Anesthesia when the power goes out

[@Harusalee_life]

Hi! ICU RN here, and I had a power failure before in my unit, and it thanksfully all life-related medical devices always have a backup battery as you explained. The power was back on in about 5 minutes thanks to emergency backup generators, but it was like being in a nightmare to see all our computers were down, and ventilators show 'AC power loss, only battery power' messages and patient monitors run only with small, portable screens. It was something I never expected to see in my life and the electric team was like a hero.

[@FerociousPancake888]

Was going to say, I’m not in the hospital yet but I have worked on the buildings before and I thought I remembered every one I had ever worked on having some pretty massive generators either in the parking garage/basement or roof. I would imagine if there was a flood and the generators were in the basement it might be trouble, but I’m sure there are protocols for that too.

[@Jony1337a]

Hello fellow ICU enthusiast 😅 We have a really good backup power in my ICU we had it tested recently when there was massive overload/ "hackervattacks" (that's what they told us) targeting our power infrastructure (Sweden 2023...) we had 10 power outages / day for more then a week. But that's not what I was going to way in on. I had something scarier happen afew years back... when there was a lighting strike in the main O2... Thingy... Turns out that there was no actual pressure monitor on the main O2 flow so suddenly all 10 respirators all over the ward started doing "the bad beep"... I can tell you that there was a hussle with getting tubes hooked up.. Oh yes, there was a hussle 😂

[@paulenriquez8307]

My cousin is a gynecologist in Palestine and had to deliver 8 babies without anesthesia because ...well...there was no electricity and it was tough

[@brentonholbrook6928]

I'll never forget the day I was working as an Anesthesia Tech while I was in the Navy. I was working at what is now Walter Reed National Military Medical Center. I get a frantic call from one of my docs screaming at me that he is bagging a patient under general anesthesia because the brand new machine we just got completely died. No monitoring, no power, no ventilator, no CO2 scrubbers, nothing. We had to run an entirely new machine down to the OR he was in and hot swap the machines. Our Department Head had a GREAT phone call with the machine rep after that one.

[@ConnerColemanMSHS]

Was it the Spacelabs machine?

[@sadib4782]

wow, much respect to you and the doc, that would be super hectic

[@brentonholbrook6928]

@@ConnerColemanMSHS no, it was a Draeger if my memory serves me correctly.

[@marvinmuller1085]

In Germany every hospital is required by law to have emergency backup generators, which active within 15 seconds of the power outage. Additionally, the hospital must store enough fuel to supply electricity for at least 24 hours.

[@MaxFeinsteinMD]

That’s great. The US likewise mandates that hospitals have backup generators that can run for at least 96 hours. However it is possible for backup generators, or the electrical system connecting them to the ORs, to malfunction.

[@JimAllen-Persona]

Make sure they're not in the basement.

[@georgiede]

Yes, during Hurricane Sandy in New York City the back up generators were flooded. I specifically remember NICU nurses carrying preemies down staircases while manually ventilating them.

[@mariachi2013]

You would have thought they would’ve learned not to put the generators in the basement after what happened during Allison and Katrina.

[@georgiede]

@@mariachi2013 the hospitals in NY were built long before either of those storms.

[@katrinawebb6285]

That was really interesting, as a child growing up in Newcastle Australia I remember when we had a really bad earthquake and they had to evacuate the hospital including theatres (I couldn’t imagine how hard this logistically this would have been) patients had to be moved outside. I don’t if it’s a true story or not but there was a story going around about a gentleman coming out of anaesthetic outside and he woke to see the sky and thought he had died.

[@Love-ql7rd]

Had this happen to me while I had a 350# 6'3" gentleman on the table prone for a spine surgery with his head in tongs. A circuit breaker blew in the hallway due to electrical overload. So, long story short I reacted quickly. The patient remained stable and had no recall of this event while they figured out what happened. I later got a letter from the hospital administration commending quick reaction to an untoward, unexpected event. Not going to lie. Scared the crap out of me to hear ALL my monitoring and ventilation stop. I hope this never happens to me or any of my colleagues again.

