn't even realize until they were waking me up. It was definitely helpful to me to not be able to remember anything that happened besides the 5-10 minutes of just having to sit there with the IV in my arm prior to the surgeon coming in
Great info! I always ask for a I.V to put me to sleep, I don’t like the mask over my face lol! I really enjoy donating to the anesthesiologist Foundation, since it was hard for me to go to college to be a anesthesiologist physician, I really wanted to be a anesthesiologist physician! I’m working on becoming a patient advocate for Anesthesiologist! I think it takes a special person to be a anesthesiologist or CRNA! I look up to all anesthesiologist and CRNA! I have had 14 surgeries because of my cerebral palsy! I’m 33
I also have cerebral palsy and loved working in emergency and acute care medicine as an EMT-B // RN. I am awaiting a pancreas transplant, but would love to consider CRNA or AGACNP school even as a 41 year old.
@@kgrfirdjy ok that’s cool awesome! Keep me updated! I’m 33
Have had several general anesthesia surgeries. Getting IV is hardest part but thankfully the surgery teams are pretty good at it. I’m usually pretty chill until last minute- then I want the happy juice 😅
@@TurboSpeedWiFi lose anxiety and start to be sleepy - if you've never had surgery consider yourself lucky :)
My question is why is there so much of that white liquid, kinda scary that much going in the vein and blood.
What happens in emergency surgery and the patient has had something to eat and drink in the last few hours ?
I think he may have mentioned it in a previous video somewhere, the title is escaping me right now...
They do a rapid sequence induction with cricoid pressure
Ugh. I hated using the mask as a kid for 2 tympanic membrane repairs. I remember how yuck the taste and smell was.
Hi, Dr. Feinstein
Thanks for this video, I have been waiting gor this topic for a long time, I always enjoy your videos. I had a needle broke off in me when I was 13, we got our shots at school in those days, I have had an extreme needle phobia ever since and loose all control at even the sight of a needle. When you showed those needles in your video, it caused me to panic attack even though I closed my eyes the second I saw them.
I also have a mask anxiety really bad, I'm ok, though, if I hold the mask while the Doctor turns the gas on. How do you handle patients like me who have extreme phobias, I also loose all control if I see restraints anywhere near me as well, sadly, I injured a nurse real bad about 6 years ago when she tried to sneak up on me to give me a needle for a bone scan. Thanks for taking the time to read my comment, your feed back is appreciated.
In 1982, I had gall bladder surgery/removal. I woke up on the table for some unknown reason. I couldn’t move my body except I could move my eyes and blink. I felt no pain. I was surprised and looked down at my body. My torso was cut open with many sponges etc and apparently I was in the middle of surgery. I could hear the doctor and nurses talking. No one was looking at me. Suddenly I heard the anesthesiologist behind me shout, “She’s coming out of it!” I felt pressure on my face by the mask then passed out. I guess they ramped up the gas. Very weird thing to have gone through. I hope it never happens again. 😬
As a 6 year old kid I was offered the choice: syringe or "the balloon". I knew what a syringe was, and that balloon sounded definitely more fun, so I opted for that.
That was 42 years ago, I still remember the panic and the screaming, the nurses/assistants/whatever holding my arms and legs (while a 5th one kept the mask on) as I was suffocating in that sh*t.
Never. Again. I had another surgery a few years later, I didn't hesitate.
Hi. I'm loving following your videos and learning new things. I am a Registered Nurse in Australia and I'm interested in and looking into becoming an anaesthetic technician. Could you do a video of what an anaesthetic techs role involves? Thank you so much.
Hey Max. In one of your videos about what happens before anesthesia, I thought you said the mask was used for every patient regardless of age to give them 100% oxygen since they’re apneic under Propofol. Even at 31, I’ve never liked the mask. I’m obviously not asking for medical advice, but when I’ve requested IV anesthesia instead of the mask technique, Anesthesiologists get a little irritated with me.
