Liver transplant anesthesia - operating room tour

what's up everybody my name is max feinstein  and i'm an anesthesia resident at the mount   sinai hospital in new york city in this video  i'm going to be taking you on a guided tour   of what i think is one of the most fascinating  operating rooms which is liver transplant surgery   without further ado let's step on in as you can tell there's a lot to see in  this operating room and so i'm going to   break it down for you piece by piece and  since i'm an anesthesiology resident i'm   of course going to have a big focus  on everything related to anesthesia starting with this IV pole you can see that we   have a lot of drips set up here and  these are actually all vasopressors which include vasopressin, norepinephrine,  epinephrine, and a line to run all these in all of these vasopressors come  together into one set of stopcocks here   which goes into one single IV which  will go through a central line panning over to the anesthesia machine you can  see that on top we have a cerebral oximeter which   isn't used in all cases but is used mostly  for fulminant hepatic failure patients when   we're concerned about increased intracranial  pressure, or cerebral edema, or herniation,   or any time we're worried about cerebral perfusion pressure next to the cerebral  oximeter is a bispectral index   monitor which we use routinely in lots  of cases not just in liver transplants and then beneath that you can see a  standard monitor that would be found   in pretty much any operating  room, our ventilator controls. you'll notice that there are several emergency  medications strategically placed on the cart here.   and this is a normal breathing circuit that would  be found in pretty much any type of operating room we have a suction canister suction absorbent and then all of our airway equipment  including a direct laryngoscopy blade,   an endotracheal tube, monitors, and this is  what a bispectral index monitor looks like right next to the anesthesia machine is a  defibrillator. liver transplant surgeries can get   extremely involved and in some cases patients can  become hemodynamically unstable or even go into   cardiac arrest necessitating defibrillation,  so the defibrillator is always close by panning right next to the anesthesia machine  you can see our anesthesia cart which has a   lot of medications drawn up and ready to go for  the case that's about to happen in this room medications shown here include atropine,  glycopyrrolate, phenylephrine, ephedrine,   epinephrine, norepinephrine,  insulin, nitroglycerin, bicarbonate,   calcium chloride, lidocaine, fentanyl, propofol,  midazolam, rocuronium, and succinylcholine opening up the cart you can see that we have  a lot more medications that we keep nearby   and you can actually click this link up here  for a guided tour of this medication cart   by Dr. Erica Fagelman who's one of our liver  transplant anesthesia attendings at mount sinai   and also one of our assistant program directors next to the anesthesia cart you'll see  this transesophageal echocardiography   setup [TEE]. TEE is used very commonly  in liver transplant anesthesia   it's worth pointing out that our liver transplant  anesthesia fellows get certified in the use of TEE this is what the scope looks  like which is inserted down   a patient's esophagus once they're  under general anesthesia so   that the anesthesiologist can get a very  good view of the patient's heart and liver the other IV pole has a pressure bag set up with  transducers for invasive lines like arterial lines   and also additional IV bags for other infusions one of the things i'll point out about this  bed is that the anesthesiologist actually has   the remote to control the bed positioning which  affects not only the ergonomics of the surgeon   but can also have really important  hemodynamic implications for patients,   and if positioned incorrectly patients  can also end up with nerve damage just next to the anesthesia card is  a large supply of albumin which is   commonly used for volume resuscitation  during liver transplant surgery along   with blood products if the patient  is willing to accept blood products and then going to the rest of  the operating room you can see   that there's surgical equipment  including electrocautery equipment needles, sutures, gloves these tables will eventually be used  to put sterile operating equipment on and on the other side of the operating room  you'll see a blood gas analyzer which is used   very frequently during liver transplant surgery to  analyze many different components of the patient's   blood which can help guide decision-making  in the operating room during surgery on this mayo stand you'll see several  kits that are used to place central lines doing procedures like placing central lines  is something that attracts a lot of people   to anesthesiology and is a big component  of doing liver transplant anesthesiology behind the anesthesia machine is a hookup for all   of the gases that come from the  central supply in the hospital.   these all get hooked up to the anesthesia  machine and we have backup tanks for them as well what's not shown in the operating room but will  be brought in right before surgery is this device   called a Belmont rapid transfusor which as  the name implies can do large volume fluid   resuscitation in a very short period of time.  these types of devices can be seen in other types   of surgeries that necessitate large amounts of  volume resuscitation, for example trauma surgery another device commonly used during surgeries  where a lot of blood loss is anticipated   is an auto transfusion system like the Soren  Xtra. this device allows us to recapture blood   that has been lost during surgery, filter it,  and then transfuse it back to the patient so   that we can minimize the amount of blood  product that needs to be given from donors well that wraps up this tour of the liver  transplant operating room and i think this   is one of the most fascinating types  of surgeries to participate in as an   anesthesiologist because there's so much that  goes on and it can be a pretty intense surgery mount sinai is actually one of the busiest liver  transplant centers in the united states and the   department of anesthesiology has a fellowship  where anesthesiologists who have finished their   residency can come and get subspecialty  training in liver transplant anesthesia special thanks to Dr. Erica Fagelman  for her help making this video   and thank you for watching! i'll see you next time

Channel: Max Feinstein

Views: 185,493

Keywords: Anesthesia, Anesthesiology, Surgery, Residency, Resident, Mount Sinai, Mt. Sinai, New York City, Surgeon, Medical school, Med school, Med student, Medical student, Premed, MCAT, PGY1, PGY2, Doctor, Physician, Medicine, CRNA, Critical care, ICU, Ventilator, Intubation, IV, Intravenous, vital signs, blood pressure, electrocardiogram, monitoring, propofol, general anesthesia, fentanyl, induction, maintenance, liver transplant

Id: Y_ReAGJorUk

Length: 6min 45sec (405 seconds)

Published: Sat Sep 04 2021