In 12 hours, I return to the operating room to address wound infection that has developed post revision of complete tear of right rotator cuff repair. Upon “flipping off the switch” to bring me back to consciousness after surgery, apparently I flatly refused to wake up. What was once anticipated as a two-hour, out-patient minor surgery, rapidly devolved into a multi-hour, “throw it against the wall and see if it sticks” shit show, culminating in their ultimately utilizing simple Narcan to bring me back from what I thought was a lovely and refreshing little nap. I was emphatically assured it was not “refreshing in any way.” When I abruptly awoke, I was surrounded by six faces of equally concerned and even outright frightened medical professionals. To quote the surgeon, “I haven’t seen that happen in twenty years!” By day two, my limbs were so sore from apparently violently shaking while fighting the anesthesia, I could barely walk and literally required help lifting my legs back onto the bed after standing to walk/shuffle to the restroom. In short, after never before having difficulty with anesthesiology, I am literally terrified. Especially after being transferred from the CCU to my regular room only to hear the nurse say, “Oh, YOU’RE the woman they couldn’t revive after surgery!? You know, you’re kinda a legend around here now! All the anesthesiologists are terrified of you!!” I have one word before dropping into surgery again…… “Yay?!” Wish me luck. Send prayers!! 😮😮
Hope the second team understands everything from the first. It would be unnerving to hear upon wake up that your nice refreshing nap was a tense, terrifying nightmare for the doctors. Could it have been wrong opiate or too much? God bless your operation.
When I was like 5 years old I had a bad case of strep throat and hadn’t slept well in 5 days. My mom took me back to the doctor to get a mild sedative for me. For whatever reason I slept for 16 hours and my mom couldn’t wake me up. To this day we don’t know what happened.
The best advice I've been given in my anesthesia training is "no surgeon gives a shit if you're good or not at providing anesthesia, they just expect perfect operating conditions and they don't care or know what that takes". This obviously isn't completely true, but if you go completely ignored for an entire case, it's generally a really good sign.
I find that very relatable. I work in entertainment automation, and sometimes I feel self conscious sitting behind my console where I sometimes only push a few buttons a night while the rest of the production is going crazy, or when I need to hold a rehearsal for a long time just to program a basic scenic move. But when life safety is on the line, you just can't rush it. We all saw what happened in Spiderman TOTD on Broadway when production forced automation's hand. It's always best when you take your time AND stay invisible while you do it.
I had an ortho professor yell at me because the patient started shivering after their procedure was done and they were putting on a cast. The patient was on Sevoflurane 2% at the time coming down from 3%, I told the professor I increased it back up and he was like "THEN WHY IS HE STILL MOVING, DON'T JUST KEEP SAYING YES AND DO SOMETHING." An absolute twat.
About the point where many doctors have no clue what anaesthesiologists do behind the the curtain, I actually learned that the hard way. I'm an anaesthesia nurse (idk if that exists in the US but I am basically a nurse with further education in anaesthesia). So once I had to take over the monitoring of a patient during surgery because the anaesthesiologist had to leave for 5 minutes. In those 5 Minutes everything started to get kinda out of hand. The patient started moving and the surgeons (ofcourse!) complained. I "deepened" the anaesthesia right away by giving more sevofluran and also injecting some Sufenta. To my bad luck, I was too late with that and the patient started breathing against the ventilation machine. I changed the settings and had to ventilate the patient by hand. At the same time the surgeons were having a problem too as the patient started bleeding a lot. The surgeon started yelling at me (he didnt even see me trying to ventilate that patient who was almost having an laryngospasm. And I yelled "I need someone to call the anaesthesia doctor! And I need help over here!" All I needed was someone to give me some propofol! LUCKILY the doc came back and she gave me the propofol immediately. Long story short, the surgeon and his whole operating team didnt realize I was struggling because they didnt see any of what I was doing behind the curtain. My mistake: Taking over that monitoring without checking the depth of anaesthesia before the anaesthesiologist left. And I should have asked the surgery nurses who werent sterile DIRECTLY by name to help me. They could have given me the propofol as well. I mean I asked for help but they werent aware of how serious the issue was so they didn't do anything.
I was on an OR internship last week. 2 anesthesiologists (the main one and a 2nd from the other theater cause that one was more experienced) were putting in a central line during a labroscopy and the surgeons didnt even notice until way after why there were suddenly 5 people standing around the head not watching the surgery or the alarms going of like crazy when the blood pressure went below 50 systolic with an over 200 heart rate. One of the surgery nurses even told me I couldnt see anything behind the curtain .... I wouldnt call placing a central line nothing when this was literally the 3rd Lap in a row.
Sounds like you were either newish or obviously thrown into a bad situation. I do IONM and I have had several times where I get up from Camp Cadwell and kindly inform you and your friends we are getting alpha waves in our EEG and we are picking up EMG. Its a rumor IOM and Anes don’t get along. So not true, we are a team.
@@morganschiller2288 I am indeed very new, yes. But no thats not the issue. In that clinic I work in, the scrub nurses always try to hinder us anaesthesia nurses. The surgeons arent that bad here, they are pretty nice for surgeons. The scrub nurses agains anaesthesia nurses is a huge problem in germany apparently, my coworkers told me that it is in almost every clinic like that (apparently very strongly so in ours). So, no. Despite me being new, it is how it is
My dad was under anaesthesia/sedation for a week, I'm so thankful for the anaesthesiologists that worked on him whilst they were trying to get him off of sedation and ventilator. They had to try 3 times to wake him up with different anaesthetics so that he was calm when he woke up and didn't rip the feeding tubes/ventilator out. Big respect.
I'm going into surgery again in only a few weeks, and your videos are so reassuring. They make me feel much more assured that my comfort and safety are pretty much guaranteed (until recovery lol) and that I'll be in good hands. Every anaesthesia and surgical team I've met have been amazing though, even when I'm a severely anxiety riddles mess.
My anesthesiologist was the best money well spent on my last surgery. He had the most important job and got paid the least between his fee, the surgery facilities fee, and the surgeons fee. Yet he was the one who wheeled me in and out, got my heartrate and blood pressure settled down and kept me under, calm, and pain free, and kept me breathing.
@@svendbentjensen5512 For my surgery, each component was paid for separate of each other, so the surgeon had their fee and I paid them directly, the facility (here we have a hospital-like facility just for surgeries)fee got paid directly, and anesthesiologist worked for a difference place that billed me directly. It was mostly by the hour.
ophthalmology is a surgical speciality. they train in the OR, see their patients in the wards, and see consults throughout the hospital 😂. you're probably thinking of optometrists, who dispense vision correction prescriptions, provide eye care education, and can screen for and treat some eye diseases.
Some opthalmologists work in private practices and purely do things like Lasik and cataract surgery. They probably trained in hospitals but I think it's possible they have never worked in a hospital after their residency.
Ophthalmologists are eye surgeons. As a surgical tech who works directly with surgeons in the OR, I can assure you they absolutely do work in hospitals. These are the doctors you see if you have a serious injury or disease of the eye and have to have surgery. Optometrists, on the other hand, are not surgeons. They function in a very different role.
Ever since I watched a documentary called 'Scream, a history of anaesthesia' I have been fascinated by the idea that consciousness can be temporarily suspended. I enjoy medical science in general, but anaesthesia is an intersection between psychopharm, theory of mind, medical ethics and probably a dozen other things, so it is particularly engaging to me. I appreciate every person that chooses this demanding specialty, particularly here in Canada where it is not as well compensated as other countries. There, that ought to be enough complimentary commentary to get me the good stuff next time they need to konk me out, maybe even the padded mallet, have a great day!
Love this! Communication is key when performing equine anesthesia. We rely heavily on 20-30 minute warnings for end of surgery to stop CRIs of lidocaine which if not discontinued can lead to severe ataxia in recovery. We also need our heads up to give additional drugs such as acepromazine and xylazine which vastly improve recovery quality.
Thanks Max, for this very informative and helpful video. With so many lay people having questions about anesthesia, this channel is really appreciated.
I looove the anesthesiologist I had for a majority of my surgeries. He always makes sure to talk me through everything like an adult (I was quite young when I had him) and address any questions. I remember he also explained to me that I need to let other anesthesiologists know that intubation is really hard with me. Also I had terrible nightmares once under anesthesia and he asked me how it went and told me he tried a different one for me to see if it’s better. I was like OMG NOOO NEVER AGAIN!
@@looksirdroids9134 our biggest mistake is underestimating children. They know what is going on when they are going into surgery. Yes they deserve to be treated like the smart, being they are.
I’m 29 and have had 7 heart surgeries in the last 4 years. Two of those surgeries were open heart surgeries that were within a year of each other. I will need more open heart surgeries to replace my tricuspid valve when it wears out and other heart surgeries as I’m 100% dependent on my pacemaker due to 3rd degree heart block from my first open heart surgery. It all started with endocarditis from a central line (port a cath) to treat an illness. I have been taken to the OR more than 11 times in 4 years for various tests and procedures, and I had a TEE in September. They said they had a lot of trouble sedating me and ended up using general anesthesia which is why they always take me to the OR for TEEs and don’t just do them bedside like they do for other patients. Is it possible that I’ve become so tolerant to anesthesia due to all my surgeries and procedures? In my life, I’ve had over 20 surgeries and way more sedated procedures than I can count. Just curious if it’s possible to build up a tolerance to anesthesia due to frequent sedation. I also have congestive heart failure and cardiomyopathy from all my heart has been through. I’m not sure if that affects anything having to do with sedation
I'm NOT an Anesthesiologist (I'm a Scientist) but I think heart issues are one of the many list of reasons people have issue with sedation. It takes longer to sedate someone with heart issues and conscious sedation just isn't feasible in some cases. I'd take just as long to get you comfortably a sleep as it would to perform the procedure snd do general anesthesia. They also might have to use an amount of medication they aren't comfortable with using for conscious sedation for you. I have neurosarcoidosis and I have ALWAYS remembered every procedure I've had including general anesthesia. I remember them positioning my head and body (cochlear implant surgeries--first one at 12yrs old) and waking up in the OR as the removed the tube. I remember playing "footsy" when being put under general anesthesia bc I kept crossing my ankles to be comfortable and someone kept throwing my foot uncrossing it as they were putting me to sleep (I remember it was 6 times they kept moving my feet snd when I woke up the first thing I asked when the tube was removed was why did you keep moving my feet I wanted to get comfortable! I also remember them positioning my head turning it to the side for the CI surgeries. And remember them wrapping it. I had another procedure and felt EVERYTHING!! I told them it hurt and cried during the whole thing. The surgeon thankfully listened for the second time I had that procedure and prepared to increase my Fentynal to 300iu (first time they used 100iu). The 300iu worked that time but I still remember LOL just wasn't as painful. The surgeon was so excited during the follow up to tell me all the funny things she thought I wouldn't remember until I cut her off and told her I remember yall told me I needed to eat before leaving so I tired to eat the cracker but missed my mouth and landed it on my cheek snd I'd said "it won't go in my mouth". I also stripped down umm...freely in front of everyone as they attempted to take me to the bathroom so my twin sister could get me dressed LOL. They thought I wouldn't remember that either. But I do and have a logical explanation: There were no other patients back there, just the surgeon checking on me and the nursing staff so I figured they already saw everything so why can't I just strip down and get dressed here?? LOL. She was just amazed at the details I knew and me remembering WHY I did and thought what I did 🤷🏾♀️ I had an Endoscopy a few months later and told that surgeon I was very concerned bc I felt a very painful procedure previously under conscious sedation and have always been very alert with general anesthesia very quickly and Versed and Fentynal just doesn't seem to work. He laughed it off and told me I wouldn't remember snd maybe the other place didn't use enough Fentynal but he'd be using 100 and thst would definitely work. Needless to say I GAGGED violently the ENTIRE Endoscopy, felt them inside my stomach, felt the sharp pinches for the biopsies taken, and couldn't breath 3X. I "woke up" SCREAMING" hoarse in pain and crying hysterically 😭. The surgeon had already moved on to the next patient and figure I wouldn't remember anything. At the follow up I told him EVERYTHING. How when they first injected me I got the woozy feeling, closed my eyes, and then...nothing happened. I was still awake and alert. I reached up to scratch my cheek but the nurse forcefully grabbed my arm to restrain me (I suppose they thought I was reaching for the bit they put in my mouth but I just wanted to scratch my cheek thst was itching (the meds make me itchy!). Then what felt like 2mins later felt the tube go in my throat (Oh and yes they sprayed the numbing stuff right before putting me to "sleep" which also doesn't work on me) and I immediately started gagging as it turned the corner down my esophagus. Then I couldn't breath 3Xs and next felt pinching in my stomach. He explained that he did an unplanned dilation bc he had a very difficult time going down (well DUH I was gagging!!). He said he's shocked I remembered so many details. I couldn't swallow my own spit for 3 days let alone eat or drink my throat was in so much pain from thst knucklehead. THAT is why you LISTEN to your patients. Anyway fast forward I learned those who have some Neurological Disorders can be VERY difficult to sedate. For some reason our bodies do bit properly metabolism the drugs---specifically Fentynal, Versed, and some numbing agents. We can only assume my neurosarcoidosis (and RECENT HSD-hypermobility spectrum disorder) has something to do with this.
