Contents of the Anesthesiologist's Medication Cart in the Operating Room

[@MichaelJTritter44]

Pharmacology and medications are my favorite things. It's just fascinating to me and I really like how you can do soo much with it.

[@MaxFeinsteinMD]

I agree! The focus on pharmacology is one of the (many) appealing aspects of anesthesiology to me.

[@davidsoto4394]

How do they teach doctors to deliver bad news to a patient or their family? I am asking because I would imagine that doctors are not allowed to lie to a patient and they should not be giving false hope to a patient.

[@davidsoto4394]

@@MaxFeinsteinMD Two questions. Do you beleive in allowing CRNA to take over the jobs of MD anesthesiologist? What is your opinion on CRNA?

[@MaxFeinsteinMD]

@@davidsoto4394 Where I went to medical school, we received lectures and had practice sessions with paid actors on delivering bad news. You are 100% right that doctors should not lie to patients.

[@MaxFeinsteinMD]

@@davidsoto4394 I think the best scenario is CRNAs and MDs working together to provide anesthetic care, not one overtaking another. I think CRNAs have an important role in helping care for patients, which is distinct from the role that physicians play.

[@Sousan0587]

I am a pharmacy student. We don’t get into anesthesia drugs, I used to think they were completely different drugs . It was interesting knowing they are everyday common medications. So this was a great video.

[@MaxFeinsteinMD]

Glad you enjoyed! There are controlled substances that weren't covered in this video which we commonly use, but I think they're also medications you'd learn a lot about as a pharmacy student (eg. fentanyl, hydromorphone, remifentanyl, etc). Thanks for watching!

[@evacraik1332]

I totally take back ever thinking anesthesiologists just sat around while the surgeons did everything! This is so fascinating!

[@Voyager23B]

Dr. Feinstein - I’m not in the medical field, but this video piqued my interest as I am having orthopedic surgery in a few days. This was excellent information as I had no idea what an anesthesiologist did in the O.R. except for pushing propofol and monitoring vitals. Fantastic compilation sir!

[@reddbendd]

Depends on the state. The anesthesiologist might only be there for the beginning and end of the surgery. Or there might be no doctor at all. It could be a nurse anesthetist, which I would promptly bang if you ever get a chance because they r LOADED

[@LS-se3ei]

My goodness no wonder the color coding tape. Thank you for sharing such detail and insights. I have a deeper appreciation for the doctors whom keep me safe and comfortable during surgery. Exceptional quality with the video. 👏

[@MaxFeinsteinMD]

Thank you! I'm glad you enjoyed and got a peak into what we do.

[@Rue100]

Anesthesiologist have ALL my respect my God you people have such an IMPORTANT job ...im having surgery in November next month and im praying that everything goes great ...

[@MaxFeinsteinMD]

There is definitely a lot of responsibility when caring for someone under anesthesia. I hope everything goes well for you during your surgery!

[@Rue100]

@@MaxFeinsteinMD thank you!!!

[@MaxFeinsteinMD]

You're welcome!

[@FA-18EF]

​@MaxFeinsteinMD you make my pre-surgery anxiety only a quarter of what it was! Much respect for anesthesiologists

[@nickbrumpton1606]

Thanks Max I have been nursing for the past 44 years in the uk The way you put the information about what you do is brilliant Keep up the great work Will continue to follow you in the future

[@craigpennington1251]

I've had a lot of surgeries over the years and am very glad that they have all those things as needed. You guys do a phenomenal job every day and a Huge Thankyou for keeping all things right. Great video too.

[@ginngerhearth7136]

thank you! Being a two time kidney transplant patient myself, I found this quite interesting to watch and learn.

[@MaxFeinsteinMD]

Glad you enjoyed the video!

[@gravityhashira8877]

I’m currently studying to be a pharmacy technician and your videos have kept me interested and wanted to learn more. I also love how for each of the medications there is a label that’s easy to read and what’s more when the medication is being described there is a super clear description on the side. Everything about this video is super helpful!