Pre-oxygenation is not the same as inhaled induction. Even though it’s more efficiently achieved by tightly adjusting the mask over patient’s face, we can let it be a little looser for comfort. During induction with an inhaled anesthetic it’s critical to tighten it effectively to avoid leakage, which would prolong the process and also pollute the OR air.
@@henriquelaydner4080I understand the difference between pre-oxygenation and inhaled agents. However, I thought that mask was needed regardless of which method is used, since the patient will likely not be breathing on his or her own in the induction phase
@@henriquelaydner4080I’m not a doctor nor do I plan to be. I just watch this channel because I frequently have surgeries.
I want the IV and I want versed first so I don’t remember or care what your doing
Dr Max, I see at time line 1:17 there are 7 syringes on the cart, one on the left & 6 on the right, why so many? What are they and are ao many typically required during a surgery? I understand one will be the anaesthesia used right at the start the induction I think you called it, I guess one may be the maintenance anaesthesia and one the emergence agent, what are the rest?
BTW, My veins are crap, with several attempts every time to have a successful cannulation. Insertion isn't the painful part, I don't feel the prick most times, it's when they start wiggling the cannula that it hurts. Paramedics, Nurses, Doctors in ER, Anaesthesiologists all have difficulty. They have even called in Nurses from Oncology who are used to dealing with difficult veins, all same result, a number of attempts, with or without the light the shows veins or using ultrasound to guide the needle. I wish the would give me an injection of something to sedate me, then insert the cannula. I have sleep apnea, and use a machine, so probably will have no issue with a mask, though my preference is an IV for the actual anaesthesia because of the speed at which I am "knocked out".
Propofol for induction
Succinylcholine for paralysis
Fentanyl for pain relief
Midazolam for anti anxiety
Atropine for cardiac stability (avoidance of bradycardia during intubation)
And I believe the yellow one is epinephrine also for cardiac regulation
I don’t see it here but Sugammadex and neostigmine can be used for emergence and reversal of the paralytic. If I’m wrong on any of these then I hope Max could correct me. I’m starting medical school soon and want to be an anesthesiologist.
Left to right (colors are part of an internationally recognized labeling system):
1- 10cc syringe to inflate the endotracheal tube cuff;
2- orange is for benzodiazepines, probably midazolam, which is the most common in an anesthesia context;
3- fentanyl (blue is for opioids);
4- saline solution, used to push medication previously given (aka “wash the IV line”);
5- propofol (as an induction agent it could be labeled yellow, like etomidate and ketamine, but given it’s unique white color we usually don’t label it);
6- a neuromuscular blocking agent, probably succinylcholine, usually diluted in a 10cc syringe;
7- methadone (another opioid, hence the blue cap, but it is also labeled because the cap colors are not part of the international labeling system).
Atropine and other muscarinic anticholinergic agents are labeled green.
Epinephrine, ephedrine and other sympathomimetic agents are labeled violet.
Reversal agents get a white label with diagonal strips colored accordingly to the drug class they’re supposed to reverse.
A sedative could be given orally or intramuscularly, but this would ensue the risk of hypoventilation, specially in a patient who already suffers from sleep apnea. This could be life threatening would the care givers not be able to ventilate your lungs properly. Safety always trumps comfort.
@@henriquelaydner4080 I understand, I just put up with the many cannulation attempts till one works. I deal with it, doesn't mean I am excited by it. IV induction of the anaesthesia is far quicker as far as time to loose awareness goes and will always be my first option if given a choice. Thanks for the previous post re the meds on the cart.
I once told a doc I'd like to self-administer the Propofol. He said "go right ahead! Knock yourself out!". It is rare, but a few docs will actually allow this today, as the dosage is already pre-meted. Sadly, I haven't had that luxury yet myself. But some docs are really cool, especially the more savvy anaesthetists. Rare today, even, as we are in a litigious society here in the USA. Cheers.