@@ndlamont01 goodness I’m so sorry you’ve been through all of that! Thankfully I don’t remember when I’ve had general anesthesia but I’ve had very traumatic endoscopies and TEEs that sound similar to you! Gagging and the doctor saying why isn’t she asleep?! Also after open heart surgeries they keep you intubated until you can breathe on your own which can be hours or days and most people don’t remember waking up with the ventilator but I for sure do. I still have nightmares of being on the ventilators after each of my open heart surgeries. I do not look forward to more surgeries because I know I’ll be conscious on the ventilator after surgery. Thanks for sharing your experiences with me!
do you regret getting that central line? Or was that entirely necessary? It honestly sounds like your body is trying really hard to die and we’re frankensteining you all up haha
@@ndlamont01 Isn't it possible to ask one of the doctors to put this "needs vastly more of the good stuff" in your file so that future doctors will take what you say more seriously?
The scariest part for me was being actually aware, I no longer had a tube or anything just those 2 prints that stick into my nose. But I felt so heavy I damn near wanted to panic until I realized I could move my feet but damn was it a moment. It's like when you have momentary sleep paralysis kinda feel.
I have had two spine patients that have had awareness. I reassured her I am running an eeg as well and if she’s aware I will know. Told em’ I am the first to know.
It’s even more amazing that they don’t do any of this stuff… if it’s not an academic training institute they are not the ones giving you anesthesia. They see you and Preop you but a Crna or an C-AA is the actual person who over sees your anesthesia
Considering my high pain tolerance from sensory processing disorder and my previous bad experience with gas as a result of that when getting my wisdom teeth out I’ve always wondered if I’d be a patient who needed more anesthesia should I ever need surgery for some reason or if I finally ever get my post weight loss skin removal surgery at some point so I’m so glad you brought this up because it answered some of my questions regarding that, great video!
I learned so much! You inspire me so much!! I always learn a lot from you!! That was very helpful! I really enjoy donating to the anesthesiologist Foundation, since it was hard for me to go to college because of my cerebral palsy!
Really good info and presented well. I require bi-annual, bilateral ureter stent placement and appreciate the not only the skills of the operating doctor but especially those of the anesthesiologist. Typically, once "under", I'm back in the recovery room within an hour and discharged to home within another.
I underwent a surgery about a month ago, and my I remember waking up in the recovery room, and the only thing I remember prior to fully coming to was the anesthesiologist saying that I would be out briefly, and then I have vague memories of the nurses asking something about antibiotics. It was a bizarre experience, but I presume that I woke fully about half an hour after the surgery had completed, under the assumption that about half an hour was spent on post-operative procedures like the dressing of the would and the placement of the wound protector around my ear afterwards. One thing I don't wish to experience again in the future is the chills I got from coming out of Anesthesia, which took more than a week to fully dissipate, but that was the only real downside I experienced as a result of the anesthesia, and mostly amounted to a week of everything feeling about 10 degrees colder than it actually was. Needless to say I was very appreciative of warm blankets for the remainder of that week.
Warm blankets in the hospital are amazing! My first experience with them was 32 years ago after an external version to reposition my oldest who was in a breech position. When the nurse offered me a warm blanket, I expected a heavy blanket that would hold my body heat close to me that I would eventually be warm … But no ! It was literally a blanket that was already warm … and OMG that was amazing!
@@looksirdroids913432 years ago those only existed for certain patients. And not every hospital had them as some states in the US are, or were, run by idiots that didn’t allow them. They used towel warmers instead.
Holy cow your job sounds complicated. The information that flows from you so easily does make it comforting to know that there are knowledgeable doctors like you out there willing to educate us.
Love your videos Max. I would like to see you make a video/videos on the 3 inhalational gasses, along with what you like and don’t like about them, and which ones you prefer for different types of procedures. It also might not be a bad idea to discuss their pungency as well, though I know that Des is too pungent and irritating for induction.
Thanks for all you and your fellow anesthesiologists due for us! Definitely couldn't have my life saving operations without you and your equipment! So far (Knock on wood) I haven't had any problems. 3 open heart surgeries were for the 3 stages of operation I needed for my Hypoplastic Left Heart Ventricle*. Another major one was an emergency surgery for blocked Cecum. The only other times have been for checkups like Cathiterization and upper Endoscopy. Also for removing my wisdom teeth. Fun times! 😏 But I'm glad for the competent skills of the team and especially the attending Anesthesiologist! 😊 *P.S. Fontan Patient. 34 years old and still going!
It may be interesting to do a video about the topic of "how to prevent patients from suffering from violent projectile vomiting during and after surgery", since literally all opioid analgesics and many anesthesia agents are able to cause intense nausea.
He's mentioned it in other videos that they do use anti-nausea meds. I remember because I'm allergic to the two most commonly used anti-nausea meds so I was very interested to hear about the other options. It might be the video where he shows all the meds he draws up and prepares before a case.
your vid was very good. When I went under in 2001 for surgery my team was awesome the Dr was able to see that I was starting to panic and they were able to give me a light sedative to keep me calm before surgery though the last words i remember saying were "ok i think i am going to panic now"lol the OR nurse claimed my first words on waking up were "just warn me before you begin" and whatever they gave me I still only remember bits and pieces of that friday and Saturday.
In an ICU setting I've taken care of a patient where they were receiving drips of 75mcg of prop (maxed), 1.5 mcg precedex (max), and 8mcg of fentanyl....and it wasnt working even though IV access was great and hemodynamically stable... would versed gtt on top of all these other sedations would be a great idea?... no PMHx just polysubstance abuse.
I used to love going under anesthetic, being an insomniac, it was my best sleep ever. Now I feel like I'm barely under, then immediately wide awake afterwards, a most unsatisfactory sleep! The worst ever was a totally silent anesthesiologist, normally they will say something, but this guy said nothing, just stared into my eyes. I felt like I was undergoing euthanasia!
I love your videos. I always learn so much. I'm a medical biller and coder and a person who has had multiple surgeries. I have always been interested in medical procedures.
wow this was extremely informative. ive had general anesthesia twice in my life (once for an endoscopy and another for a tonsillectomy) and i have to say that whatever cocktail of drugs the anesthesiologists gave me during those operations were like magic. i woke up from what i felt like was the best sleep of my life feeling extremely happy and chatty.
An anesthetist I worked with years ago in a small remote hospital and was obligated to circulate as well as be the ER Nurse, told me anesthesia was like flying a plane, danger on take off and landing, and not too much issue in between. As I watched her accidently deintubate a child during a T&A , and start screaming, I got her point, the scrub nurse got her a new tube to insert. She terrified me ever after, because of her panicked screaming.
That is a shit pour example of an anesthetist… you need to keep your calm in all situations… I’ve dealt with level 1 and level two trauma for over ten years….. anesthesia is the the captain of the ship and this person should have done better
I’m cold as ice while doing chest compressions running a code blue because that sets the tone for the rest of the OR… getting upset or panicked is the worst thing an anesthetist can do
Cool video. I didn’t realize Doctors also perceive anesthesia as an “On/Off” switch as well. When I had kidney stones a couple years back, I remember counting down from ten while breathing the stuff in, then _bam,_ I wake up suddenly and back in my room. Also, I was wondering what effect anesthesia has on the brain? Does it just prevent the brain from sending/receiving signals, or what? Or do you have another video that covers that?
Surgeons SHOULDN'T expect that, after all they too ought to want a patient that wakes up with no additional medical troubles and no unnecessary complaints. Do surgeons even normally stick around after the final stitch?
Quick question: I once heard that 2L/min flow is normally used in America and I noticed that you had that setting in your video so I was wondering if what I heard is correct. In my clinic we try to do 0,5L/min whenever possible 'cause we wanted to minimize the enviromental impact we have with our anaesthesia. Do you notice the trend to low flow anaesthesia in your hospital as well?
Hi Coffee, some anesthesiologists do prefer to use 2L/min flows when running sevoflurane in particular due to the historical concern about compound A. However this is not substantiated in human models, so modern recommendations for sevoflurane usage entail lower flows. But to answer your question, many anesthesiologists in my hospital do run low flows for the same environmental reason you cited.
Well you open yourself up to the possible accumulation of compound A…. I mean read a book dude. If you are in a non litigious country then do whatever…. You want to be fancy and try some closed circuit anesthesia… go for it But In America you can get sued for that horse shit
Thank you for these videos I’m actually having knee surgery on January 9th And I’m super nervous I watched your video on when the patient comes into the operating room for surgery and what you do to prepare them I’m just really nervous so thank you for your videos they do help because my surgeries in literally two weeks
Really good explanation about how to time emergence. It is a really tricky concept for me as a student nurse anesthetist. I will try your starting propofol at the end approach next time!!
Hey Max, loved the informative video! Have you ever had a case where you turned off the anesthetic an hour or so before the surgery is expected to get done, and then there’s a complication and you’ve had to restart the process? Would that create any complications on your end?
It's not unusual for the end of surgery to take longer than anticipated, in which case we can simply increase the dose of anesthetic agent until it's no longer needed.
One thing I'm curious about. So, here's what I remember from being under anesthesia twice (once for adenoid/tonsil removal, the other for wisdom teeth removal) It's pretty much like your consciousness is reduced to a little bubble. Nothing outside the bubble can be felt, and you're alone with your own thoughts. The deeper the anesthesia, the shallower the thoughts, but you're still present. You never completely just...dissipate. Two unique things I remember from coming out of it. The first one, for coming out of the adenoid/tonsil one: I remember that I liked the sticky blackness I was bubbled in. I wanted to go back to sleep for a bit, and did continue to kind of doze for a little bit while listening to my Mom talk with another person next to her. (I was only 8 years old.) Edit to add to the first now that I think of it hard: I remember very vaguely (like, the imagery is so fuzzy, like I wasn't entirely conscious) waking up in the operating room. I asked if everything was okay. The lady I was talking to said yes, that we were done, but she just needed me to do a couple of things for her. I remember it was so hard to think and focus on anything that I didn't like following her asking me to do things like wiggle my fingers and follow her hand with my eyes. She told me I could go back to sleep after that. My consciousness in the recovery room (what I described before the edit) was much clearer than this. The second, for the wisdom teeth. I was listening to an audiobook through earbuds with my tablet as I went under, so I could still hear the audiobook in the background, but when in the "bubble", it sounded so distant it was pretty much nonexistant, like having the TV set to the volume setting 2 or 1. I was comfortably letting my mind kind of wander at its own pace in that bubble, when suddenly I felt a sharp pain in the bottom right corner of my mouth. At first I didn't know where the pain was coming from, just that it was there...and that I didn't like it. I tried to identify where that spot was, and realized it was my mouth. In my sticky thoughts, I tried to reason out why there would be pain in my mouth. That's when the memory of what happened before I entered the "bubble" returned I realized that it must be that I was feeling the surgery. I tried to push back against that barrier keeping my consciousness in place, tried to move my mouth to yell "stop!!!" But I could not, no matter how hard I tried. Eventually I slipped back into the bubble and that awareness of what was going on dissipated, but still...it was not fun. For me, neither anesthesia experiences involved dreams...just blackness, being stuck with a bubble around your consciousness and being alone with your thoughts, slow as they may be. The reason why I'm certain I was not dreaming is because I have vivid dreams all the time. If I don't remember even a scrap of an idea from what I dreamed the night before, it unnerves me. Is the way anesthesia affects everyone different for each individual?
thats super interesting, and it must be- i went under once for my wisdom teeth, and it just felt like a videogame load screen. i was talking to the doctors, darkness took me, and then what felt like moments after my eyes opened and my whole brain was in a super thick haze. i was bleeding like crazy and remember trying to spit out all the gauze which got me reprimanded but i became alert again by the time i was home, which couldnt have been more than an hour
When I had my wisdom teeth out I woke up so quickly that I thought I was still in the operating room and nearly threw myself off the gurney jumping and yelling.