[@lulumoon6942]

Very interesting tour! It''s nice to hear as a patient how prepared the team is for different surgical emergencies, especially as someone who's had them! 👍🙏❤️🌈

[@MegaPoliyo]

In the UK we have an anaethesia room attached to the OR. All our drugs are there we do the induction and all procedures in the anaesthetics room before transferring patients to theatre. Also we have an assistant with us at all times so if I need any drugs the assistant can grab them for me.

[@M157-04LLY]

Glycopyrrolate used for SLUDGE -salivation -Lacrimation -urination -Defecation -gastrointestinal -Emesis

[@MaxFeinsteinMD]

Great mnemonic, I use this often!

[@markarca6360]

Beta-blockers are second-line antihypertensive meds. First-line antihypertensive meds are Ca-channel blockers including amlodipine and nifedipine.

[@embrykendrick4517]

As a 4th year optometry student, I rotated through a referral center. My first assignment was to memorize the contents of the crash cart: name, MOA, indication, routes of administration. I'll bet things have changed over the intervening 30 years.

[@rjyeezy76]

For optometry school?? In case someone jabs their eyes to death or what??...

[@embrykendrick4517]

@@rjyeezy76 RSFA, rapid sequence fluorescein angiography. Requires injection of a 5 cc bolus of sodium fluorescein. Rarely induces anaphylaxis. Usually patient just vomits.

[@steveabraham3052]

Dr. Feinstein, this was a great video 👍🏾 Thank you for sharing & please pass along a special thanks to the chief resident who narrated the video & provided the details regarding the drugs in the cart. I look forward to one day embarking on the anesthesia journey myself... CRNA that is 😁 I hope to see more of your videos as you progress through your journey as well. Thank you again for sharing 👍🏾

[@MaxFeinsteinMD]

Thanks for watching Steve! Glad you found it helpful and will let Dr. Fagelman know.

[@ashleyaniyankunju5971]

Actually I hate pharmacology in my student period... But I passed all exams without coping... Years ago I struggled so much Cuz my pharmacology knowledge Was very lack... Still now I trying to learn.. I like This video ...thank you sir

[@vickyburton2434]

Color coding is such a smart thing to do. I love your vlogs; I learn so much. Blessings from Texas!

[@MaxFeinsteinMD]

Thanks again Vicky! I wish I could take credit for the color coding. That is one of many standardized strategies to reduce medication error, and I’m very glad that’s routine practice.

[@TheBalls55]

I loved pharmacology and was planning to be an anesthesiologist , but ultimately chose Radiology.

[@MaxFeinsteinMD]

Nice, I'm sure that's an interesting and fulfilling career, too!

[@davidsoto4394]

@@MaxFeinsteinMD Do you beleive that premedical students should be taught by physicians and not by scientist and researchers because I beleive that doing this would make premedical education better and more clinicly relevant?

[@officalJalgara]

Dude Anesthesiologist and Radiology is like 3 million miles apart, why would you do that...? hope Ultrasound, CT, MRI and PET's are compensating for the fun you could have had learning what you loved being an "anesthesiologist"

[@hb2998]

Yes and no. As a physician in an academic setting who knows a ton about my field, I don’t really remember that much about many of the basic sciences or have kept up enough to discuss it in detail. I had a very science heavy undergrad so I came in to medschool solid on many of the basic sciences but medschool is just so much information that some of my undergrad courses were summarized in one single slide. So.. I don’t think practicing physicians are really equipped to go over the basic sciences in that level of detail. But yes, I do agree with you that the curriculum should be heavily guided by clinical practice. I remember in my medical school we spent 2 weeks on mycology while we spent 3 weeks on the physiology, pharmacology, pathology, histology of the renal system. As a practicing physician, my knowledge about mycology makes up around 0.05% of my practice while the renal is pretty important.

[@TheBalls55]

@@officalJalgara Radiologist have alot of freedom and independence. I didn't want to work in the OR most of the day with a pain in the ass surgeon .