My 7 year old got gas to sleep and i was very grateful. She was prepared to get a needle as i had spoken with her to prepare her. I've only been put under with medication but I've had the mask on to administer o2 prior to rsi.
You’re not sticking someone with a needle! An iv is already placed so no additional sticks are needed. No midazolam!! Wrecks your memory permanently!
But the IV had to be placed at some point right 😅
Its oddly comforting seeing people in the comments speaking about their feelings about having the mask vs. having IV induction. Being a cancer survivor, I've definitely been through many procedures that required me to be put under. I was mortified by mask-induced anesthesia because of the scent of the mask, the taste of the fumes; it made me panic every time! Even as a child, I vividly recall asking to get poked so that they can use IV induction--a LOT faster and more comfortable!
Even to this day, if I think deeply enough, I can STILL smell the scent of those masks!
Hey Max, how about something quite exotic, effective, safe (and *very* expensive), namely Xe / O2 induction and / or anaesthesia? You may even go open circuit and charge the patient for the xenon gas wasted 😁.
i would also like to read dr. Feinstein's thoughts on using Xenon.
I’m scrolling through the comments and I’m so happy that I’m not the only one who has trauma with the mask and prefer an iv.
Glad i always went with IV for my surgery
I wish you’ve not missed the opportunity to show that, no matter how big is the needle, only it’s tip brakes the skin so the IV catheter can be introduced into the vein.
He did that in his video about considerations for iv size
It blows my mind how nice of a doctor you are because i as a kid i hated doctors because in my country pretty much every doctor(specialist) dosent give a shit about how comfortable you are.
would love to see a IV insertion guide Max! I heard anesthesiologists are the best at starting IVs. it would be a blessing to the world to see how you approach it with your own insights
Check his video lists, i think he made one a while ago :)
I wouldn't let a Doctor stick me with ANY needle, EVER. Once my primary care Physician said " I can give you the injection if you like" I said, " That's all right, the nurse will do it"
Nurses are the ones who give the best injections.
@@sophiasocal68 ...while I'd rather an anaestheologist do any vein... for IM's, I'll do it myself :)
Paramedics are 😁 as a former medic I did 15-20 ivs a day while the ambulance was moving then became a nurse I do ultrasound sound guided IVs and on my for CRNA
I have had both IV and mask. I also have terrible needle phobia. The mask induction worked wonderfully. Nice drift to sleep with IV taking over after I'd never notice. No complaints. Then I had IV conscious sedation with propofol. Some sadist knocked out the real anaesthesiologist and decided it was time to crank it to 11. Apparently I'm one of the few lucky people who don't get along with propofol and get the burning sensation. He came in, did the flush (which hurt) and snarked at my reaction. THEN began the push with "This is propofol. Most people tolerate it fine, but there are a select few who experience a burning sensation. If you're one of them, you'll feel that... NOW." Cue panic. I'm sure the nurses were so much happier when I stopped fighting and went down. AND, despite being warned I don't stay down, stopped the meds for too long during the procedure so I woke up. Not a great time.
That hat looking like brain surface makes Dr. Feinstein look like an invader from Mars! (I like my doctor to be literally open minded)😀😀😀 Jokes aside, I believe that the sight of it would make me freak out before having an operation.. I prefer hats with teddy bears or something like that.. Anyway, another great video!!
Great video. I’ve had a lot of surgery due to spina bifida. I’m 52. As a child, general anaesthesia was always induced with a mask, which I detested (I felt like I was suffocating and there was a distinctive taste). As soon as I was able, I requested iv induction and found it SO much easier. Personal preference I suppose.
I'm unsure of pediatrics encompasses, but I imagine perhaps for the older children/teenagers, explain what the differences are and what they would prefer. I always preferred to just be stuck with the iv and be done with it, rather than having the nasty tasting gas mask. ( since the iv was gonna be done with anyway, and i preferred the poke to the mask. )
I was born with a defective heart, so had lots of surgeries as a baby. Then I was okay for a few years. So when I was about 6 or so, needed a procedure done. They told me about the mask to give me sleeping gas, and let me chose the "flavor". I asked for strawberry and bubble gum mixed together, and they said sure.