Yeah it must be different. I COMPLETELY lose myself/dissipate and it's like literally nothing, boop blackout, time blinked, I wasn't there at all for my surgeries. 9 hours passed instantly. I've had full anaesthesia and the twilight sleep for wisdom teeth. I vaguely remember that bubble you were talking about for a millisecond before falling asleep and after waking with the twilight sleep of wisdom teeth but not at all with my tonsils out. I'm wondering if they didn't give you quite enough, or something interacted with it. I've also heard genetics like red hair can make one need more anaesthesia to be fully under. Possible you might be under sensitive or need a different drug if you ever need surgery again.
@@thexenocide6013 That's interesting that we both had different experiences! I've heard that completely blacking out is the most common experience with it.
What parameters go into determining PICC or central line versus standard IV during surgery? It seems like all my long operations use the more invasive method. In Dec 22 I’ll be having another spinal fusion surgery. We saw the surgeon last week and he’s estimating 5-6 hours for surgery and then another two hours for recovery. He also commented that positioning before and during the procedure is another hour. He told my husband to expect it to be about ten hours before I’m in my hospital room.
The determination about a central line in addition to a peripheral IV is based on a number of factors including whether or not significant vasopressor use may be indicated, ICU stay is anticipated, central venous pressure needs to be monitored, and so forth. It is very uncommon for an anesthesiologist to place a PICC, as those are very high resistance central lines that aren't especially useful in the OR.
@@MaxFeinsteinMD Thank you for taking the time to respond. The last two “big” fusion surgeries used central lines. These are surgeries in excess of 5 hours. I know these spinal procedures require a lot of positioning time before and during the procedure. The last two big ones were A/P fusions, this next one is R XLIF and then PLIF with bilateral anchoring rods into my pelvis.
Thank you for the videos you make! Excellent information and great delivery. If you have a passion for teaching you would be excellent. I'm one of the lucky ones where every surgery I have, has been a great experience from the general anesthesia side. Recovery after getting home can be more of a challenge.
look them up individually in conjunction with anesthesia. answer to your example is that everything has a lethal dose, docs/pa/nps try to shy away from using that much.
@@TravisDoesGames Right, I just find it fascinating why these drugs affect other muscles but not cardiac muscle? Apparently cardiac muscle cells have "intrinsic automaticity" which means they beat without stimulation from the nervous system. At least as far as I understand it.
Recently i had a surgery under GA. It was the third time in 10 years that i go under GA. The first two operations, post OP my chest and lungs filled amazing and filled with air and i was breathing better than ever. But the last procedure was the opposite and i felt like my chest was tight and i was out of breath, even though my PO2 was almost 100, basically i was breathing far much better pre op than post op. Any ideas ?
@@BakrAli10 long story, but let me say that going to two different gyms continuously for the last one year improved my lungs, it wasn't easy. Gym 1 weight lifting, Gym 2 moderate crossfit. Four times a week.
Question: Do US Hospitals not use waking rooms close to the operating room? When I went in for surgery I woke up in a bed in a special waking room close to the operating room where personell were watching my vitals and waiting for me to wake up. It seems like this would make efficiency less of an issue even if a patient takes an hour or so to wake up.
Recently had a five hour surgery, no co-morbidities , healthy. Took me more than three hours to wake up. Released from hospital with legs that could barely support me for another few hours. Should I be concerned if future general anesthesia necessary?
@@MaxFeinsteinMD Is it possible that an anesthesiologist consultation can take place in such cases, so that if the patient is prone to such things hopefully the anesthesiologist can figure out something different, or if they can't then something like a rented powered wheelchair can be arranged?
Many hospitals have pre-surgical consultations with anesthesiologists available. Specific mobility requests like powered wheelchairs would likely be best directed to social workers.
Great video. Do you have a video about delayed emergence? Sister took about 9 hours to wake up fully. Semi conscience after four hours with fully dilated eyes and unable to speak clearly and words were gibberish for several hours. During post-op her BP dropped and they had to give her maximum oxygen. Said she was forgetting to breathe. I cannot find anything online about what happened to her.
I always wake up in the recovery room. I always wondered how they know to send me on and how long I’m in recovery before the nurse wakes me up. Still confused 😕
You wake up and are extubated in the OR, but have no memory of the fact due to amnestic (amnesia-causing) properties of the sedatives. Afterwards, you likely fall back asleep, and by the time you wake up once again in recovery, you are able to create memories, so your mind thinks that this is the first time it woke up.
@@voxov1907 thank you! That makes since. I always wondered. My last thought was the Dr saying “okay, I’m going to give you the medicine now”. Next the nurse says “ wake up, it’s time to go home” lol
I've been under twice, and the second time was a minor horror story. Back in May 2020, I had an ERCP a week after a lap choley. I woke up and was able to open my eyes just as they started to pull the breathing tube. I couldn't lift my arms and of course couldn't breathe. After a couple seconds I could lift my arm and waved at them, at which point someone said twice "You're okay (my name), youre done." They were still pulling the tube out for a second or 3 longer after that, leaving me coughing and gasping for breath. I assume the anesthesiologist screwed up pretty royally here. Though I understand that it was during Covid and all
Just recently had both of those done myself, but in reverse order. With the endo on Monday and the lap on Wednesday. The only negative I remember is that that the mask over my nose and mouth was sealed so well by the person holding it, that it was hard to exhale and that briefly freaked me out. But that’s about the last thing I remember before waking up in recovery.
@@adams303 Then why did I wake up in the recovery room after the lap choley? Noone should be making new memories of choking to death while unable to move and having a huge tube painfully reefed out of your windpipe
@@adams303 It sure is bud. You want to wake in recovery room. You don't want to be waking up and making full and clear memories with the breathing tube still fully down in your lungs and still paralyzed. And that is what happened on my second surgery.
I've only ever had 2 surgeries that I remember. Gall bladder about 15 years ago. and ACL reconstruction 3 years ago. I remember waking up in the recovery room from the gall bladder surgery. But for the ACL it was a bit weird. I remember regaining consciousness near the end of the surgery. I remember listening to the doctors talking for what seemed like a minute or two before opening my eyes just as they were applying the bandages in the surgical room.
Retired RN here. I guess 5 months ago I went to my local dermatologist. I let a lipoma grow for way too long at the base of neck... posterior. It was a good 3-4 inches in diameter. The PA says come back on x date and we'll have the dermatologist remove it. Next day the office called and said the "dermo" said I might want to see a general surgeon and go under general anesthesia to have it removed. I said HELL NO. You either do it under local or I'll find another dermo. He recovered it under local... didn't feel a thing. Nurses make the worst patients! LOL GA was over kill and that's a no for me.
I'm figuring that it's not on account of pain but other "weird" sensations that some doctors want their minor surgery patients to be put under. Some might be violently nauseated or panicked, others might not even care, being comfortable understanding what is transpiring.
Thank you Max for the videos you do. I work as an OR Tech retired and enjoyed it very much. I have a question, I have had many surgeries, two of them in particular my TKR after surgery developed low BP and respiratory arrest in the recovery room and remained in the RR due to over load in ICU. For my THR my BP dropped to 89/44 and respiration of 79. I need a LTHR soon and I am very nervous about going under after these two scares. What questions in your opinion should I ask my anesthesiologist. Thank You for your videos.
Hi Cindy, I'm glad you enjoyed the videos. I would encourage you to share you past experiences with your anesthesiologist so they can make a plan with you that will be tailored to your concerns and medical history. Best wishes for your upcoming surgery!
I had a tonsillectomy at Guys Hospital in London and never considered the existence of the anesthesiologist that put me under and carefully watched over me the entire time before hitting the "off" switch. Lol. I have this newfound gratitude for someone taking care of me that I never even knew existed before.
This is so interesting! Thanks for sharing! I do have a question. What kind of symptoms or things will you be looking for to see if a patient is becoming too light on the anesthesia?
Always very interesting Max, question, I'll do my best to phrase the question as good as I can so in many Industries you have many people highly trained highly skilled doing serious important jobs like yours, do anesthesiologists end up doing what you do in their own way or the way they like to administer different medications or do you have guidelines in the industry as to how you gauge and modify procedures? I guess what I'm asking is can different and anesthesiologists have different ways of going about their procedures in surgery or do all of you follow the procedures pretty close considering you have to keep the patient safe with the same medicines?
Good question. There are general guidelines from anesthesiological societies (like ASA, ESA, JSA, ...) that reflect the general consensus and state of medical knowledge, sometimes supplemented by hospital-internal SOPs (standard operation procedures), reflecting local preferences (like surgeons preferences, available medications, ...). Also there are country-specific laws and jurisprudence. Since you have to provide medicine according to the current state of medical knowledge you´re required to attend a minimum amount of trainings each year to keep you up to date. Your training is pretty eminence-based (meaning, you´re very likely only to be taught the preferred way of the department head to provide anesthesia), although this is slowly changing towards evidence-based, and overall your training is to teach you the aforementioned "limits" and (ideally different) ways of safely providing anesthesia. After you´ve finished your training and are certified, you´re pretty much free to do as you like as long as you stay within the aforementioned boundaries, but if you don´t actively try to learn different ways of doing things you can end up providing the same kind of anesthesia for decades (especially if you stay at the same hospital). Even if you want to change the way you´re often limited by the available tools and medications (which are preferences by the department head or due to business decisions), but you usually have at least a small selection available to adapt anesthesia to the patient. So in short: yes, there are different ways of providing anesthesia to achieve the same goal
Awesome video! I've been intrigued by anesthesia since I was a patient after a traumatic accident. I underwent 5 surgeries within a year (ENT, oral-facial, and orthopedic). The first two surgeries, I woke up in the worst pain I had ever experienced in my entire life (even more than the accident), but other surgeries I woke up very comfortable and nearly pain-free. I also know that after one surgery, my parents said I was extraordinarily angry, cussing out nurses and trying to punch my friends and family who were at my bedside (oops, sorry, I remember nothing!). Others, I was sweet and quiet, and others I was loopy / goofy / flirty.
Ive had several operations on my right foot due to a lisfranc fracture. After anesthesia I always suffer from delirium. I'm 58years old and basically for 3 or 4 days after I wake up I am completely useless I can't remember where I am who I am or why I am in hospital. This fades over 3 days and suddenly I'm back to my normal self and don't remember the missing time period. I would be interested to see a video on delerium which I understand is common in older patients.
I'm a bit of a difficult patient, but not on purpose. I always have to have more Lidocaine than expected when I go to the dentist for cavities/etc, and I woke up during eye surgery
What would interest me, to be honest is, why propofol was administered to Mr. Jackson for his insomnia. Could you give a little background on why this was even considered a therapeutic measure?
I went through a surgery under total anesthesia a few years ago, I remember they were concerned that I was taking too long to raise my oxygen levels before putting me under (I was taking deep breaths from an oxygen mask). Then the propofol went in, a little sting and good night. Later I woke up in a recovery area, in pain (but not too severe). It didn't really feel like instant time travel, but more like a deep sleep. They gave me something and reduced the pain a little. They warned me in advance that I may feel sick and vomit after waking up, but that didn't happen. Over all, it was fine.
The standard recovery room is called PACU, which stands for "post-anesthesia care unit". From there, patients either go to their room in the hospital, or to "phase 2 recovery" prior to heading home.
I have been put to sleep a couple of times. Sometimes it hurts when they are administrate propofol. Last time i got put to sleep i asked the nurse anesthetist why it hurts when propofol are administrated. They told me that they could mix Lidokain with the propofol. But i never got an answare about why it hurts. Do you know why?
My favorite quote I heard in my training was "how deep a patient is, is indirectly proportional to how anxious you feel". Essentially you need to be able to trust your gut to tell how close the patient is to waking up.
This is legitimately really interesting. Also, I'm getting a spine surgery for my scoliosis in literally 3 days. I'm mostly calm, but when I start thinking about it too much, my heart starts beating faster and I get nervous. Anyone have any tips on how to...not internally panic the day of the surgery?