[@lauraeager373]

Super interesting, not just as a premed working in a clinical setting but also as a veteran patient. I’ve undergone multiple surgeries and endoscopic procedures, which will include two next month. Will check out your other videos

[@HmmmmmLemmeThinkNo]

Okay this video calmed my anxiety about going under significantly, bc I am already at least vaguely familiar with most of these drugs, and there's only two that I shouldn't be given in normal circumstances. Of course i'll talk w whoever my team is when I go in for my surgeries, but the relief is here nevertheless. Thank you

[@nurshark10]

Hey, Max! I’m an RN and love your videos. I have a question: Who counts your drugs? Is it done between cases? Is it done at the end of the day? How do you reconcile your drawn up drugs that you may not use. Do you waste it with a witness? We do drug counts, as nurses, between shifts. If a drug or portion of a drug is not used, it must be wasted with a witness who signs the sheet with you. I’m just curious as to how the drugs are accounted for and who is responsible to whom when counting drugs -especially the narcotics, paralytic, etc. Thanks for your very interesting videos. Deedi

[@kgrfirdjy]

at the hospital where I worked for a little bit, all controlled substances were stored in a Pyxis locking medication safe which would only open one medication drawer at a time for controlled substances. at the start of each shift, the charge nurse and a pharmacist would download records of which meds, including controlled substances, were used on the previous shift, the number of dosing vials // pre-filled syringes that should be remaining, as well as if any meds needed to be restocked. Our department also had at least 1 RSI drug box in a separate safe that could only be unlocked by the charge nurse during emergencies such as status epilepticus or code blue events. Any time we had to waste controlled substances, a second nurse // pa // doctor // dentist // pharmacist would sign off as a witness of the medication wasted. Beyond that, there were security cameras, audible, and silent alarm systems to prevent theft. Unfortunately, if you made a typo on the quantity of controlled substances remaining, your account would be locked and you needed to call the pharmacy and security to unlock it to get out any other medications from the safe, regardless of whether they were or were not controlled substances, meaning you could accidentally get locked out and not be able to get meds people needed in a hurry. This was what I worked with about 10 years ago, keeping in mind that systems get upgrades and changes over time.

[@bobbylucas2914]

Anesthesia has always been something that interested me. I've had over 70 surgeries and always wondered how it it was done

[@DeAngeloYouKnow]

Damn why have you had so many surgeries?

[@lauraeager373]

I’ve had a lot of surgeries and GI procedures under MAC or general anesthesia. Learning about the meds used due8mg anesthesia is interring

[@usernamehere94]

Hello Doctor Feinstein, I'm aware of several non-depolarizing paralytics, pancuronium, vecuronium, cis-atricurium, rocuronium etc. What determines which agent is used, is it based on hospital policy/availability, duration of action/onset, patient specific indications/contraindications, provider preference? Thank you for producing this content, please continue as you are able.

[@MaxFeinsteinMD]

Hi Aaron, great question. We tend to prefer rocuronium at my hospital, I'm assuming partly because it's one of two non-depolarizing paralytics that has a direct reversal agent (sugammadex aka Bridion). The other reversible paralytic is vecuronium which you mentioned. Vecuronium and pancuronium both cause changes in hemodynamics where as rocuronium does to a lesser extent, which is probably why it's used more. Mivacurium, atricurium and cisatracurium are in a different class of paralytics and neither have reversal agents. I believe they have higher incidence of histamine-related side effects like hypotension. I've only used cisatracurium for kidney transplants since their metabolism is completely independent of the kidney. Hope that helps!

[@DarkKn1ght430]

Favorite video by far. Very informative

[@MaxFeinsteinMD]

Thanks so much!

[@gingerd45]

I was so terrified of having anethesia that I almost didn’t have breast cancer surgery. Took me a month to get up the courage to make my surgery appointment. The dr gave me Versed right before going into the operating room and it sure helped calm me down.

[@MaxFeinsteinMD]

Yes, I've had it once before a procedure and can confirm it helps considerably with pre-procedure jitters!

[@witatter1]

@@MaxFeinsteinMD that’s good to know! I’m having hiatus hernia and fundopliction (probably not spelled correctly) in about 10 days. I’ve had plenty of surgeries but this one has me nervous even now. Btw, don’t know why I never thought you guys had a med cart in the or! Guess I just had other stuff going on.

[@coffeepandacat]

The one time I had to have anaesthesia was when I got my wisdom teeth done 9 years ago. When I was waking up, it felt like only 5 minutes had passed and I felt amazing when I woke up. It was a strange but intriguing experience.

