Preoperative Preparation: What an Anesthesia Resident Tells Patients Right Before Anesthesia Starts

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 sharing with you what i tell my patients as   i'm getting ready to give them general anesthesia  for surgery if you find this video interesting or   helpful i'd really appreciate it if you liked it  and subscribe to the channel let's get started before we get too far let me give you a sense  of what the patient actually goes through   before getting anesthesia for surgery the  very first thing that will happen as far as   the anesthesiologist is concerned is that i'll  go ahead and place an IV typically in the hand   or in the arm. sometimes this is done by a nurse  or another healthcare professional but at a major   academic teaching center in the united states  it's pretty common for an anesthesia resident   to be the one placing the IV before surgery.  once the IV is placed and the nursing staff   and anesthesia and surgery has all spoken with the  patient then we go back into the operating room,   and typically i'll disconnect an IV for  transport and then i reconnect it when i   get back to the operating room and i just want  to make sure that it works so that's the first   thing that i test when we get back into the  operating room. "all right mr. patient first   thing we're going to do is get that IV tubing  reconnected and make sure that still works"   "yeah sure thing doc make sure that IV still  works so you don't have to do that again"   "great, running beautifully, so next up  i'm gonna get some monitors put on you"   this next part is nothing official but at least  in my own head i break down the pre-anesthesia   components into three categories: so the first one  is putting on monitors, the second one is called   pre-oxygenation, and the third part is called  induction. for every procedure that has anesthesia   with it, i always place at a minimum the following  monitors: starting with a blood pressure cuff   which goes anywhere between once every three  minutes and once every five minutes. i place EKG   leads, at a minimum three but typically i place  five of them, then this device which is called a   pulse oximeter which allows me to see oxygenation  in the patient's blood and also gives me their   heart rate. another monitor that i place is a  thermometer which can be placed in a variety of   areas on the body and i usually put that on after  the patient's already gone to sleep. the other   monitor that doesn't exactly get connected to the  patient per se is a co2 monitor which is connected   to whatever type of breathing device that i'm  using. once i've got all my monitors placed and i   made sure that they're working well, i move along  to pre-oxygenation. pre-oxygenation is a really   important process of essentially filling up the  patient's lungs with a hundred percent oxygen. so   you may know that the air that we're breathing is  actually mostly nitrogen- it's about 78% nitrogen,   so another term for the process of pre-oxygenation  is called denitrogenation which means removing all   the nitrogen from the patient's lungs and having  the patient's lungs be filled as close as possible   to 100% oxygen. so if i can get to 90% oxygen in  the patient's lungs that's an excellent level for   getting ready to start general anesthesia. after  i've completed pre-oxygenation which typically   takes anywhere from two to three minutes then  i'll go ahead and induce general anesthesia. so   the induction of anesthesia is an extremely  important time where we're giving a very   carefully calculated mix of medications in  order to safely get the patient to sleep.   the kinds of things that i'm thinking about as i'm  inducing general anesthesia include the patient's   heart rate their blood pressure because often  the anesthetic agents that we use can decrease   a patient's blood pressure so we have to be very  mindful of that i want to make sure that their   oxygen levels are adequate i want to make sure  there aren't any concerning changes on the EKG   and i want to make sure that there aren't any  sorts of indications of an adverse drug reaction-   that could be changes in skin color, that could be  changes in some of the settings that i'm seeing on   my ventilator- so all of these things i'm being  mindful of as i'm inducing general anesthesia.   what the patient experiences is typically, maybe  some relaxation if i've decided to give a drug   called versed or midazolam to relax a patient  several minutes before giving general anesthesia.   to induce general anesthesia there are  a number of different medications that   we can use but the one that i'd say is by far the  most common is called propofol, and propofol is a   medication that usually kicks in within about 10  seconds and patient will have the experience of   losing consciousness and the next thing they  know they're waking up, the surgery is all done,   and they're probably not going to start forming  new memories until they're in the recovery room   although patients are usually awake and responsive  once we have stopped the anesthesia and woken them   up in the operating room themselves but typically  that's not something that people even remember   after surgery. anyways so at this point i'm about  five months into my training and i've administered   roughly 250 anesthetics of which approximately  200 of those have been general anesthesia.   now there are different levels of anesthesia but  for the most part when people think about going   under for anesthesia they think about general  anesthesia which means not being conscious,   not making memories, not being aware of any pain  from surgery, so this is the type of anesthesia   that i'm focusing on in this video. so i'd say out  of those 200 general anesthetics that i've given,   probably about 90% of them fall into what i call  the "usual category" and the usual category is a   patient who may be a little bit nervous- it's  very normal to be nervous before surgery-   but they're not overwhelmingly nervous, they're  maybe talkative, not overly talkative but we have   conversation and i like to chat about all sorts  of stuff before surgery and especially if that   helps them get their mind off surgery. anyways for  the usual patient we get into the operating room,   we connect the IV, put on all the monitors,  do the pre-oxygenation with the mask and then   induce general anesthesia and it's not really  anything for me to write home about although   i can definitely appreciate that it can be a  very nerve-wracking experience for patients.   