Nope! Noooo...I have no idea what happened, but that smell was NASTY!!! Like old, stale rubber.
I happily accepted IVs after that!
I’m 19 and have been under anesthesia 12 times. The first 3 times was when I was 2 and 3 so I really only remember the last 9 times I was put under. When I was 10 I was put under laughing gas for dental work. The 8 other times I’ve been under have been for surgeries. 2 iv sedations and 6 mask sedations. The two times I was put under via iv the anesthesia going in my arm hurt extremely bad, it felt like my arm was on fire. When I woke up both times I had a massive headache and felt extremely uncomfortable. No matter what I did I couldn’t get comfortable, I couldn’t even get comfy in my own bed when I got home. When I was put to sleep via the mask, I felt really relaxed and when I woke up felt extremely sleepy but comfortable. The last few times I’ve been put under have been through both mask and iv at once, but it still turned out much better than just the iv sedation for me. It’s interesting reading all these comments about people doing better with iv sedation rather than mask sedation, but everyone’s different. For me when I wake up from a mask sedation I feel really relaxed and sleepy, when I wake up from an iv sedation I feel like I got hit by a truck.
I have a question. Would a child be able to choose what type of induction method?
It really depends on the circumstances (surgery type, anesthesiologist, child's interest, etc) so I couldn't say.
My IV's have always been done in pre-op. I remember when the "happy" drug was given. It felt like I was floating.❤
I've done both. I was born with a bi-lateral cleft lip & palate. The mask does feel odd, and you start to overthink when the mask is on you about when you will fall asleep. The IV is seamless. I hate IV's, but if you had to choose one or the other; it would be IV.
When it comes to general anesthesia with the mask vs. IV, when I was a kid, masks felt pretty heavy. And I felt I couldn't breathe. So then I opted for the IV type of the anesthesia. But as time progresses, the people who make the masks have found a way to make them lighter and softer so that way, the patient can be put to sleep and hardly notice that the mask is even there. When I went in for the colonoscopy, they put the mask on, and turned the operating lights off. And within less than a minute, I was out like a light.
Max. You are the best. The end. I hope your kind and approachable nature inspires other docs. Thanks for these videos
i had mask induction when i had major surgery they told me to take a deep breath the first deep breath i literally felt myself fall out of the world. Everything lost focus and i was instantly fatigued. they said "good" and told me to relax and said try my best to take another deep breath. I'm pretty sure i took a half breath and the next thing i know i had a nurse smiling at me in the recovery room. I saw no major downsides.
Are there any kind of Antianxiety gases that one can give to “take the edge off” with a mask first, then insert the IV without risk of airway compromise?
Nitrous oxide can be used to reduce anxiety with a low likelihood of airway compromise.
i am now a teen and have a condition hypochondra plasia and have had about 20 surgeries including 10 hour long ones and i have really hard veins and my most recent surgery and the nurses started poking me with needles about 10 time at the same time i love the mask because for me i dont need to worry about the iv this has never been a problem. please dont hate on my condition thanks
I prefer the mask. I’ve had so many procedures and surgeries in my life. I don’t like getting poked. I always try to ask if we could do the IV after I’m asleep but they always say no now.
I've had both the mask and the IV. I've gone under anaesthesia several times (I've disability since birth) and I've never had a bad experience yet. Most of the times it's been the mask and this video helped me understand why most anaesthesiologist chose to.
Personally both the mask and the IV are fine. I'm more familiar with the masks so I'm not intimidated by them as I know what will happen to me. IV's are however quicker way to go to sleep. Masks are okay but the smell gets pretty strong and you can smell it even hours after the surgery.
Again it all depends on the situation and the doctor.
For anyone who hasn't had a anaesthesia yet, don't be scared you'll be fine. By the time you wake up you'll won't remember half of it anyways.