[@lauraeager373]

Wisdom teeth was my first time under anesthesia

[@gregoryholstein3033]

I just discovered this channel and I love it, great content & presentation is fantastic. New sub. Cheers.

[@AroundSun]

Several questions. 1 - have you yourself ever been anesthetized for surgery? If so, how old were you and do you know what was used? 2 - I recently had an appendectomy and I think they used Propofol, but...I remember prior to injection the doctor put a mask over me and said it was oxygen, and I'm sure it was, but I started to get the same smell/taste that I had when I was 5 years old and broke my arm and was put under gaseous anesthesia. So do you think that occurred? 3 - Do you ever use two anesthesia's? (Gas/IV) If so, why? What are the pros and cons of gas versus IV?

[@MaxFeinsteinMD]

Hi there, these are great questions: 1- Yes I have, I was a young child and I'm pretty certain a gas anesthetic was used, probably sevoflurane because it has the least unpleasant smell compared to others. 2- The masks tend to have a plastic smell that itself is a little odd, maybe even unpleasant. It's possible that's what you were smelling. There's also a small chance there was still a small amount of anesthetic gas still in the circuit and you could have inhaled a tiny bit of it, but I think that's less likely. My bet is that it was probably just oxygen and a strong plastic smell. 3- Yes, occasionally I do mix gas and IV anesthetics. There are some surgeries that essentially require IV anesthesia with remifentanyl+propofol in order to keep a patient completely still without actually administering paralytics (spine surgery, brain surgery). I also prefer propofol for patients who have higher risk of nausea/vomiting because it can help prevent it. Otherwise anesthetic gas is usually a fair option for a lot of surgeries that require general anesthesia.

[@baijunair1720]

Can u make a video on dilution of each emergency drugs...like ionotropes,pressure,dialators,antiarrythmics,steroids,bronchodialators etc...would be really helpful...

[@markarca6360]

Albuterol is known as Salbutamol (Ventolin) outside the United States.

[@HisNameIsRobertPaulson01]

The first time I had surgery back in 1994, I think I had a bad reaction to something. I went in for a 'scope on my knee and it was supposed to be an in and out the same day type procedure. I remember waking up, having a hard time breathing, dry heaving and it wouldn't stop. I couldn't hold anything down and I was actually admitted and stayed overnight until it passed. I still have uneasy feelings when thinking about that day. I can't remember what I was told the cause of it was.

[@mrquarters1]

I had a Heart Transplant in 1992, and was wondering if you can respond to my question on here? I would like to know what was used when I had my Tx in October 26th/92 to knock me out? What was all given to me? Please fill this space of question in my mind that I've had for the last 30 years for me. GREAT VIDEO. And Thank you.

[@Crymeariver227]

@mrquarters1 You may find that answer in the OR notes from your surgery, of which a copy would be in your medical records. Or, if you have it, look at the itemized bill from the transplant surgery. Not sure this doc could tell you what was used on you 25-30 yrs ago. Good luck!🍀

[@sherrydawson6253]

Wow thats a pharmacy rt in 1 drawer. So I thought prophanol spelled that wrong is used in alot of surgerys. So if u can't have it in your drawer do u order it ahead of time? Also I'd like to know how do u keep the pt under through out the surgery? As some cases go longer then planned. Like at what point do u know to push more meds? Thank u this was very informative.

[@MaxFeinsteinMD]

Hi again Sherry,! You're right that propofol is used very commonly. In some hospitals, there's a special locked cart that required a code/fingerprint to open (this is called a Pyxis machine) which stores controlled medications like propofol. In my hospital, we order it ahead of time from a special pharmacist near the OR. If cases go longer than planned, we can always get more (during the case) from the pharmacist, although that might require someone else to physically get the medication since we're in the OR with our patient the whole time they're under anesthesia. We base our medication dosing (ie. when to push more meds) with clinical goals, like keeping a certain heart rate, blood pressure, or brain-wave reading (EEG) that indicates the extent to which someone is anesthetized. Hope that helps!

[@sherrydawson6253]

@@MaxFeinsteinMD thank you.Have a great weekend!!"

[@grantdenton554]

What was the name of the drug that made me feel so relaxed and happy even though the opthalmologist had just punched a hole in my eyeball to give me a new lens. Anesthesiology is my favorite.