[@danpettus2634]

Always worthy information! In the 1990’s I worked for an anesthesiology automated documentation system company... Arkive. Doing a gig in Los Angeles at Cedars-Sinai and struck by an earthquake. Lost power. Most everything on battery and the staff was trained on procedures. As soon as the shaking stopped… a runner went from OR to OR with a checklist like used during an aircraft emergency. Power restored. Small aftershocks were freaky, but all was safe. Never forget it!

[@Echin0idea]

I'd love to see an interview with someone on the electrical/maintenance team to see what actions they would be taking to diagnose the problem and restore power and what systems (backup generators etc.) they manage to prevent a sustained power outage in the first place. Would be lovely to see a spotlight on the non-healthcare workers who nevertheless are crucial in ensuring patient safety

[@canadianemergencylights]

What we do is just start the generator and them the whole building *usually* has power.

[@d.l.harrington4080]

In my hospital, we had a backup generator plus a large battery bank UPS. (Universal Power Supply) for the ORs. No surgeries could be started unless there was two sources of power. That means that no surgeries could be started if the utility power was out or the emergency generator was offline. Any started surgeries that were started could be completed. When we lost utility power, the lights didn't even blink in the ORs. All OR equipment kept running like there wasn't even a problem. When the building first opened, we had a lot of power loss until they put in a dedicated line to our building. The generator would start with the loss of power automatically. Our backup generator had a major problem and while it was under repair, we had a trailer mounted generator brought in and wired to the system so surgeries could go on. In my 25 years at that facility, utility power was our only problem. I had a direct phone number to them, so I did not have to go through channels to get the system restored ASAP. Lastly, no surgeries could be started unless a facility engineer was on duty, which was always. That was more than just power. Oxygen, OR air and vacuum as well as HVAC was under our control and responsibility. He had to be there 1/2 hour before the start of surgeries and stay until the last surgery was completed. I'll stop here before this becomes a book.

[@bellefeu4933]

Never forget being scrubbed into a case doing 2 simultaneous pts in adjacent ORs for GSW ex laps, open bellies, 3am, ready with crash carts and zolls for crumping pts, entire room goes dark out of absolutely nowhere. Machines clinking off attached to red backup generator plugs, out. Everything out in the entire room, all at once, buzzing and screeching noises for a fraction of a second followed by a deafening silence. Nobody said a word for probably 10 seconds kind of, "oh shit". Room stays pitch black for 30sec until we find a flashlight to aid surgery, stays black with manual bvms for a full 5 min until it resumes. This is a massive lv1 trauma center that accepts patients across multiple states lines as it is the biggest in the region. Somebody hit a mainframe transformer off the highway drunk driving. Both pts fine. Absolutely wild.

[@lbrookesahm465]

I just found your channel. It's awesome. But as I just had surgery ten days ago, my anesthesiologist is so lucky I didn't discover you before my surgery. I would have asked her so many questions. Not anything worried about what she did, but I would have loved to hear what she had prepared, and what her plan was.

[@Husamtarawneh1]

I recently experienced a power outage in my OR. An emergency cut off power button was accidentally pressed and all power even the emergency back up was turned off. ( I believe it's a safety feature in case of fires I'm not sure? ) And to make things worse the anesthesia machine battery backup system was faulty that it did not hold charge and was turned off immediately. Lesson learned that day is to always check the batteries by removing the power cable to check for battery backup system.

[@filanfyretracker]

I am surprised the machine did not self test its batteries. I have a fairly basic APC UPS on my gaming PC and it self tests monthly, surprised a machine that actually runs a life critical operation does not warn of a failing battery or charge system.

[@neillthornton1149]

I was very fortunate to work at a few hospital's operations and facilities crews. The guys that run the cogen and emergency backup plants take their work very seriously. If you have more than 30 seconds of power loss, something has gone very very wrong. In the most unique setting I have dealt with, the hospital ships USNS MERCY and USNS COMFORT have gigantic battery banks that provide continuous power to critical medical equipment (vents being one type) while the engineers could re-align power generation to get the main feeds back online.