@@tatyanakern3795 Alright so it’s been like- six days now. Here’s the thing. I was in the hospital for three days. My back was aching. It was so annoying. I wanted to be out of there. Third day, got to go home. THE CAR RIDE HOME WAS LIKE GOING TO HELL AND BACK. I could not figure out what position I should be in. I just reclined the seat as far back as I could. Got home, took some pain meds, felt like I was in heaven as soon as I laid on the bed…then proceeded to sob into my pillow for the next five minutes. I don’t know if maybe it was because of the pain, or if I just felt really overwhelmed or what- next few days, I take meds, walk around a little, do some exercises, eat, *take meds-* okay but honestly though, the pain is REAL. I guess it’s gotten maybe a little bit better, but still. Haven’t went to school yet. Won’t for a couple weeks, and here’s why. Walking and laying is fine, BUT SITTING FEELS HORRENDOUS. And you know, in school you have to sit for an hour and a half for every class so yeah, gonna be a bit before I feel comfortable going back to school. Also I sobbed in my pillow again yesterday- I can’t help it. The aftermath of back surgery comes with things you can’t fully expect, (like pain, and some limitations) and it’s gonna take a good while before I can feel 100%😅
@@acedreamer2004 Oh wow thanks for your answer! I'm glad that the surgery went well and you're home now. Actually, I'm surprised you mentioned school, I thought it would be at least a few months before you would even think about going back to school. But congratulations! You did it! happy to hear that you're ok (well, as ok as a person could be after a spine surgery :D) I think I would just drop dead from panic before the surgery:D
@@tatyanakern3795 Yeah it hasn’t been easy. Also yeah, about school, I legit don’t think I should be going back so early either. But I have a doctor’s appointment tomorrow so my mom and I will ask them if I should start going back to school again on Wednesday or if it’s better to wait more
Really interesting information! The more you learn about medicine, the more you realize almost everything is just poisoning the body in various amounts to get the desired effects and keeping it controlled to avoid undesired effects - like paralysis, organ damage and death. I heard that in some operations you'd use substances for medication that would basically kill the patient for cramping if not paralyzed at the same time and applied to automatic breathing device. Sounds really complicated to manage so all respect to the professionals doing it accurately for every individual with different body and conditions.
I had three hip surgeries on the same hip in a month. When I talked to the Anesthesiolgist I always liked to play the game of "I'm gonna make it from 10 to 1" I never made it to 9...
I was awake during my hand surgery and now I need a knee surgery and I’m afraid I’ll wake up again. The surgeon didn’t believe I was awake during my surgery and I told him that he was talking about his fishing trip! He apologized and said sometimes this happens. Now I’m scared. I know I take a lot of medications even for dental work to be done.
Watching your videos, I understand now that I like probably freaked some poor anesthesiologist out. 30 y/o, scheduled surgery, was supposed be out for 2 hours, ended up under for 8. Woke up in the operating room on the way out to recovery. Someone of the crew asked you're awake?? how do feel?... Response from a brain made up of jello was: "Like I'm going to be sick". Everyone stops dead for a second and is like yeah, yeah you would, and gives me something". The hospital trotted the entire team in front of me afterward to see if I remembered any of them and I'm like no why are you asking me this, is there something wrong with me, am I supposed to?? Realized that whole situation was crazy.
I had aortic valve and root replacement surgery about 6 months ago,the surgery was 12 hours long,the surgeon left me open for 2 days and in a coma for 5 days,it took me another 5 days to clear my head from the anesthesia I had vivid dreams I not sure when they started,I don’t remember the tubes in my belly or breathing tubes! Can you tell me what they had me on in the coma?
When I was a kid I had my tonsils removed. And initially the nurse was trying to find a vein in my arm. And she poked me in the wrong spot. She kept trying to find a vein. And I was crying and very upset. So they decided to give me the anesthetic gas. The nurse in the operating room was talking softly getting me to calm down. While slowly I went to sleep. When I woke up the procedure was done and they had put an iv in me while I was asleep. Now as an adult I look back and realize that they sometimes have to be creative when a kid is crying. They did what they had to do. And I was not forced to do anything. The only thing I disliked was the anesthetic gas made me nauseated post op. Not sure if that's a side effect of that stuff. But as an adult I prefer iv sedation. Assuming they can find a vein. I'm still am hard to poke. Thanks again for informing. Would be interested in a video about anesthetic gas. Not sure if u have one already
Another factor that I'm pretty sure comes into it is if a patient regularly uses opioids -- often quite legally -- because tolerance is a Thing. Please correct me if I'm wrong, but I would guess that if someone is prescribed oxycodone or hydromorphone and has built up a tolerance to that drug, they may need more fentanyl for effective anesthesia.
Im pretty sure everyone who's not an anaesthetist snoozed off during this thorough explanation. And that is actually how we induce anaesthesia in real time.
What causes a patient to have spasms and uncontrolled limb flailing as a patient is waking up from anesthesia ? How do you communicate this to one's doctor?
I'm going for a colonoscopy and endo next week. Will I be able to refuse the Propofol and only accept the Versed and Fentanyl? I don't want to be completely put under, I would like "mild/medium" sedation. My BP drops a lot when taking my home meds (Xanax-3 years, and oxycodone-1 month) So, I'm quite nervous to accept the Propofol. I don't want to die during diagnostic testing... But I must have them done. I can't take the pain, weakness, tiredness, loss of sleep, constipation/diarrhea, inability to tolerate liquids/food and severe weight loss (38 lbs in 3 months/181 to 143) much longer. I'm only 37 and extremely scared of what I'm going to be told.
May have posted (Old age has robbed me of a lot of memory). I had a HoLEP procedure 12 months ago. I had not watched such a procedure but I had watched a lot of Max's clips. They're interesting so when my anaesthetist came to see me before surgery. I asked how would he induce me (why do you want know). Is this surgery done in the Trendelenburg position? (Why are you asking). How long is the procedure? (till you wake up). The nice bit was a lovely Indian nurse holding my hand in recovery saying - it was 90 minutes. I though you'd like to know. He induced me with sevoflurane and that was magical. He tricked me a Little because I had seen Max say I always make sure the patient has a lungful of oxygen so when Dr X said take a breath for me I thought it was was going to be 02 but I slid instantly into the arms of morpheus instead.
How do you sign out the use of sevoflurane? Anesthesia records document all the other narcotics, but not seen that, the only thing recorded was %inspired and %expired minute by minute when intubated, then on CPB, no ventilation so how is anesthesia maintained without propofol or being ventilated? Or gas used documented?
there are some rare horror stories I have heard on the internet about people who were not given anesthesia correctly such that they were paralyzed but could feel pain during major surgery.... obviously I understand that these are extremely rare cases, but nonetheless haunt me.
Anesthesia awareness. I saw a documentary on it back when they showed that kind of stuff on Discovery Channel. Needless to say, when I had surgery that year, I had a panic attack.
@@ferretyluv there is a lot more to it than that, random dunce... IA doctors killing patients is the 3rd leading cause of death in the USA - the country where people pay by far the most for medical care ☝️
I just went under last week from too many years of lifting in my daily work. Never did i go under before.Anestheologist said "this (mask) is just to help you breathe a little easier". Next thing i know i am back in my room, and when i come to, i ask the nurse ,what happened are we delayed ? She laughed and said we are all done.THANKYOU Max for what you and all the other anesthesiologists do to keep us safe and PAIN free
Your videos are pretty amazing. I've been under many times in 50 years. I once asked an anesthesiologist if I slipped him a fifty, if he would juice up my dosages. He thought that was pretty unique. I don't know if he did or not, but it was free.
Great channel, one of my favorite! Also, it would be nice if you make a video on long term consequences of anesthesia. For example, I have patient who have demenita. And her dementia deteriorated rapidly after surgery. Is this a thing or just a coincidence? What surgeon should know about anesthesia before deciding whether or not perform surgery?
I’m not a doctor, but I have worked 10+ years at a SNF facility where I did notice that some dementia residents deteriorated seemingly faster than others. At least from my perspective. Also, and perhaps more relevant, I recently had to be put under twice in one week due to a misbehaving gallbladder. When comparing notes with my daughter who had had the same procedures done a few years ago… I asked her how long she thought I should expect my “post anesthesia brain fog” might last. (I’ve long joked about someday needing to be in a memory care unit, but hopefully that’s decades off yet) She told me that she did remember dealing with that brain fog, but wisely pointed out that she was 30 some years younger - relatively speaking- when she had the procedures. This was two weeks after discharge … and I was still feeling frustrated that I couldn’t find words that I knew I used to know. I’m four weeks out now, and pretty much back to my previous “normal” level of absent mindedness. My totally uneducated guess is that you might see some improvement with time, but perhaps not a full return to who they were just before the sedation. Thank you for your work, memory care residents can try your patience, but they can also be endearing as well.
Go hard on the remifentanyl and low flow the sevo, add ket to the mix and you can play with a 0.5 MAC easily. Ket has paradoxical emergence and remi also has an additive effect combined to make your 0.5 sevo equivalent to a 1+ anaestehtic. Flush the sevo at the end and hyperventilate the patient who remains apnoeic cause of the remi and then stop that too. Once they're breathing again hit em with some Alf/morphine combo. Chefs kiss. Dont have to ask about end time don't have to worry about operation duration.
It took him a long time to tell us that it’s two switches and he’d really like you to consider his feelings.
You're not wrong
Tell me you're a zoomer without telling me you're a zoomer
@@MaxFeinsteinMD YESS THATS THE CONTENT I WANT!!
In 12 hours, I return to the operating room to address wound infection that has developed post revision of complete tear of right rotator cuff repair. Upon “flipping off the switch” to bring me back to consciousness after surgery, apparently I flatly refused to wake up. What was once anticipated as a two-hour, out-patient minor surgery, rapidly devolved into a multi-hour, “throw it against the wall and see if it sticks” shit show, culminating in their ultimately utilizing simple Narcan to bring me back from what I thought was a lovely and refreshing little nap. I was emphatically assured it was not “refreshing in any way.”
When I abruptly awoke, I was surrounded by six faces of equally concerned and even outright frightened medical professionals. To quote the surgeon, “I haven’t seen that happen in twenty years!”
By day two, my limbs were so sore from apparently violently shaking while fighting the anesthesia, I could barely walk and literally required help lifting my legs back onto the bed after standing to walk/shuffle to the restroom.
In short, after never before having difficulty with anesthesiology, I am literally terrified. Especially after being transferred from the CCU to my regular room only to hear the nurse say, “Oh, YOU’RE the woman they couldn’t revive after surgery!? You know, you’re kinda a legend around here now! All the anesthesiologists are terrified of you!!”
I have one word before dropping into surgery again…… “Yay?!”
Wish me luck. Send prayers!! 😮😮
Hope the second team understands everything from the first. It would be unnerving to hear upon wake up that your nice refreshing nap was a tense, terrifying nightmare for the doctors. Could it have been wrong opiate or too much? God bless your operation.
When I was like 5 years old I had a bad case of strep throat and hadn’t slept well in 5 days. My mom took me back to the doctor to get a mild sedative for me. For whatever reason I slept for 16 hours and my mom couldn’t wake me up. To this day we don’t know what happened.
Hope your surgery went well legend
I’ve woken up during procedures and operations. Freaks them right out. I guess mine is the better option.
Did you make it through round 2? I hope you did!
The best advice I've been given in my anesthesia training is "no surgeon gives a shit if you're good or not at providing anesthesia, they just expect perfect operating conditions and they don't care or know what that takes". This obviously isn't completely true, but if you go completely ignored for an entire case, it's generally a really good sign.
I find that very relatable. I work in entertainment automation, and sometimes I feel self conscious sitting behind my console where I sometimes only push a few buttons a night while the rest of the production is going crazy, or when I need to hold a rehearsal for a long time just to program a basic scenic move. But when life safety is on the line, you just can't rush it. We all saw what happened in Spiderman TOTD on Broadway when production forced automation's hand. It's always best when you take your time AND stay invisible while you do it.
I had an ortho professor yell at me because the patient started shivering after their procedure was done and they were putting on a cast. The patient was on Sevoflurane 2% at the time coming down from 3%, I told the professor I increased it back up and he was like "THEN WHY IS HE STILL MOVING, DON'T JUST KEEP SAYING YES AND DO SOMETHING." An absolute twat.
Any IT person will tell you the same thing. If they feel like a waste of money, it means they're doing their job.
The case starts on time. The patient doesn't move. The blood is red. And they remember their names.