[@MaxFeinsteinMD]

Most likely midazolam

[@lilbatz]

Way cool! Now we know why we feel like the hot mess express after OR. Amazing you can keep it all straight.

[@jimmybonse7151]

The one I was most curious about, Haloperidol, didn’t get mentioned. I’m somewhat familiar with its use as an antipsychotic but can’t imagine what it’s purpose would be in anesthesia

[@MaxFeinsteinMD]

In low doses, it can be a pretty effective anti-emetic

[@antismatic]

You also give it to patients who are freaking out and at risk to themselves or others. May not be comforting to know it's there as a patient, which may be why it wasn't discussed.

[@vancouveropenbsd985]

I initially read hydralazine as hydrazine. I was momentarily surprised to see that rocket fuel was an OR drug.

[@kaidosbuddyagaindoberman9119]

Dr Max. I have a ? Brag I sure if you have covered this topic but having shown a friend your videos, my friend Chris asked a great question that maybe you could cover sometime. What tool(s) and procedures do you have and use to monitor patients in surgery that assures they aren’t feeling the surgery as the famous horror stories we have heard about. People who weren’t sedated enough and had to endure the horror of it all. Think it would be interesting for people to learn how this is handled, since surely it is a pre-surgical fear many could have.

[@powerbuilt2008]

What are "secretions"? Are these terrible pains in the muscles (locked up, e.g. cramp) after paralyzing agents are wearing off ?

[@lucianomisitrano]

Hi, do you ever use atropine before neostigmine instead of using glycopyrrolate? Also, I didn't see sugammadex, do you ever need to use it or do you try to avoid using it and why?

[@johnpaul3889]

Man im glad I found this channel. I aspire to go into CRNA school one day! 💯💯🤞🤞

[@MaxFeinsteinMD]

Glad you enjoyed the video! Hope to see you in the OR one day

[@nickrobinson5895]

I’ve seen sugammadex used much more frequently to reverse rocuronium. I’m curious what your thoughts are for that?

[@butchdavid127]

In the latter part of my career I replaced a lot of these with Pyxis A-systems(not call that anymore). Are you getting those or something similar?

[@outoftheklosset]

Toradol is a saving grace for me! I'd much rather have an injection of Toradol than a narcotic after surgery even tho I usually have to negotiate it bc of bleeding risk.☺️

[@MaxFeinsteinMD]

Yes it’s a very effective medication!

[@justahugenerd1278]

Same here! I had it during a nasty trip to the ER--saved me from so much pain that day. God bless!

[@mkcottawa]

Thanks for this. Is dantrolene not stocked in the cart in case of Malignant Hyperthermia?

[@mkcottawa]

Just watched the MH video so I found the answer to my question. Cheers!

[@mariahgosling3478]

MS3 curious why glycopyrrolate and neostigmine are used for reversal instead of sugammadex? Thank you!

[@MaxFeinsteinMD]

It's really hospital-dependent and probably just comes down to cost at the end of the day. It used to be that sugammadex was more expensive than neostigmine, but I believe both drugs have had considerable price adjustments in recent years. Different hospitals are able to negotiate different prices with drug distributors, so it really just depends on specific circumstances. One other consideration is that sugammadex can theoretically render oral contraceptives ineffective for up to a week, so it's not ideal for use in elective surgery on a woman of reproductive age on OCPs.

[@mariahgosling3478]

@@MaxFeinsteinMD Thank you for the information! Please keep the videos coming for the budding anesthesiologists!

[@RoyaltonDrummer922]

It's crazy how much control over our bodies they have

[@E7R1I6C]

Question: does this only apply to operating rooms and not the ER. Meaning, pharmacy is only open at a certain time and you can't get controlled substances, is it different if working in the ER as an anesthesiologist?

[@The_New_Abnormal_World_Order]

I was surprised to see a label for haloperidol at the back. I would be interested to know which kinds of situations this would be needed during anaesthesia?

[@MaxFeinsteinMD]

Post-operative delirium and also post-op nausea/vomiting prevention.