[@PsRohrbaugh]

I wonder if there's a documentary on these engineering systems. That sounds incredibly interesting.

[@marklelt]

When I worked in ICU all the bedside equipment was on the emergency backup circuit so when ever there has been a power failure the battery has only had about 5 seconds use until the emergency diesel generators are online. All wards in our hospital also have critical power outlets at each bed, which are specifically on the emergency generator circuit. I know other critical hospital infrastructure also has its specific emergency power set ups, such as the Pharmacy's walk-in fridge unit (which easily can be holding >£1,000,000 in stock, and thus cannot afford to lose power for longer than a few hours). As to how often it's happened here (im in NW England), we have planned generator tests, but its happened genuinely a few times over 15 yrs of my practice.

[@AlbornozVEVO]

video notification hits different when you practice in a country where power outages are commonplace and affect hospitals too.

[@calfeggs]

Coming from IT, UPS backup batteries are often overlooked for years till they fail critically. I imagine hospitals have regular equipment maintenance testing. But it's absolutely imperative that those batteries are tested properly and replaced when necessary.

[@darriontunstall3708]

Good info! I learned a lot! It takes a special person to be an anesthesiologist or CRNA and you’re one of them! I really enjoy donating to the anesthesiologist Foundation, since it was hard for me to go to college because of my cerebral palsy, I really wanted to be an anesthesiologist physician! Happy new year

[@richardmillhousenixon]

I live far from a fault line, and most hospitals around here typically have 3 backup generators, any one of which can pick up the load for all essential equipment. They're on a rotation, with at least one being fully functional, and one being on standby. Only 1 of the 3 is allowed to be down for maintenance at any given time. A lot of them are dual fuel, able to run on both natural gas and diesel/kerosene. Because we aren't on a fault line, a power cut is unlikely to cause a loss of natural gas at the same time, but they still have enough diesel on hand to run independently for at least a day or two.

[@panzertorte]

I think everyone watching is left with one burning question - if all your screens go down early on, would you advice the surgeon to abort the procedure or do you continue "on manual" until further notice? Would you reschedule an rapidly upcoming surgery if you already KNOW the power is out?

[@MaxFeinsteinMD]

The answer of what to do depends on factors such as: How far along in the surgery are they, how urgent/emergent is the surgery, is it possible and/or safe to complete the surgery vs. end early, and other related factors like these.

[@michaelmcgrail6522]

Great coverage, we have been doing a loss of power simulation with our CA1/2s.

[@nextgen00]

Bro, The way he turns the selection wheel on the monitor, you sense mastery. Like Max Vestappen who manages the steering wheel of his formula one 😅👌

[@Uaua881]

I hate Anasthesiology during my clerkship, but your style of lecture has giving me some interest in this field, really interesting doc

[@benbookworm]

In my hospital, we have to do monthly generator tests. Maintenence will come check what's functioning and not. In my pharmacy, I think at most 2 (of 20) computers go down. While they do work, our sterile room and drug carousels are disrupted during the switch. Everything else continues as normal.

[@billybassman21]

The last hospital I worked for has two diesel generators large enough to provide 100% backup power to the whole facility including HVAC. They added a second generator a few year after it was built in 2006 when I hurricane hit in 2008. The red plugs and some lighting come on about 10 second after the outage and a few second later everything else. That isn't typical though, most hospitals like the hospital one I'm at now just have the red plugs, IT closets and some lighting, don't think any of the chillers function. We had an outage 2 weeks ago, was really missing my old facility where everything functions normally. I wish more hospitals would invest in being able to power more than the bare minimum.

[@GreggBB]

Fantastic information! Thanks for addressing this topic. I will guess for a power outage during surgery the pucker factor must be high

[@stillthakoolest]

Electrician here - arent the receptacles for all these ventilators and devices on the critical and life safety branch of the Essential Electrical System at the hospital? They should really be on battery backup for no more than 30 sec. while the generator picks up the load. Good video!

[@hackmiester1337]

Sure, but imagine the case of a faulty circuit breaker, cable cut, etc. - still some potential sources of prolonged outages.