Just like in visual effects. If no one notices, then you've done your job well.
Same when you drive your car.
About the point where many doctors have no clue what anaesthesiologists do behind the the curtain, I actually learned that the hard way. I'm an anaesthesia nurse (idk if that exists in the US but I am basically a nurse with further education in anaesthesia). So once I had to take over the monitoring of a patient during surgery because the anaesthesiologist had to leave for 5 minutes. In those 5 Minutes everything started to get kinda out of hand.
The patient started moving and the surgeons (ofcourse!) complained. I "deepened" the anaesthesia right away by giving more sevofluran and also injecting some Sufenta. To my bad luck, I was too late with that and the patient started breathing against the ventilation machine. I changed the settings and had to ventilate the patient by hand. At the same time the surgeons were having a problem too as the patient started bleeding a lot. The surgeon started yelling at me (he didnt even see me trying to ventilate that patient who was almost having an laryngospasm. And I yelled "I need someone to call the anaesthesia doctor! And I need help over here!" All I needed was someone to give me some propofol! LUCKILY the doc came back and she gave me the propofol immediately.
Long story short, the surgeon and his whole operating team didnt realize I was struggling because they didnt see any of what I was doing behind the curtain.
My mistake: Taking over that monitoring without checking the depth of anaesthesia before the anaesthesiologist left. And I should have asked the surgery nurses who werent sterile DIRECTLY by name to help me. They could have given me the propofol as well. I mean I asked for help but they werent aware of how serious the issue was so they didn't do anything.
I was on an OR internship last week. 2 anesthesiologists (the main one and a 2nd from the other theater cause that one was more experienced) were putting in a central line during a labroscopy and the surgeons didnt even notice until way after why there were suddenly 5 people standing around the head not watching the surgery or the alarms going of like crazy when the blood pressure went below 50 systolic with an over 200 heart rate. One of the surgery nurses even told me I couldnt see anything behind the curtain .... I wouldnt call placing a central line nothing when this was literally the 3rd Lap in a row.
That sounded so stressful but i guess it gives a really good learning experience in a way
Sounds like you were either newish or obviously thrown into a bad situation. I do IONM and I have had several times where I get up from Camp Cadwell and kindly inform you and your friends we are getting alpha waves in our EEG and we are picking up EMG. Its a rumor IOM and Anes don’t get along. So not true, we are a team.
@@morganschiller2288 I am indeed very new, yes. But no thats not the issue. In that clinic I work in, the scrub nurses always try to hinder us anaesthesia nurses. The surgeons arent that bad here, they are pretty nice for surgeons. The scrub nurses agains anaesthesia nurses is a huge problem in germany apparently, my coworkers told me that it is in almost every clinic like that (apparently very strongly so in ours).
So, no. Despite me being new, it is how it is
@@nyx9924 NyX
Being put under is the closest thing to time travel, it was like blinking my eyes and jumping forward 4 hours
I took a 30 day "trip" on anesthesia once.
My dad was under anaesthesia/sedation for a week, I'm so thankful for the anaesthesiologists that worked on him whilst they were trying to get him off of sedation and ventilator. They had to try 3 times to wake him up with different anaesthetics so that he was calm when he woke up and didn't rip the feeding tubes/ventilator out. Big respect.
Was he in a medically induced coma?
@@saphiriathebluedragonknight375 All general anaesthesia is a medically induced coma.
I'm going into surgery again in only a few weeks, and your videos are so reassuring. They make me feel much more assured that my comfort and safety are pretty much guaranteed (until recovery lol) and that I'll be in good hands. Every anaesthesia and surgical team I've met have been amazing though, even when I'm a severely anxiety riddles mess.
My anesthesiologist was the best money well spent on my last surgery. He had the most important job and got paid the least between his fee, the surgery facilities fee, and the surgeons fee. Yet he was the one who wheeled me in and out, got my heartrate and blood pressure settled down and kept me under, calm, and pain free, and kept me breathing.
How do you know the individual doctor's fees?
@@ATOMIC_V_8 Bill from a hospital?
@@svendbentjensen5512 For my surgery, each component was paid for separate of each other, so the surgeon had their fee and I paid them directly, the facility (here we have a hospital-like facility just for surgeries)fee got paid directly, and anesthesiologist worked for a difference place that billed me directly. It was mostly by the hour.
@@PatrickDKing how much was the difference between the surgeon's and the anesthesiologist's fees?
I'm impressed with how accurate Dr. Glaucomfleckens videos are considering he's an ophthalmologist and probably doesn't work in a hospital
ophthalmology is a surgical speciality. they train in the OR, see their patients in the wards, and see consults throughout the hospital 😂. you're probably thinking of optometrists, who dispense vision correction prescriptions, provide eye care education, and can screen for and treat some eye diseases.
Some opthalmologists work in private practices and purely do things like Lasik and cataract surgery. They probably trained in hospitals but I think it's possible they have never worked in a hospital after their residency.
Ophthalmologists are eye surgeons. As a surgical tech who works directly with surgeons in the OR, I can assure you they absolutely do work in hospitals. These are the doctors you see if you have a serious injury or disease of the eye and have to have surgery.
Optometrists, on the other hand, are not surgeons. They function in a very different role.
@@polarberri yeah who do you think operates on eyes during traumas, eye tumors, eye diseases, etc?
@Whitney I mean you might not SEE them very well until after surgery..
I had an 11 Hour operation and I'm dam thankful to people like you that spent your lives studying and perfecting your craft to take care of us!
Ever since I watched a documentary called 'Scream, a history of anaesthesia' I have been fascinated by the idea that consciousness can be temporarily suspended. I enjoy medical science in general, but anaesthesia is an intersection between psychopharm, theory of mind, medical ethics and probably a dozen other things, so it is particularly engaging to me. I appreciate every person that chooses this demanding specialty, particularly here in Canada where it is not as well compensated as other countries.
There, that ought to be enough complimentary commentary to get me the good stuff next time they need to konk me out, maybe even the padded mallet, have a great day!
Right? Isn't it fascinating, the overlap between science, medicine, neurology and spirituality/soul consciousness?
No
@@svendbentjensen5512 Cheese sandwich.
Love this! Communication is key when performing equine anesthesia. We rely heavily on 20-30 minute warnings for end of surgery to stop CRIs of lidocaine which if not discontinued can lead to severe ataxia in recovery. We also need our heads up to give additional drugs such as acepromazine and xylazine which vastly improve recovery quality.
that's horse sense
Who let the horse doctor in?
I did a shit ton of anesthesia on sheep during grad school… veterinary anesthesia is primitive at best
Shit I was still using halothane when I did vet med
Because it was cheaper
Thanks Max, for this very informative and helpful video. With so many lay people having questions about anesthesia, this channel is really appreciated.
I looove the anesthesiologist I had for a majority of my surgeries. He always makes sure to talk me through everything like an adult (I was quite young when I had him) and address any questions. I remember he also explained to me that I need to let other anesthesiologists know that intubation is really hard with me.
Also I had terrible nightmares once under anesthesia and he asked me how it went and told me he tried a different one for me to see if it’s better. I was like OMG NOOO NEVER AGAIN!
It isn't a good idea to talk to children like they're adults on account of children not being adults.
@@looksirdroids9134 our biggest mistake is underestimating children. They know what is going on when they are going into surgery. Yes they deserve to be treated like the smart, being they are.
I’m 29 and have had 7 heart surgeries in the last 4 years. Two of those surgeries were open heart surgeries that were within a year of each other. I will need more open heart surgeries to replace my tricuspid valve when it wears out and other heart surgeries as I’m 100% dependent on my pacemaker due to 3rd degree heart block from my first open heart surgery. It all started with endocarditis from a central line (port a cath) to treat an illness. I have been taken to the OR more than 11 times in 4 years for various tests and procedures, and I had a TEE in September. They said they had a lot of trouble sedating me and ended up using general anesthesia which is why they always take me to the OR for TEEs and don’t just do them bedside like they do for other patients. Is it possible that I’ve become so tolerant to anesthesia due to all my surgeries and procedures? In my life, I’ve had over 20 surgeries and way more sedated procedures than I can count. Just curious if it’s possible to build up a tolerance to anesthesia due to frequent sedation. I also have congestive heart failure and cardiomyopathy from all my heart has been through. I’m not sure if that affects anything having to do with sedation
I'm NOT an Anesthesiologist (I'm a Scientist) but I think heart issues are one of the many list of reasons people have issue with sedation. It takes longer to sedate someone with heart issues and conscious sedation just isn't feasible in some cases. I'd take just as long to get you comfortably a sleep as it would to perform the procedure snd do general anesthesia. They also might have to use an amount of medication they aren't comfortable with using for conscious sedation for you.
I have neurosarcoidosis and I have ALWAYS remembered every procedure I've had including general anesthesia. I remember them positioning my head and body (cochlear implant surgeries--first one at 12yrs old) and waking up in the OR as the removed the tube. I remember playing "footsy" when being put under general anesthesia bc I kept crossing my ankles to be comfortable and someone kept throwing my foot uncrossing it as they were putting me to sleep (I remember it was 6 times they kept moving my feet snd when I woke up the first thing I asked when the tube was removed was why did you keep moving my feet I wanted to get comfortable! I also remember them positioning my head turning it to the side for the CI surgeries. And remember them wrapping it.
I had another procedure and felt EVERYTHING!! I told them it hurt and cried during the whole thing. The surgeon thankfully listened for the second time I had that procedure and prepared to increase my Fentynal to 300iu (first time they used 100iu). The 300iu worked that time but I still remember LOL just wasn't as painful. The surgeon was so excited during the follow up to tell me all the funny things she thought I wouldn't remember until I cut her off and told her I remember yall told me I needed to eat before leaving so I tired to eat the cracker but missed my mouth and landed it on my cheek snd I'd said "it won't go in my mouth". I also stripped down umm...freely in front of everyone as they attempted to take me to the bathroom so my twin sister could get me dressed LOL. They thought I wouldn't remember that either. But I do and have a logical explanation: There were no other patients back there, just the surgeon checking on me and the nursing staff so I figured they already saw everything so why can't I just strip down and get dressed here?? LOL. She was just amazed at the details I knew and me remembering WHY I did and thought what I did 🤷🏾♀️
I had an Endoscopy a few months later and told that surgeon I was very concerned bc I felt a very painful procedure previously under conscious sedation and have always been very alert with general anesthesia very quickly and Versed and Fentynal just doesn't seem to work. He laughed it off and told me I wouldn't remember snd maybe the other place didn't use enough Fentynal but he'd be using 100 and thst would definitely work. Needless to say I GAGGED violently the ENTIRE Endoscopy, felt them inside my stomach, felt the sharp pinches for the biopsies taken, and couldn't breath 3X. I "woke up" SCREAMING" hoarse in pain and crying hysterically 😭. The surgeon had already moved on to the next patient and figure I wouldn't remember anything. At the follow up I told him EVERYTHING. How when they first injected me I got the woozy feeling, closed my eyes, and then...nothing happened. I was still awake and alert. I reached up to scratch my cheek but the nurse forcefully grabbed my arm to restrain me (I suppose they thought I was reaching for the bit they put in my mouth but I just wanted to scratch my cheek thst was itching (the meds make me itchy!). Then what felt like 2mins later felt the tube go in my throat (Oh and yes they sprayed the numbing stuff right before putting me to "sleep" which also doesn't work on me) and I immediately started gagging as it turned the corner down my esophagus. Then I couldn't breath 3Xs and next felt pinching in my stomach.
He explained that he did an unplanned dilation bc he had a very difficult time going down (well DUH I was gagging!!). He said he's shocked I remembered so many details. I couldn't swallow my own spit for 3 days let alone eat or drink my throat was in so much pain from thst knucklehead. THAT is why you LISTEN to your patients.
Anyway fast forward I learned those who have some Neurological Disorders can be VERY difficult to sedate. For some reason our bodies do bit properly metabolism the drugs---specifically Fentynal, Versed, and some numbing agents. We can only assume my neurosarcoidosis (and RECENT HSD-hypermobility spectrum disorder) has something to do with this.
@@ndlamont01 goodness I’m so sorry you’ve been through all of that! Thankfully I don’t remember when I’ve had general anesthesia but I’ve had very traumatic endoscopies and TEEs that sound similar to you! Gagging and the doctor saying why isn’t she asleep?! Also after open heart surgeries they keep you intubated until you can breathe on your own which can be hours or days and most people don’t remember waking up with the ventilator but I for sure do. I still have nightmares of being on the ventilators after each of my open heart surgeries. I do not look forward to more surgeries because I know I’ll be conscious on the ventilator after surgery.