[@Pazos311296]

Amazing video! Keep up the nice content, I'm currently searching for my specialty and anesthesia might be it

[@MaxFeinsteinMD]

Thanks Felipe, I appreciate the kind words. I *love* anesthesia and would be happy to answer any questions about picking it as a specialty! For what it's worth, I was considering internal medicine and emergency medicine prior to anesthesiology.

[@Pazos311296]

@@MaxFeinsteinMD Being from Brazil, things here are quite different when it comes to specialty choosing (EM is basically non existent here, the field is 5 or 10 yo). In the end I'm pretty sure anesthesia is where I'm going, just wish we had the same program dynamic and cool stuff you have in the US. I'd very interested in seeing more about Mount Sinai program, which is what you channel is all about. Keep up the good work!

[@davidsoto4394]

@@MaxFeinsteinMD I am not in medical school but I find surgery and anesthesiology to be interesting. Is it possible for someone with Cerebralpalsy to attend medical school in the future and after completing all required traning and testing can someone with cerebralpalsy become an anesthesiologist in the future?

[@davidsoto4394]

@@MaxFeinsteinMD Excellent video.

[@MaxFeinsteinMD]

@@davidsoto4394 Hi David, good question. I think it depends on the level, if any, of physical manifestations of CP that might limit the ability to do certain physical tasks. When I was filling out paperwork to apply for or start medical school, I vaguely recall some documentation I had to sign indicating that I would be physically able to do some physically demanding tasks that were only loosely described. Stuff like CPR, having reasonable visual acuity to see monitors/paperwork/computer screen etc. I wish I could find that form. Anyways, I think this is a great question to ask a medical school admissions dean (even if you aren't ready to apply) to get a more insightful answer.

[@misskarinaleigh]

Such a cool video. I just love pharmacology!

[@roxyali9815]

Hello, I would like to ask about studying for a doctorate in anesthesia technology in the USA. Is the specialization available?

[@XSemperIdem5]

What's your go to alternative for patients allergic to both Zofran and Reglan?

[@MaxFeinsteinMD]

Hi there, I would make sure the patient got decadron at the beginning of the case (assuming no contraindications) and would also tailor my anesthetic plan to include propofol, if appropriate, as it has antiemetic properties.

[@kyledeitz2760]

We also use Haldol at my institution if no contraindications.

[@kamsononso7567]

How do you keep all these names and their purpose memorized

[@geddon436]

Given two patients who are the same weight, same height, but one smokes and the other does not, jow does that effect type of medication and doseage?

[@MaxFeinsteinMD]

I probably wouldn't change anything about my medication types or dosing, but I would take more time as I prepare the patient who smokes to emerge from surgery. That's someone who I have more concerns about their ability to breath without any problems as the anesthesia wears off and I remove the breathing tube. Smokers are more susceptible to issues like bronchospasm, which is where the lungs kind of freeze up temporarily in a way that effectively stops breathing altogether. I've seen that once in a patient (who happened to be a smoker) and was able to treat it with epinephrine through the IV. Anyways, smokers' lungs are just more sensitive/delicate during surgery so I have to be even more on guard for issues that can arise.

[@geddon436]

@@MaxFeinsteinMD i enjoyed your explanation

[@AudyMP]

Thank you, Dr. Feinstein. Interesting to watch your video. I would like to ask you. Is there no ranitidine and sodium metamizole in your cart? In Jayapura hospital, these two medications are usually administered together with ondansetron. Greeting from Indonesia

[@MaxFeinsteinMD]

Hi Audy, thanks for watching. We don't use ranitidine or sodium metamizole as far as I'm aware. I don't know why those wouldn't be on formulary or part of our daily practice - I'll see if I can find out!

[@markarca6360]

Ranitidine (Zantac) is administered orally as an antacid.

[@markarca6360]

It differs on a per-country and per-hospital basis.

[@ZbyKamen]

Great video. I just wanted to ask, is Dantrolene sometimes a part of your cart, or do you specifically only stock it when a patient has a history of malignant hyperthermia?

[@MaxFeinsteinMD]

Thank you! We have several separate MH carts strategically located in our OR clusters.

[@LaurenE1991]

I love you mentioned this, MH isn't brought up enough. I have it a long family history of it. Alot of people also have no idea what it is. When I say I have it most people ask what it is. Takes so long to explain.