[@PsRohrbaugh]

Why in the heck do you have pure nitrogen? Is there ever a situation you'd want to go hypoxic below regular air? I know nothing about surgery, but am a technical SCUBA diver and am very familiar with hypoxic gas mixes - but only at many atmospheres of absolute pressure (so your partial pressure of oxygen remains near atmospheric). So yeah why do you need it in an operating room?

[@MaxFeinsteinMD]

Great observation! Nitrogen is actually not piped into operating rooms, but it’s in this simulation lab to drive some of the pneumatic processes that power the simulated mannequin.

[@414s4]

Having worked in a large hospital system for over a decade, I’ve become very familiar with hospital power in the US. There should be three distinct categories of power available, normal with no protection, power backed up by generators, and power backed up by a ups and generator. The later won’t see any blip even if commercial power is down. The one exception is if plant operations doesn’t follow the proper procedures when doing maintenance on the level 1 trauma center’s ups, and fries it. All hell breaks loose when that happens. Good thing for batteries in vents, and other critical equipment.

[@paulkoza8652]

All this is good to know. There are Plans B, C, and D. But how often does this happen for and extended time period?

[@MaxFeinsteinMD]

It's very rare. Most anesthesiologists in the US will not experience a power loss in their entire career.

[@tomgoggin3865]

All of these videos are fascinating, informative, and entertaining to watch. Very well done.

[@sherrydawson6253]

Omg all your videos are so interesting. I'd have to say though i wouldnt even be a nurse in OR if that happened. But u have such calmness to you ,that your voice alone would keep the room calm all while takeing care of all your serious tasks. I have a qeustion. Can u do a video on how everything is handeled if the surgery was on a carotid artery and the cauterazation machine caught fire and u knew the pt and drapes ignited? Its like youve been an anesthesiologist forever. Once done with everything any hospital would be blessed to hire you.❤❤❤❤oops was trying to get thr comment in then heard u say u have a fire what u do. Now thats fast answer. Thank u. 😊❤

[@JacobConkin]

Hi Max, question for you. What is the difference between Medical Air and normal air, and why do you need medical air in addition to O2?

[@MaxFeinsteinMD]

Medical air has been specially filtered and also comes at a specific (dry) humidity level. We use that in combination with pure oxygen because delivering 100% oxygen to certain patients can actually pose a health risk (particularly babies and people who have received a cancer drug called bleomycin) and can actually cause lungs to not function as well under anesthesia.

[@rfitzgerald2004]

As an IT guy myself it seems odd to me that priority spaces such as operating rooms aren't fully covered by a UPS backup which could hold the power until a generator starts up. Is there a reason they don't do this?

[@zephyfoxy]

I was thinking the same thing. Server rooms have entire walls covered in batteries to bridge the gap, why the hell wouldn't an OR have full-room battery backup lol

[@atburke6258]

A timely subject with many sources predicting power/grid shortages ramping up in 2024.

[@UnknownPerson-cl9di]

It's insane how the most important part of medical is engineering

[@ChadOhman92]

Healthcare IT here - most if all hospitals with ORs have generators that will kick on within 90 seconds of a power failure. Most of not all ORs have conditioned power that are connected to battery backup and won't see an interruption if a power failure occurs.

[@SlothOnMeth]

We had a failure of all monitors due to IT outage. The displays next to the beds straightup didn't work.

[@ChrisCapoccia]

What drives the hospital oxygen flow? Do they have big pressurized tanks? Or pumps?

[@MaxFeinsteinMD]

Big pressurized tanks

[@richardmillhousenixon]

If it's anything like oxygen storage for industry, it's refrigerated liquid oxygen kept under partial pressure in insulated tanks. It's kept liquid so they can store way more oxygen in the same volume. It boils off fairly easily, so they can keep a constant pressure in the lines, and vent any excess safely away from the building.

[@Mistersky46]

What if the batteries on the infusion pumps have also run out? Can you continue anesthesia by hand, like propofol?