Thanks for sharing your experiences with me!
do you regret getting that central line? Or was that entirely necessary? It honestly sounds like your body is trying really hard to die and we’re frankensteining you all up haha
@@matt566 the central line was completely necessary but I wish I would’ve have needed it! Haha I know.
@@ndlamont01 Isn't it possible to ask one of the doctors to put this "needs vastly more of the good stuff" in your file so that future doctors will take what you say more seriously?
The scariest part for me was being actually aware, I no longer had a tube or anything just those 2 prints that stick into my nose. But I felt so heavy I damn near wanted to panic until I realized I could move my feet but damn was it a moment.
It's like when you have momentary sleep paralysis kinda feel.
I have had two spine patients that have had awareness. I reassured her I am running an eeg as well and if she’s aware I will know. Told em’ I am the first to know.
Seriously what anesthesiologists do is just friggin magical and incredible.
It’s even more amazing that they don’t do any of this stuff… if it’s not an academic training institute they are not the ones giving you anesthesia. They see you and Preop you but a Crna or an C-AA is the actual person who over sees your anesthesia
Anesthesiologist don’t actually do your anesthesia….
Thank the Crna or C-AA that really did it….
Love the nuance! Emergence is something I never knew was such a delicate balance
Considering my high pain tolerance from sensory processing disorder and my previous bad experience with gas as a result of that when getting my wisdom teeth out I’ve always wondered if I’d be a patient who needed more anesthesia should I ever need surgery for some reason or if I finally ever get my post weight loss skin removal surgery at some point so I’m so glad you brought this up because it answered some of my questions regarding that, great video!
Dentists use sedation, meaning you're just really relaxed and may have some awareness of the procedure. With anesthesia, you're not aware of anything.
I always find your videos very interesting. You seem very confident and comfortable in your position. Good for your patients.
I learned so much! You inspire me so much!! I always learn a lot from you!! That was very helpful! I really enjoy donating to the anesthesiologist Foundation, since it was hard for me to go to college because of my cerebral palsy!
Really good info and presented well. I require bi-annual, bilateral ureter stent placement and appreciate the not only the skills of the operating doctor but especially those of the anesthesiologist. Typically, once "under", I'm back in the recovery room within an hour and discharged to home within another.
I underwent a surgery about a month ago, and my I remember waking up in the recovery room, and the only thing I remember prior to fully coming to was the anesthesiologist saying that I would be out briefly, and then I have vague memories of the nurses asking something about antibiotics. It was a bizarre experience, but I presume that I woke fully about half an hour after the surgery had completed, under the assumption that about half an hour was spent on post-operative procedures like the dressing of the would and the placement of the wound protector around my ear afterwards.
One thing I don't wish to experience again in the future is the chills I got from coming out of Anesthesia, which took more than a week to fully dissipate, but that was the only real downside I experienced as a result of the anesthesia, and mostly amounted to a week of everything feeling about 10 degrees colder than it actually was. Needless to say I was very appreciative of warm blankets for the remainder of that week.
Warm blankets in the hospital are amazing!
My first experience with them was 32 years ago after an external version to reposition my oldest who was in a breech position. When the nurse offered me a warm blanket, I expected a heavy blanket that would hold my body heat close to me that I would eventually be warm …
But no !
It was literally a blanket that was already warm … and OMG that was amazing!
@@tanya5322 You've obviously not heard of heated blankets.
@@looksirdroids913432 years ago those only existed for certain patients. And not every hospital had them as some states in the US are, or were, run by idiots that didn’t allow them. They used towel warmers instead.
Holy cow your job sounds complicated. The information that flows from you so easily does make it comforting to know that there are knowledgeable doctors like you out there willing to educate us.
Love your videos Max.
I would like to see you make a video/videos on the 3 inhalational gasses, along with what you like and don’t like about them, and which ones you prefer for different types of procedures.
It also might not be a bad idea to discuss their pungency as well, though I know that Des is too pungent and irritating for induction.
Great idea for a video, I will keep this in mind in the future! Thanks.
Thanks for all you and your fellow anesthesiologists due for us! Definitely couldn't have my life saving operations without you and your equipment!
So far (Knock on wood) I haven't had any problems.
3 open heart surgeries were for the 3 stages of operation I needed for my Hypoplastic Left Heart Ventricle*. Another major one was an emergency surgery for blocked Cecum. The only other times have been for checkups like Cathiterization and upper Endoscopy. Also for removing my wisdom teeth.
Fun times! 😏
But I'm glad for the competent skills of the team and especially the attending Anesthesiologist! 😊
*P.S. Fontan Patient.
34 years old and still going!
It may be interesting to do a video about the topic of "how to prevent patients from suffering from violent projectile vomiting during and after surgery", since literally all opioid analgesics and many anesthesia agents are able to cause intense nausea.
He's mentioned it in other videos that they do use anti-nausea meds. I remember because I'm allergic to the two most commonly used anti-nausea meds so I was very interested to hear about the other options. It might be the video where he shows all the meds he draws up and prepares before a case.
Zofran, there. A lot of remi is dumped in you during the course of your case and it happens. Its just one of those things.
Yet another reason why we have ppl FAST before OT
@@susie9893you don’t need to eat or drink anything to vomit though. You can vomit the IV meds and fluids you’re given.
your vid was very good. When I went under in 2001 for surgery my team was awesome the Dr was able to see that I was starting to panic and they were able to give me a light sedative to keep me calm before surgery though the last words i remember saying were "ok i think i am going to panic now"lol the OR nurse claimed my first words on waking up were "just warn me before you begin" and whatever they gave me I still only remember bits and pieces of that friday and Saturday.
WTF is a vid?
In an ICU setting I've taken care of a patient where they were receiving drips of 75mcg of prop (maxed), 1.5 mcg precedex (max), and 8mcg of fentanyl....and it wasnt working even though IV access was great and hemodynamically stable... would versed gtt on top of all these other sedations would be a great idea?... no PMHx just polysubstance abuse.
I used to love going under anesthetic, being an insomniac, it was my best sleep ever. Now I feel like I'm barely under, then immediately wide awake afterwards, a most unsatisfactory sleep! The worst ever was a totally silent anesthesiologist, normally they will say something, but this guy said nothing, just stared into my eyes. I felt like I was undergoing euthanasia!
3:37 Coming from a physics background it was slightly strange for me to hear this called "half time" and not "half life".
two separate things, they have both in anaesthesiology
I love your videos. I always learn so much. I'm a medical biller and coder and a person who has had multiple surgeries. I have always been interested in medical procedures.
I wouldn’t be alive today without Mount Sinai anesthesia. So thank you!
wow this was extremely informative. ive had general anesthesia twice in my life (once for an endoscopy and another for a tonsillectomy) and i have to say that whatever cocktail of drugs the anesthesiologists gave me during those operations were like magic. i woke up from what i felt like was the best sleep of my life feeling extremely happy and chatty.
I've always wondered what kind of conversations my doctors have during my last 43 brain surgeries!
43??
God bless you and your health 😇🙏
An anesthetist I worked with years ago in a small remote hospital and was obligated to circulate as well as be the ER Nurse, told me anesthesia was like flying a plane, danger on take off and landing, and not too much issue in between. As I watched her accidently deintubate a child during a T&A , and start screaming, I got her point, the scrub nurse got her a new tube to insert. She terrified me ever after, because of her panicked screaming.
That is a shit pour example of an anesthetist… you need to keep your calm in all situations… I’ve dealt with level 1 and level two trauma for over ten years….. anesthesia is the the captain of the ship and this person should have done better
That shit is weak as hell
I’m cold as ice while doing chest compressions running a code blue because that sets the tone for the rest of the OR… getting upset or panicked is the worst thing an anesthetist can do
Cool video. I didn’t realize Doctors also perceive anesthesia as an “On/Off” switch as well. When I had kidney stones a couple years back, I remember counting down from ten while breathing the stuff in, then _bam,_ I wake up suddenly and back in my room.
Also, I was wondering what effect anesthesia has on the brain? Does it just prevent the brain from sending/receiving signals, or what?
Or do you have another video that covers that?
Surgeons SHOULDN'T expect that, after all they too ought to want a patient that wakes up with no additional medical troubles and no unnecessary complaints. Do surgeons even normally stick around after the final stitch?
Quick question: I once heard that 2L/min flow is normally used in America and I noticed that you had that setting in your video so I was wondering if what I heard is correct.
In my clinic we try to do 0,5L/min whenever possible 'cause we wanted to minimize the enviromental impact we have with our anaesthesia. Do you notice the trend to low flow anaesthesia in your hospital as well?
Hi Coffee, some anesthesiologists do prefer to use 2L/min flows when running sevoflurane in particular due to the historical concern about compound A. However this is not substantiated in human models, so modern recommendations for sevoflurane usage entail lower flows.
But to answer your question, many anesthesiologists in my hospital do run low flows for the same environmental reason you cited.
Well you open yourself up to the possible accumulation of compound A…. I mean read a book dude. If you are in a non litigious country then do whatever…. You want to be fancy and try some closed circuit anesthesia… go for it But In America you can get sued for that horse shit
Thank you for these videos I’m actually having knee surgery on January 9th And I’m super nervous I watched your video on when the patient comes into the operating room for surgery and what you do to prepare them I’m just really nervous so thank you for your videos they do help because my surgeries in literally two weeks
Really good explanation about how to time emergence. It is a really tricky concept for me as a student nurse anesthetist. I will try your starting propofol at the end approach next time!!
What are the considerations for organ compromised (kidney/liver) or current drug dependent patients in an emergency situation?
Hey Max, loved the informative video! Have you ever had a case where you turned off the anesthetic an hour or so before the surgery is expected to get done, and then there’s a complication and you’ve had to restart the process? Would that create any complications on your end?
It's not unusual for the end of surgery to take longer than anticipated, in which case we can simply increase the dose of anesthetic agent until it's no longer needed.
One thing I'm curious about.
So, here's what I remember from being under anesthesia twice (once for adenoid/tonsil removal, the other for wisdom teeth removal)
It's pretty much like your consciousness is reduced to a little bubble. Nothing outside the bubble can be felt, and you're alone with your own thoughts. The deeper the anesthesia, the shallower the thoughts, but you're still present. You never completely just...dissipate.
Two unique things I remember from coming out of it.
The first one, for coming out of the adenoid/tonsil one: I remember that I liked the sticky blackness I was bubbled in. I wanted to go back to sleep for a bit, and did continue to kind of doze for a little bit while listening to my Mom talk with another person next to her. (I was only 8 years old.)
Edit to add to the first now that I think of it hard: I remember very vaguely (like, the imagery is so fuzzy, like I wasn't entirely conscious) waking up in the operating room. I asked if everything was okay. The lady I was talking to said yes, that we were done, but she just needed me to do a couple of things for her. I remember it was so hard to think and focus on anything that I didn't like following her asking me to do things like wiggle my fingers and follow her hand with my eyes. She told me I could go back to sleep after that. My consciousness in the recovery room (what I described before the edit) was much clearer than this.
The second, for the wisdom teeth. I was listening to an audiobook through earbuds with my tablet as I went under, so I could still hear the audiobook in the background, but when in the "bubble", it sounded so distant it was pretty much nonexistant, like having the TV set to the volume setting 2 or 1.
I was comfortably letting my mind kind of wander at its own pace in that bubble, when suddenly I felt a sharp pain in the bottom right corner of my mouth. At first I didn't know where the pain was coming from, just that it was there...and that I didn't like it.
I tried to identify where that spot was, and realized it was my mouth.
In my sticky thoughts, I tried to reason out why there would be pain in my mouth.
That's when the memory of what happened before I entered the "bubble" returned
I realized that it must be that I was feeling the surgery.
I tried to push back against that barrier keeping my consciousness in place, tried to move my mouth to yell "stop!!!"
But I could not, no matter how hard I tried.
Eventually I slipped back into the bubble and that awareness of what was going on dissipated, but still...it was not fun.
For me, neither anesthesia experiences involved dreams...just blackness, being stuck with a bubble around your consciousness and being alone with your thoughts, slow as they may be.