Side note: Remember not to panic. Whenever I got under the mask the doctor would always say that if I'm feeling uncomfortable I could raise my hand to let them know, this however depends on the doctor ig
I’d love to see a video on moderate sedation cases like for a colonoscopy, TEE, etc.
Disclaimer I’m not a medical professional so all I say may be complete bollocks.
But I’m pretty sure that in some regions of the world you can actually get midazolam as a oral solution.
I’m not from the states so I don’t know if it’s a thing there or not
At least in my part of the world I believe it’s a pretty common practice.
sevofluran is also used if you have had any signs of hypersensitivity to propofol I think
Yes there is an oral formulation of midazolam
@@MaxFeinsteinMD good to know my memory didn’t fail me completely. Hihi
I don’t know if it’s true
But I’ve heard it’s actually just the IV solution that you drink
So it’s supposed to taste really bitter because it’s not really meant for oral consumption
But it does work
I'm always afraid that if I go under anesthesia, that I won't wake up, even though I've had 2 pretty serious surgies, a hysterectomy ( not the bikini cut kind ) and had my gallbladder removed. But yet I still am afraid if I have to have another surgery, that I won't wake up. Which doesn't make for an easy procedure, I will fight tooth and nail. I can't help it.
I appreciate your thoughts. I'm terrified of needles and I have been in and out of hospital.
You did a great job explaining all of these considerations Max! Thanks
I had AFIB surgery ayr ago and need to have more surgery. I told all 3 residents and the the anesthwsia doctor not to give me opiates because I have a receptor that stops the opiates from working. I gave them all the info from the Harvard study explaining it and told them what drug to use. They all asked me questions, some read the article, and told me fine. When I woke up, later that night I was in pain and asked for pain medication. I was told they had to give me huge amounts of opiates during surgery, and couldn't have any other medication. What can I do? I have to go to the same hospital, and I did everything I know to do, (my surgeon knew) . Do you have any ideas? This surgery is much more extensive and will be more painful.
Weird some of the meds are used I'm lethal injection
The first step is just an anaesthetic, like a surgical anaesthetic. Both have the same goal, to avoid the following procedure being torturous. It's intended to be a pain free death, at least in theory. The main issue is that a medical professional cannot carry it out. This means it's not unheard of for it to go horribly wrong, which can result in essentially torturing the victim.
But huffing that bubblegum gas is so lovely! I had two surgeries as a kid and that stuff smelled so damn good.
The number 1 questions I was asked as a kid for the 14 surgery's I had was " What flavour you want"? Yuck! Just smack me with a hammer.
If I'm terrorized by needles, can I have, in theory, a a blood test done while I'm under Mask anesthesia?
PROPOFOL!!! FOR induction all day, quck bolis then work with the SEVO, easier on the Lungs ! And no coughing Reflex for induction
Had to have an operation once for some oral surgery. Had propofol by injection, no problem. Fast forward 5 years later and now I needed an operation in Germany (US citizen). Went to a german hospital and they decided that mask/gas was the way to go. Getting knocked out went fine, but when I came out of it I have never had such a nausea and vomit fest as that afternoon. Oh well. Over now.
I can tell you I honestly have no idea if the anesthesia gas or IV meds put me to sleep 3 weeks ago. I have no idea when they even gave me Versed, but it was billed so I assume I got it. They had me taking breaths with an oxygen mask, then I recall them complaining about new monitors, the BP wouldn’t read and I was helping trying to fix it. It started working, they showed me they were putting a Peds Pulse Ox monitor on me and joked about me being a Peds RN, I saw them put my right foot into stirrups and was out. Totally fun…not. But I like the No dreams sleep 😂 Just not any of the post op stuff like ureteral stents.
As a child patient: please respect children who hate masks and are fine with IV.
Needles never scared me. But oh my god having to feel that process? for mask induction? shoot me.
I will take iv induction vs the nausea of gas induction. Btw. that stuff stinks.