[@MishaElla94]

I see no reason why you can't. It's administered by hand when you're first anaesthetised, and bags of fluid like saline are gravity fed very regularly so i suspect there's a similar set up for syringes in theatre so the anaesthetist has free hands for everything else. Edited to add due to below correction, yes anesthesia can be continued to be administered by hand, but not propofol evidently!

[@henriquelaydner4080]

As shown here, inhaled anesthetics can be delivered without power supply, so they could substitute propofol infusion to maintain the patient unconscious. In the event of a formal contraindication to inhaled anesthetics, then yes, you could try to emulate the continuous infusion using an app to calculate the infusion rate, but it would be cumbersome. Ideally we would rather use other IV anesthetic that could be given in a bolus dose, knowing that the patient would most likely have a delayed recovery, given the alternatives usually have longer times to be metabolized. The same reasoning applies to the infusion of remifentanil.

[@henriquelaydner4080]

@@MishaElla94, the continuous infusion of propofol and remifentanil, to mention only the most common drugs used for total IV anesthesia, are meticulously controlled by specific algorithms that will, at any given moment, inject each one’s exact amount solely to maintain the stipulated plasmatic concentration. This allows us to have fewer adverse effects and ultimately a smoother and faster wakening after surgery. To reproduce this by manually injecting them is very difficult, if not impossible.

[@MishaElla94]

very interesting, thank you! I was running purely on my experience with fluids as a ward RN, glad to be further educated, much obliged. @@henriquelaydner4080

[@PsRohrbaugh]

​@@henriquelaydner4080see: Michael Jackson

[@mattbrown817]

I have not been faithful in our KZbin relationship Dr. F I am ashamed to say I've been watching... music videos. Music videos save lives but not anymore as much as your teaching so I shall put on my scrubs and report for duty.

[@Mike-b3v]

Fortunately I have been many places. And unfortunately I have seen very old equipment being used. I won’t say where but when you see a post it note with Bat-missing * backup broke You kinda wonder how did I end up here.

[@DamonJohnCollins]

These battery backups are there to stand in until power can be restored, either by generator or plugging into an alternate circuit. You would not expect to continue a procedure relying on just that battery. In the case of a utility outage, generators will restore power (to essential power systems) in less than 10 seconds (code required and tested monthly). I think you mentioned this in another video, but, if an outage should occur, it's important clinical staff figire out the nature of the outage. Besides backup generators, there are many other redundantcies built in place to protect patients in critical care locations (like an OR). Power receptacle went bad, there are extra (in critical care locations, 2 per circuit); circuit tripped, plug into another, in an OR, you have several per panel; if the panel lost power, power is provided by another as 2 different panels are installed for an OR (both are located in the OR for staff access); if the power source of that panel were to fail, the second panel is fed from another source. All this is to protect the patient from all sorts of outage conditions. From utility power outage, to electrical equipment failure to outage resulting from construction/maintenance occurring elsewhere in the building. I hope this helps. Great video Max... Keep them coming.

[@donotcare330]

They really need some serious 10,000 va APC battery backup banks behind the walls for these surgical rooms and twist-lock plugs. :-)

[@rhr-p7w]

Does that equipment include a way to connect an external battery, for example a car battery? I mean on the aftermath of a quake

[@wolfgirl618]

You should do a Q&A!

[@sib113]

Hey didn't you done the same topic about this before?

[@MaxFeinsteinMD]

Yes! This video goes into more detail than the prior video.

[@sib113]

epic!@@MaxFeinsteinMD

[@Boodieman72]

If it's just in one operating room would you ever just move to an empty operating room during surgery?

[@henriquelaydner4080]

It’s not impossible, but very unlikely. Even more than experiencing such a scenario. Moving patients around is one of the most challenging things in a hospital, more so when they are in critical condition, which is exactly what an anesthetized patient being operated is, no matter how healthy he was prior to surgery. In most cases it would be safer to work around the electrical problem and proceed in the same room.

[@GM8101PHX]

I am thinking most all hospitals have generators that automatically come online to power the operating rooms, ER and other areas of the hospital, then once the generator is powered up all the equipment comes back on and automatically recharges the batteries so there is constant electrical power!!! We have generators backing up the jails as well!