The reason why I'm certain I was not dreaming is because I have vivid dreams all the time. If I don't remember even a scrap of an idea from what I dreamed the night before, it unnerves me.
Is the way anesthesia affects everyone different for each individual?
thats super interesting, and it must be- i went under once for my wisdom teeth, and it just felt like a videogame load screen. i was talking to the doctors, darkness took me, and then what felt like moments after my eyes opened and my whole brain was in a super thick haze. i was bleeding like crazy and remember trying to spit out all the gauze which got me reprimanded but i became alert again by the time i was home, which couldnt have been more than an hour
When I had my wisdom teeth out I woke up so quickly that I thought I was still in the operating room and nearly threw myself off the gurney jumping and yelling.
Yeah it must be different. I COMPLETELY lose myself/dissipate and it's like literally nothing, boop blackout, time blinked, I wasn't there at all for my surgeries. 9 hours passed instantly. I've had full anaesthesia and the twilight sleep for wisdom teeth. I vaguely remember that bubble you were talking about for a millisecond before falling asleep and after waking with the twilight sleep of wisdom teeth but not at all with my tonsils out.
I'm wondering if they didn't give you quite enough, or something interacted with it. I've also heard genetics like red hair can make one need more anaesthesia to be fully under. Possible you might be under sensitive or need a different drug if you ever need surgery again.
Also wanted to say I'm sorry for your experiences, those most definitely do not sound pleasant
@@thexenocide6013 That's interesting that we both had different experiences! I've heard that completely blacking out is the most common experience with it.
What parameters go into determining PICC or central line versus standard IV during surgery? It seems like all my long operations use the more invasive method. In Dec 22 I’ll be having another spinal fusion surgery. We saw the surgeon last week and he’s estimating 5-6 hours for surgery and then another two hours for recovery. He also commented that positioning before and during the procedure is another hour. He told my husband to expect it to be about ten hours before I’m in my hospital room.
The determination about a central line in addition to a peripheral IV is based on a number of factors including whether or not significant vasopressor use may be indicated, ICU stay is anticipated, central venous pressure needs to be monitored, and so forth. It is very uncommon for an anesthesiologist to place a PICC, as those are very high resistance central lines that aren't especially useful in the OR.
@@MaxFeinsteinMD Thank you for taking the time to respond. The last two “big” fusion surgeries used central lines. These are surgeries in excess of 5 hours. I know these spinal procedures require a lot of positioning time before and during the procedure. The last two big ones were A/P fusions, this next one is R XLIF and then PLIF with bilateral anchoring rods into my pelvis.
Thank you for the videos you make! Excellent information and great delivery. If you have a passion for teaching you would be excellent. I'm one of the lucky ones where every surgery I have, has been a great experience from the general anesthesia side. Recovery after getting home can be more of a challenge.
Can you explain how some of these medications work? For example, why don’t the paralytics stop the heart from beating?
look them up individually in conjunction with anesthesia. answer to your example is that everything has a lethal dose, docs/pa/nps try to shy away from using that much.
@@TravisDoesGames Right, I just find it fascinating why these drugs affect other muscles but not cardiac muscle? Apparently cardiac muscle cells have "intrinsic automaticity" which means they beat without stimulation from the nervous system. At least as far as I understand it.
Recently i had a surgery under GA. It was the third time in 10 years that i go under GA. The first two operations, post OP my chest and lungs filled amazing and filled with air and i was breathing better than ever. But the last procedure was the opposite and i felt like my chest was tight and i was out of breath, even though my PO2 was almost 100, basically i was breathing far much better pre op than post op. Any ideas ?
Did your condition improve? What was the problem?
@@BakrAli10 long story, but let me say that going to two different gyms continuously for the last one year improved my lungs, it wasn't easy. Gym 1 weight lifting, Gym 2 moderate crossfit. Four times a week.
Max,
Are you ok? You don't have your usual energy. One Love
You are kind to ask! I was trying not to move too much during this video because the green screen I was using isn't very wide lol
@@MaxFeinsteinMD Thanks for replying! Happy Holidays to you and the Mrs
Question: Do US Hospitals not use waking rooms close to the operating room? When I went in for surgery I woke up in a bed in a special waking room close to the operating room where personell were watching my vitals and waiting for me to wake up. It seems like this would make efficiency less of an issue even if a patient takes an hour or so to wake up.
I'm going to face a surgery and although I'm not worried about it it's nice to have information about it. Congrats.
Recently had a five hour surgery, no co-morbidities , healthy. Took me more than three hours to wake up. Released from hospital with legs that could barely support me for another few hours. Should I be concerned if future general anesthesia necessary?
I would recommend discussing this with your doctor in the event you need surgery again in the future.
@@MaxFeinsteinMD Is it possible that an anesthesiologist consultation can take place in such cases, so that if the patient is prone to such things hopefully the anesthesiologist can figure out something different, or if they can't then something like a rented powered wheelchair can be arranged?
Many hospitals have pre-surgical consultations with anesthesiologists available. Specific mobility requests like powered wheelchairs would likely be best directed to social workers.
Great video. Do you have a video about delayed emergence? Sister took about 9 hours to wake up fully. Semi conscience after four hours with fully dilated eyes and unable to speak clearly and words were gibberish for several hours. During post-op her BP dropped and they had to give her maximum oxygen. Said she was forgetting to breathe. I cannot find anything online about what happened to her.
I always wake up in the recovery room. I always wondered how they know to send me on and how long I’m in recovery before the nurse wakes me up. Still confused 😕
You wake up and are extubated in the OR, but have no memory of the fact due to amnestic (amnesia-causing) properties of the sedatives. Afterwards, you likely fall back asleep, and by the time you wake up once again in recovery, you are able to create memories, so your mind thinks that this is the first time it woke up.
@@voxov1907 thank you! That makes since. I always wondered. My last thought was the Dr saying “okay, I’m going to give you the medicine now”. Next the nurse says “ wake up, it’s time to go home” lol
This is very inspiring. It’s almost like I can’t wait to have surgery just to see this in action.
Lol you won't see it coming or even know what happened. It's like a 9 hour time blink
I've been under twice, and the second time was a minor horror story. Back in May 2020, I had an ERCP a week after a lap choley. I woke up and was able to open my eyes just as they started to pull the breathing tube. I couldn't lift my arms and of course couldn't breathe. After a couple seconds I could lift my arm and waved at them, at which point someone said twice "You're okay (my name), youre done." They were still pulling the tube out for a second or 3 longer after that, leaving me coughing and gasping for breath. I assume the anesthesiologist screwed up pretty royally here. Though I understand that it was during Covid and all
Just recently had both of those done myself, but in reverse order. With the endo on Monday and the lap on Wednesday. The only negative I remember is that that the mask over my nose and mouth was sealed so well by the person holding it, that it was hard to exhale and that briefly freaked me out. But that’s about the last thing I remember before waking up in recovery.
No, they didn’t. They wanted to be awake and breathing independently before pulling the tube.
@@adams303 Then why did I wake up in the recovery room after the lap choley? Noone should be making new memories of choking to death while unable to move and having a huge tube painfully reefed out of your windpipe
@@Sumanitu I’m not sure what you mean? Surely the recovery room is where you want to wake up?
@@adams303 It sure is bud. You want to wake in recovery room. You don't want to be waking up and making full and clear memories with the breathing tube still fully down in your lungs and still paralyzed. And that is what happened on my second surgery.
I've only ever had 2 surgeries that I remember. Gall bladder about 15 years ago. and ACL reconstruction 3 years ago. I remember waking up in the recovery room from the gall bladder surgery. But for the ACL it was a bit weird. I remember regaining consciousness near the end of the surgery. I remember listening to the doctors talking for what seemed like a minute or two before opening my eyes just as they were applying the bandages in the surgical room.
Retired RN here. I guess 5 months ago I went to my local dermatologist. I let a lipoma grow for way too long at the base of neck... posterior. It was a good 3-4 inches in diameter. The PA says come back on x date and we'll have the dermatologist remove it. Next day the office called and said the "dermo" said I might want to see a general surgeon and go under general anesthesia to have it removed. I said HELL NO. You either do it under local or I'll find another dermo. He recovered it under local... didn't feel a thing. Nurses make the worst patients! LOL GA was over kill and that's a no for me.
I'm figuring that it's not on account of pain but other "weird" sensations that some doctors want their minor surgery patients to be put under. Some might be violently nauseated or panicked, others might not even care, being comfortable understanding what is transpiring.
I don't know about you but I prefer not feeling things while they happen
dermo?
@@Capecodham USA spelling "derma". Your point is what?
@@joecooksey4331 What is a derma?
Thank you Max for the videos you do. I work as an OR Tech retired and enjoyed it very much. I have a question, I have had many surgeries, two of them in particular my TKR after surgery developed low BP and respiratory arrest in the recovery room and remained in the RR due to over load in ICU. For my THR my BP dropped to 89/44 and respiration of 79. I need a LTHR soon and I am very nervous about going under after these two scares. What questions in your opinion should I ask my anesthesiologist. Thank You for your videos.
Hi Cindy, I'm glad you enjoyed the videos. I would encourage you to share you past experiences with your anesthesiologist so they can make a plan with you that will be tailored to your concerns and medical history. Best wishes for your upcoming surgery!
@@MaxFeinsteinMD thank you very much. Be blessed
Reaction to glaucomflecken would make a wicked awesome death metal band name.
I had a tonsillectomy at Guys Hospital in London and never considered the existence of the anesthesiologist that put me under and carefully watched over me the entire time before hitting the "off" switch. Lol. I have this newfound gratitude for someone taking care of me that I never even knew existed before.
This is so interesting! Thanks for sharing! I do have a question. What kind of symptoms or things will you be looking for to see if a patient is becoming too light on the anesthesia?
Always very interesting Max, question, I'll do my best to phrase the question as good as I can so in many Industries you have many people highly trained highly skilled doing serious important jobs like yours, do anesthesiologists end up doing what you do in their own way or the way they like to administer different medications or do you have guidelines in the industry as to how you gauge and modify procedures? I guess what I'm asking is can different and anesthesiologists have different ways of going about their procedures in surgery or do all of you follow the procedures pretty close considering you have to keep the patient safe with the same medicines?
Good question. There are general guidelines from anesthesiological societies (like ASA, ESA, JSA, ...) that reflect the general consensus and state of medical knowledge, sometimes supplemented by hospital-internal SOPs (standard operation procedures), reflecting local preferences (like surgeons preferences, available medications, ...). Also there are country-specific laws and jurisprudence. Since you have to provide medicine according to the current state of medical knowledge you´re required to attend a minimum amount of trainings each year to keep you up to date.
Your training is pretty eminence-based (meaning, you´re very likely only to be taught the preferred way of the department head to provide anesthesia), although this is slowly changing towards evidence-based, and overall your training is to teach you the aforementioned "limits" and (ideally different) ways of safely providing anesthesia.
After you´ve finished your training and are certified, you´re pretty much free to do as you like as long as you stay within the aforementioned boundaries, but if you don´t actively try to learn different ways of doing things you can end up providing the same kind of anesthesia for decades (especially if you stay at the same hospital).
Even if you want to change the way you´re often limited by the available tools and medications (which are preferences by the department head or due to business decisions), but you usually have at least a small selection available to adapt anesthesia to the patient.
So in short: yes, there are different ways of providing anesthesia to achieve the same goal
Awesome video! I've been intrigued by anesthesia since I was a patient after a traumatic accident. I underwent 5 surgeries within a year (ENT, oral-facial, and orthopedic). The first two surgeries, I woke up in the worst pain I had ever experienced in my entire life (even more than the accident), but other surgeries I woke up very comfortable and nearly pain-free. I also know that after one surgery, my parents said I was extraordinarily angry, cussing out nurses and trying to punch my friends and family who were at my bedside (oops, sorry, I remember nothing!). Others, I was sweet and quiet, and others I was loopy / goofy / flirty.
I'm suing the hospital if I ever wake up from a surgery in pain. They're meant to manage the pain. No excuses.
Ive had several operations on my right foot due to a lisfranc fracture. After anesthesia I always suffer from delirium. I'm 58years old and basically for 3 or 4 days after I wake up I am completely useless I can't remember where I am who I am or why I am in hospital. This fades over 3 days and suddenly I'm back to my normal self and don't remember the missing time period. I would be interested to see a video on delerium which I understand is common in older patients.