[@jacobking2864]

You mention the regulated drugs you will/did make a video for has that been done yet, if so what is the title of that video? I love your content!

[@DavidTiptonJr]

Do you keep sugammadex on hand since you're utilizing roc?

[@MaxFeinsteinMD]

Yes, we have sugammadex nearby but not stocked in every cart. We typically use neostigmine for reversal.

[@PalmPeakMarketing]

When I was in the hospital for an asthma attack I had the albuterol through the IV

[@IslandBabe-bj4ig]

for a patient with bronchospasm while under anesthesia, why would you give a MDI instead instead of a nebulized treatment?

[@MaxFeinsteinMD]

Sort of guessing here, but I think MDI is just easier to open / administer in the OR, especially when bronchospasm is suspected and we have to do multiple interventions very quickly. We don’t stock nebs in the cart, I’m assuming for that reason. I’ll ask an attending, I’m curious too.

[@Inflamarie]

Not a doctor, but I’m assuming it’s for speed, I’d like to know the answer officially thought

[@Questavitabella]

What are other reasons if any besides in a case of cardiac arrest or to abort an allergic reaction that an anesthesiologist might push 1mg of epinephrine while under general?

[@MaxFeinsteinMD]

The only reason I can think of to push a full 1mg of epi under any circumstance is cardiac arrest. Even for an allergic reaction, I would only dose 100mcg (which is 10% of 1mg) at a time. The only place you'd probably see people pushing 1mg epi for conditions ranging from arthritis to sneezing is Grey's Anatomy lol.

[@Questavitabella]

@@MaxFeinsteinMD haha I don’t doubt that they haven’t in one of their episodes! So if 1mg of epi is pushed with 80mcg of Clonidine then would the purpose of that combination given be that a patient is hypertensive and going into cardiac arrest or that a patient went into cardiac arrest and it caused hypertension?

[@nickiedannunzio3827]

Are those Medline SensiCare Silk nitrile gloves that she is using in the following KZbin video sized in size extra small or sized in size small on her hands

[@22Squiggle22]

I saw there was naloxone. Is that used in case too much fentanyl is administered?

[@MaxFeinsteinMD]

Yes, fentanyl or any other narcotics we use like dilaudid.

[@christiankrueger8048]

Thank you!

[@a3minutevideo737]

Thank you ❤️

[@arminarlert1953]

So basically being a Pharmacist and Anesthesiologist kinda overlaps? Is just that the latter is MD right? Just askin 🥲

[@MaxFeinsteinMD]

Intuitively it would seem like that, but the reality is that the knowledge base and clinical expertise is actually quite different. A pharmacist wouldn’t be able to do any of the procedures I do, nor would I know much about how to dose meds outside the realm of anesthesia like a pharmacist does, for example.

[@arminarlert1953]

@@MaxFeinsteinMD ohhhhh thank you so much 😊

[@gagegesch9733]

Im in 9th grade and about 2 weeks ago i started getting interested in pursuing being an anesthesiologist ive been watching your videos and wanted to ask if there is any advice you have for a high school student maybe any classes or subjects to study in?

[@MaxFeinsteinMD]

Hey that's awesome! I actually made a video where I include advice for highschoolers who are interested in anesthesiology. That video is called "Become an Anesthesiologist - Career Advice from an Anesthesia Resident" if you want to check that out. Let me know if you have any other questions. Thanks for watching, future Dr. Gesch!

[@lapislazarus8899]

I've worked in veterinary medicine, and was always taught to not handle an uncapped Sharp with both hands. I'm just curious?

[@MaxFeinsteinMD]

I’ve seen various methods of handling sharps being taught. I don’t know of one that’s been demonstrated to be safer than another- a lot of it seems to be personal preference, or what a person learned from the person who taught them.

[@babonjuguini1563]

Sux and roc is not refrigerated?

[@MaxFeinsteinMD]

They are refrigerated and then pulled out of the fridge when the carts are stocked.

[@pinkysplawn7453]

Having surgery on December 23 👌 next Friday

[@steveroesler5194]

what do you typically use the haldol for?

[@MaxFeinsteinMD]

If someone is very disinhibited when they wake up, haldol can be helpful. But also it can help control nausea and vomiting, so I occasionally use it for that indication, too.