[@MaxFeinsteinMD]

Yes hospitals in many countries (including mine, the US) are actually required by law to have backup generators.

[@emilysmith6897]

It's like in aviation, you have to train for what to do in the event of a loss of power.

[@slakishmi643]

Hi bro l am. From India it is little bit difficult to understand the flow of your english please include the subtitles this request from India please

[@KindnessObimba]

My question is if general anesthesia is excessively given isn't there a neutralizer to dissolve the drugs

[@HmmmmmLemmeThinkNo]

Depends on the drug. Propofol doesn't, and fentanyl does, for example.

[@gir489returns2]

Oh god. It makes the same noise the McDonald's friers make. When I'm on my death bed, the last thing I'm gonna hear as the power goes out is that damn beeping.

[@LEGENDARYPartyonwayne]

Nice work doctor!

[@ingridfrisinger9522]

Why does the surgery room have a backup generator?

[@jakubkavka653]

It does not, the whole hospital has backup generators that power the whole hospital

[@bungus2414]

I'm totally not going to look at that urban legend about the hospital janitor the same again.

[@bungus2414]

For those that don't know there was an urban legend where people kept dying in scary numbers at a hospital icu and what actually happened was the janitor was unplugging life support to plug in a vacuum. I would feel terrible for the janitor as well as everyone else.

[@JimAllen-Persona]

@@bungus2414 You have any idea how many alarms would go off if that was actually true? In a similar vein, we had a facilties guy that went into clean our server room and literally hit the kill button for the entire server room when he just meant to hit the button that unlocked the door.

[@frotoe9289]

@@bungus2414 We had a similar problem at a university computer facility located on a floor of the library. Apparently one of the new custodial hires hadn't gotten the proper briefing on how to clean the data center and between 2am and 4am every few days, a rack of servers would lose power, then 10 or 15 minutes later, it'd come back. Then another rack on the other side of the room would lose power similarly. Finally figured out it was a custodian unplugging operating systems and plugging in his cleaning equipment. And shortly afterwards we finally (after years of requesting it) got permission from higher authorities to take the data center off the master facility key so the custodians had to come in only when staff was present. Catching a custodian pawing through grades on printed sheets wasn't enough to convince the administration, but this bit of idiocy got their attention.

[@Mark_Ocain]

You still use Iso?

[@PsRohrbaugh]

Every operating room have a bottle of chloroform and a rag, "just in case" 😂

[@houseclearance7509]

How do you think they would manage in Gaza if the power went out and it became like an Army field hospital. Alan Alda would not be there either...

[@Simon_the_penguin]

No one gonna talk about that terrifying dummy he’s using

[@Ms.Opinionated]

Thank you as always for educating us Meer mortals. 😂

[@thesethese-t6j]

Hello max, i am an anesthesiologist in Europe, i m 34 , i want to go to the us and do anesthesia . is it to late ? am i old ? can i match and repeat residency ? please advice

[@philmiller2465]

I'm not Max, but I know someone who studied medicine in the UK (pre-Brexit), and then trained in Anesthesiology at Metropolitan Hospital in New York City. I don't know whether she matched or applied directly, but I do know that hospital does accept some non-match applications.

[@philmiller2465]

Separately, mid 30s is definitely not too old to be accepted into US medical training. I personally know at least a few others who are doing residency from that starting point right now.

[@almaxie342]

Get me to another hospital if this one doesn’t have backup generators.

[@MaxFeinsteinMD]

Mt. Sinai Hospital has a very robust backup generator system.

[@Twinsen764]

Wait a minute, so has the power gone out when you were working on a patient?

[@kristinchong629]

🎉🎉🎉

[@ligram630]

Second!

[@Drkorimd]

Third 🙌🏾

[@EmM-ko7mu]

still scared

[@JimAllen-Persona]

Step 1: Fire the facilites manager for doing a DR test during business hours. Step 2: Move the generators out of the basement.

[@martinpena4544]

First!