I'm a bit of a difficult patient, but not on purpose. I always have to have more Lidocaine than expected when I go to the dentist for cavities/etc, and I woke up during eye surgery
What would interest me, to be honest is, why propofol was administered to Mr. Jackson for his insomnia. Could you give a little background on why this was even considered a therapeutic measure?
Anesthesia is never indicated to treat insomnia.
I went through a surgery under total anesthesia a few years ago, I remember they were concerned that I was taking too long to raise my oxygen levels before putting me under (I was taking deep breaths from an oxygen mask). Then the propofol went in, a little sting and good night. Later I woke up in a recovery area, in pain (but not too severe). It didn't really feel like instant time travel, but more like a deep sleep. They gave me something and reduced the pain a little. They warned me in advance that I may feel sick and vomit after waking up, but that didn't happen. Over all, it was fine.
That was really interesting. Especially the part about switching in order to keep things safe while not accumulating more halftime!
Your so interesting to watch. Is it true u guys have your own recovery room where the pt starts to wake up. Then there take. To regular recovery?
The standard recovery room is called PACU, which stands for "post-anesthesia care unit". From there, patients either go to their room in the hospital, or to "phase 2 recovery" prior to heading home.
I have been put to sleep a couple of times. Sometimes it hurts when they are administrate propofol. Last time i got put to sleep i asked the nurse anesthetist why it hurts when propofol are administrated. They told me that they could mix Lidokain with the propofol. But i never got an answare about why it hurts. Do you know why?
My favorite quote I heard in my training was "how deep a patient is, is indirectly proportional to how anxious you feel". Essentially you need to be able to trust your gut to tell how close the patient is to waking up.
Would a Bis monitor help more with determining the anesthesia ?
This is legitimately really interesting. Also, I'm getting a spine surgery for my scoliosis in literally 3 days. I'm mostly calm, but when I start thinking about it too much, my heart starts beating faster and I get nervous. Anyone have any tips on how to...not internally panic the day of the surgery?
hey! how are you? How did it go?
@@tatyanakern3795
Alright so it’s been like- six days now. Here’s the thing. I was in the hospital for three days. My back was aching. It was so annoying. I wanted to be out of there. Third day, got to go home. THE CAR RIDE HOME WAS LIKE GOING TO HELL AND BACK. I could not figure out what position I should be in. I just reclined the seat as far back as I could. Got home, took some pain meds, felt like I was in heaven as soon as I laid on the bed…then proceeded to sob into my pillow for the next five minutes. I don’t know if maybe it was because of the pain, or if I just felt really overwhelmed or what- next few days, I take meds, walk around a little, do some exercises, eat, *take meds-* okay but honestly though, the pain is REAL. I guess it’s gotten maybe a little bit better, but still. Haven’t went to school yet. Won’t for a couple weeks, and here’s why. Walking and laying is fine, BUT SITTING FEELS HORRENDOUS. And you know, in school you have to sit for an hour and a half for every class so yeah, gonna be a bit before I feel comfortable going back to school.
Also I sobbed in my pillow again yesterday- I can’t help it. The aftermath of back surgery comes with things you can’t fully expect, (like pain, and some limitations) and it’s gonna take a good while before I can feel 100%😅
@@acedreamer2004 Oh wow thanks for your answer!
I'm glad that the surgery went well and you're home now.
Actually, I'm surprised you mentioned school, I thought it would be at least a few months before you would even think about going back to school.
But congratulations! You did it! happy to hear that you're ok (well, as ok as a person could be after a spine surgery :D)
I think I would just drop dead from panic before the surgery:D
@@tatyanakern3795
Yeah it hasn’t been easy. Also yeah, about school, I legit don’t think I should be going back so early either. But I have a doctor’s appointment tomorrow so my mom and I will ask them if I should start going back to school again on Wednesday or if it’s better to wait more
Really interesting information! The more you learn about medicine, the more you realize almost everything is just poisoning the body in various amounts to get the desired effects and keeping it controlled to avoid undesired effects - like paralysis, organ damage and death. I heard that in some operations you'd use substances for medication that would basically kill the patient for cramping if not paralyzed at the same time and applied to automatic breathing device. Sounds really complicated to manage so all respect to the professionals doing it accurately for every individual with different body and conditions.
I had three hip surgeries on the same hip in a month. When I talked to the Anesthesiolgist I always liked to play the game of "I'm gonna make it from 10 to 1" I never made it to 9...
I was awake during my hand surgery and now I need a knee surgery and I’m afraid I’ll wake up again. The surgeon didn’t believe I was awake during my surgery and I told him that he was talking about his fishing trip! He apologized and said sometimes this happens. Now I’m scared. I know I take a lot of medications even for dental work to be done.
Watching your videos, I understand now that I like probably freaked some poor anesthesiologist out. 30 y/o, scheduled surgery, was supposed be out for 2 hours, ended up under for 8. Woke up in the operating room on the way out to recovery. Someone of the crew asked you're awake?? how do feel?... Response from a brain made up of jello was: "Like I'm going to be sick". Everyone stops dead for a second and is like yeah, yeah you would, and gives me something". The hospital trotted the entire team in front of me afterward to see if I remembered any of them and I'm like no why are you asking me this, is there something wrong with me, am I supposed to?? Realized that whole situation was crazy.
I had aortic valve and root replacement surgery about 6 months ago,the surgery was 12 hours long,the surgeon left me open for 2 days and in a coma for 5 days,it took me another 5 days to clear my head from the anesthesia I had vivid dreams I not sure when they started,I don’t remember the tubes in my belly or breathing tubes! Can you tell me what they had me on in the coma?
When I was a kid I had my tonsils removed. And initially the nurse was trying to find a vein in my arm. And she poked me in the wrong spot. She kept trying to find a vein. And I was crying and very upset. So they decided to give me the anesthetic gas. The nurse in the operating room was talking softly getting me to calm down. While slowly I went to sleep. When I woke up the procedure was done and they had put an iv in me while I was asleep. Now as an adult I look back and realize that they sometimes have to be creative when a kid is crying. They did what they had to do. And I was not forced to do anything. The only thing I disliked was the anesthetic gas made me nauseated post op. Not sure if that's a side effect of that stuff. But as an adult I prefer iv sedation. Assuming they can find a vein. I'm still am hard to poke. Thanks again for informing. Would be interested in a video about anesthetic gas. Not sure if u have one already
Another factor that I'm pretty sure comes into it is if a patient regularly uses opioids -- often quite legally -- because tolerance is a Thing. Please correct me if I'm wrong, but I would guess that if someone is prescribed oxycodone or hydromorphone and has built up a tolerance to that drug, they may need more fentanyl for effective anesthesia.
Dr Feinstein can you make a video on if the ventilator fails. thanks.
Im pretty sure everyone who's not an anaesthetist snoozed off during this thorough explanation. And that is actually how we induce anaesthesia in real time.
What causes a patient to have spasms and uncontrolled limb flailing as a patient is waking up from anesthesia ? How do you communicate this to one's doctor?
Crazy???
You just gotta realize some people are weird
I'm going for a colonoscopy and endo next week. Will I be able to refuse the Propofol and only accept the Versed and Fentanyl? I don't want to be completely put under, I would like "mild/medium" sedation. My BP drops a lot when taking my home meds (Xanax-3 years, and oxycodone-1 month)
So, I'm quite nervous to accept the Propofol. I don't want to die during diagnostic testing... But I must have them done. I can't take the pain, weakness, tiredness, loss of sleep, constipation/diarrhea, inability to tolerate liquids/food and severe weight loss (38 lbs in 3 months/181 to 143) much longer. I'm only 37 and extremely scared of what I'm going to be told.
May have posted (Old age has robbed me of a lot of memory). I had a HoLEP procedure 12 months ago. I had not watched such a procedure but I had watched a lot of Max's clips. They're interesting so when my anaesthetist came to see me before surgery. I asked how would he induce me (why do you want know). Is this surgery done in the Trendelenburg position? (Why are you asking). How long is the procedure? (till you wake up). The nice bit was a lovely Indian nurse holding my hand in recovery saying - it was 90 minutes. I though you'd like to know.
He induced me with sevoflurane and that was magical. He tricked me a Little because I had seen Max say I always make sure the patient has a lungful of oxygen so when Dr X said take a breath for me I thought it was was going to be 02 but I slid instantly into the arms of morpheus instead.
How do you sign out the use of sevoflurane? Anesthesia records document all the other narcotics, but not seen that, the only thing recorded was %inspired and %expired minute by minute when intubated, then on CPB, no ventilation so how is anesthesia maintained without propofol or being ventilated? Or gas used documented?
Suggamadex and I do t get along . I ended up with anaphylaxis from it and on a vent . This so makes me nervous. I’m having shoulder surgery tomorrow
I love that Max speaks probably the best English I've ever heard LOL
there are some rare horror stories I have heard on the internet about people who were not given anesthesia correctly such that they were paralyzed but could feel pain during major surgery.... obviously I understand that these are extremely rare cases, but nonetheless haunt me.
Anesthesia awareness. I saw a documentary on it back when they showed that kind of stuff on Discovery Channel. Needless to say, when I had surgery that year, I had a panic attack.
Not rare
Just rarely talked about by Doctors
Like all iatrogenic disease....
@@kxkxkxkx Antimicrobial resistance is talked about plenty, don’t know what you’re on about.
@@ferretyluv there is a lot more to it than that, random dunce... IA doctors killing patients is the 3rd leading cause of death in the USA - the country where people pay by far the most for medical care ☝️
@@kxkxkxkx Covid is the third leading cause of death, don’t know what you’re on about.
I just went under last week from too many years of lifting in my daily work. Never did i go under before.Anestheologist said "this (mask) is just to help you breathe a little easier". Next thing i know i am back in my room, and when i come to, i ask the nurse ,what happened are we delayed ? She laughed and said we are all done.THANKYOU Max for what you and all the other anesthesiologists do to keep us safe and PAIN free
Wait... there is more to it than the nurse calling my name after surgery.
Amazing.
Most calming man in the world
Your videos are pretty amazing. I've been under many times in 50 years.
I once asked an anesthesiologist if I slipped him a fifty, if he would juice up my dosages. He thought that was pretty unique. I don't know if he did or not, but it was free.
can you do a video about common surgeries you'd use paralidics
for? like breast reductions, sinus surgery etc
Hi! could you please do a video on pseudocholinesterase deficiency, i have it and don’t fully understand it and it makes me very scared of surgery.
How dependent are you on BIS monitoring to see level of patients consciousness?
Great channel, one of my favorite! Also, it would be nice if you make a video on long term consequences of anesthesia. For example, I have patient who have demenita. And her dementia deteriorated rapidly after surgery. Is this a thing or just a coincidence? What surgeon should know about anesthesia before deciding whether or not perform surgery?
I’m not a doctor,
but I have worked 10+ years at a SNF facility where I did notice that some dementia residents deteriorated seemingly faster than others. At least from my perspective.
Also, and perhaps more relevant, I recently had to be put under twice in one week due to a misbehaving gallbladder. When comparing notes with my daughter who had had the same procedures done a few years ago… I asked her how long she thought I should expect my “post anesthesia brain fog” might last. (I’ve long joked about someday needing to be in a memory care unit, but hopefully that’s decades off yet)
She told me that she did remember dealing with that brain fog, but wisely pointed out that she was 30 some years younger - relatively speaking- when she had the procedures.
This was two weeks after discharge … and I was still feeling frustrated that I couldn’t find words that I knew I used to know. I’m four weeks out now, and pretty much back to my previous “normal” level of absent mindedness.
My totally uneducated guess is that you might see some improvement with time, but perhaps not a full return to who they were just before the sedation.
Thank you for your work, memory care residents can try your patience, but they can also be endearing as well.
It has nothing to do with anesthesia…. If it’s a problem then don’t have surgery in the future
Can you explain an anesthesiologist responsibility during a status epilepticus case? Please?
Go hard on the remifentanyl and low flow the sevo, add ket to the mix and you can play with a 0.5 MAC easily. Ket has paradoxical emergence and remi also has an additive effect combined to make your 0.5 sevo equivalent to a 1+ anaestehtic. Flush the sevo at the end and hyperventilate the patient who remains apnoeic cause of the remi and then stop that too. Once they're breathing again hit em with some Alf/morphine combo. Chefs kiss. Dont have to ask about end time don't have to worry about operation duration.
I take so much longer than others to come outta anesthesia... not sure why but its literally days to fully be alert! This has been since I was a kid!