next up is the "funny patient" encounter and  that might be because the patient's cracking   jokes. occasionally i'll have a patient who's  just hilarious and making jokes all the time   or sometimes i think i'm funny so i try to crack  jokes, anyways one time i had a patient who wanted   to count backwards and that's not something that  i instruct patients to do but this patient was   really excited about it so i let them go ahead  and do that. "doc is this a point where you   tell me to count backwards?" oh well that's  not actually something that we ask patients   to do sorry to disappoint "oh well can i just  count backwards anyways like they do on tv?"   uh sure yeah you can go ahead and count backwards  from ten, you probably won't make it to five   honestly but uh yeah go ahead you can knock  yourself out "oh yeah well i got a liver of steel   i bet i can count backwards from 10 twice before i  fall asleep" uh sure thing go ahead and try "10 9   8 7 six five four three two one ten nine eight  seven six five four three two one" i'm impressed! but definitely the funniest part of this  experience was actually in the recovery   room after the surgery happened because i told  the patient that they counted backwards from 10   twice and they didn't believe me.  and not only did they not believe me,   they aggressively did not believe  me. they went so far as to accuse   me of being a liar and it was getting  a little intense in the recovery room "you're a liar man i don't believe you you are  full of it you are lying to your patient man" anyways once i made sure the patient was feeling  well and i signed out to the nurse in the recovery   room i went ahead and left without trying to  fully convince the patient of what had happened the other thing that i used to think was funny was  telling patients to just let me know when they're   asleep once i started inducing general anesthesia.  i thought that was really clever and sometimes a   nurse in the operating room might laugh a little  bit but then i had this one patient who was   actually a pediatric patient "alrighty buddy  why don't you let me know when you're asleep"   "i bet that's not the first time you've used that  joke" uh you're right but it's probably the last yeah so that was fairly shameful  after that i stopped using that joke.   sometimes i get patients who are just  really talkative they might be really   talkative because that's just how they  are normally or maybe they're really   nervous about surgery so that makes  them talkative these patients do not   care what i'm doing to them or whether i'm  listening to them they just keep talking "...yeah sometimes i like to  watch videos on youtube but i   haven't really seen any good videos  on youtube especially in the medical   profession aren't really people who  are releasing good videos on youtube" yeah okay all right we're gonna  go ahead and connect that IV "...about it but i couldn't find anybody who  was good with anesthesia so i don't know..." but especially once i give this relaxing  medication midazolam the talkers   really start talking "...and i love mount sinai hospital and i've  been feeling so good especially since giving   me that a couple minutes ago i wonder  if i can get more medication like that   what's inside the medication i just  love being inside and outside..." right yeah that's nice um yeah can you go  ahead and start breathing this oxygen for me and to be honest that's totally fine because  as long as they're safe and they're comfortable   then i'm happy and they can talk all they  want until the general anesthesia kicks in okay time to sleep now next up is the extremely nervous patient and  i can totally empathize with this. i have had   anesthesia myself- it was a concerning experience  to me although everything went very well and so   i can completely understand if somebody is very  nervous about their experience with anesthesia.   one of the wonderful things about being  an anesthesia resident is that i can do   something to help out with that nervousness.  so one of the ways that i can help patients   is pharmacologically either with midazolam or  some other medications that help patients relax.   and the other way that i like to help someone  relax is to just turn on music and i usually   carry a speaker with me so i can have music in  the operating room either before or during surgery   so when i can i do like to ask patients  what they'd like to listen to as they're   getting ready to undergo anesthesia and their  surgery. "hey mr patient you feeling okay?" "yeah doc i'm real nervous right now" sure that's completely understandable  and normal to feel that way right now.   would it be helpful if i  put on some music for you? "sure yeah some music would be great" yeah here let me just go  ahead and pull up some music   and uh what kind of stuff would  you like to listen to right now? "yeah i mean the music that always calms me down   the most is underground european  rave music from the late 90s" oh yeah i uh i think i can dig some of that up... the only thing about this technique is that once  the surgeon walks in after anesthesia has been   induced and they hear this music playing over  the speaker i do get some funny looks sometimes   depending on what the patient picked out. i  do put on a lot of reggaeton in my operating   rooms and nobody's ever told me to turn it  off so i'm just going to keep doing that the last type of patient that i actually haven't  encountered that much of is a pediatric patient.   so we have formal pediatric rotations  throughout residency. i have not done mine yet-   i have done some cases with pediatric patients  but just a handful at this point and i have to   say that with kids and especially with young  kids i really have no idea how their brain   works and what i can do to help them  feel relaxed and at ease and let them   know everything that's going on during the  process. i don't want to be that stuffy   non-fun doctor behind a mask so i usually try  to find ways to make pediatric patients feel   at least a little more comfortable. i have no idea  what kids actually find funny or comforting so   my approach has been to pretty much  just dissociate reality and try and   come up with things that may be entertaining  somehow and i found that it actually works "okay now i'm gonna put this clippy on your  finger that all the cool kids are using and   if you put it on just right it'll light up a red  light and then make the beeps go beep beep beep" "whoa do you smell that it  smells like bubble gum?" one of the best things that i've seen to keep  a kid's mind occupied especially as we're   getting ready to do the pre-oxygenation  and a mask is going over their mouth   is they make this special  concentrated bubble gum flavor   that you can just drop onto the mask  so the mask smells like bubble gum "i love bubble gum do you want to smell the  bubble gum? the bubble gum smells great" maybe i'll just start bringing bubble gum  flavor concentrate into the operating room   for all surgeries because who wouldn't like that? well that wraps up this video and if you have  any feedback and especially any ideas for funny   things i can tell patients before i induce  general anesthesia i'd really appreciate it   if you left it in a comment below thanks very  much for watching and i'll see you next time

Channel: Max Feinstein

Views: 1,068,656

Keywords: Anesthesia, Anesthesiology, Surgery, Residency, Resident, Mount Sinai, Mt. Sinai, New York City, Surgeon, Medical school, Med school, Med student, Medical student, Premed, MCAT, USMLE, PGY1, PGY2, Doctor, Physician, Medicine, CRNA, Critical care, ICU, Ventilator, Intubation, Preoperative

Id: rn1tjqiRVck

Length: 12min 25sec (745 seconds)

Published: Sat Dec 12 2020