[@steveroesler5194]

@@MaxFeinsteinMD thank you!

[@JKarstadt]

Shadowing an anesthesiologist tomorrow and I’ve forgotten 98% of my pharm over the summer after MS1😭

[@MaxFeinsteinMD]

It takes lots of repetition to learn the pharm!

[@insignia9325]

Question from a subordinate: why paralytics? What do the paralytics do beneficial in a surgery?

[@geddon436]

How do you calculate dosages for patients?

[@MaxFeinsteinMD]

Most medications I use have recommended weight-based dosing, however everyone's body responds differently so I always consider changing doses up or down depending on how much or how little effect I need (eg. medications to lower blood pressure). Great questions. Hope that helps!

[@geddon436]

@@MaxFeinsteinMD what book would you recommend someone read about anesthesia? Specifically, leaning about how reading a patients vitals on machines dictates at what times during the procedure you adjust meds?

[@MaxFeinsteinMD]

Hey sorry for late reply. There’s a good book for starting to understand anesthesia, and it’s called Anesthesia Made East by Jeff Steiner. Hope that helps!

[@M157-04LLY]

Wait did I just catch that that EPI was 1:1000 and she said we can use this whole mg for cardiac arrest? ....😅 maybe that was intentional. It’s just scared me for a sec 😂 .....😳 great channel. Subscribed Forsure

[@MaxFeinsteinMD]

You pay very close attention to detail! The stock image I grabbed from Google shows 1:1000 (Dr. Fagelmen didn't mention the specific dilution) but what we have in the carts is 1:10,000. Thanks for subscribing!

[@M157-04LLY]

#1) I want to say thank you for replying to comments etc. #2) i have a question... I REALLY want to be a anesthesiologist. It has been my dream for ever. So i guess the question is, how and where did you start? What did you get a bachelors degree in? What kind of study time did you put in? Did you work while going to school? How old were you when you made this decision? Is there anything you wish you would have done differently? Did you have any field experience prior to going into this career? What steeping stones did you take ? It would be awesome if you could make a video talking about how you got to where u are now. Much respect. Like i said iv never had a chance to talk with someone about this and I’m sure in not the only one curious. Thanks man, I appreciate you.

[@FezCaliph]

Fentanyl is used in anesthesia? I learned something new today.

[@theavideventer]

What is the difference in roles between an anesthesiologist and a CRNA?

[@MaxFeinsteinMD]

Hi Lindsay, an anesthesiologist is someone who went to medical school and became a physician, then later did a 4-year residency to specialize in anesthesiology. A CRNA is someone who went to nursing school to become a nurse, worked in an ICU for at least several years, then later did an additional ~2 years of training in anesthesiology. In practical terms, CRNAs work under the medical direction or supervision of an attending anesthesiology. It's often the case that there will be 4 operating rooms that each have a CRNA there the whole time, and then 1 MD who floats between the rooms. Hope that helps!

[@nikhil4316]

@@MaxFeinsteinMD From AANA it seems like CRNAs only need 1 year of ICU nursing experience.

[@coreyjohnson6239]

@@nikhil4316 that is the minimum required although the average is 3 years

[@passion5554]

@@MaxFeinsteinMDMost CRNA programs are 3 years in length with it being 36 months of non-stop training.

[@rban123]

Looking at all these medications makes me feel like I'm going to pass out

[@MaxFeinsteinMD]

Sorry, I know it can be nauseating to look at this stuff!

[@Jemalacane0]

Why would you use haloperidol?

[@MaxFeinsteinMD]

Either when patients wake up very delirious, or as an alternative medication for nausea control.

[@michaelcapdevilla7872]

But why so many drugs and medications do you use all of it In case or is some on standby for an emergency during the surgery

[@MaxFeinsteinMD]

The vast majority of everything in the cart is standby just in case it's needed. We have so many different drugs because they accomplish lots of different effects that may be needed during surgery.

[@michaelcapdevilla7872]

@@MaxFeinsteinMD makes sense cause you never know what may happen and you have to be on the ready the whole time

[@LS-se3ei]

I noticed you had gloves on and not for preparation of patient. Any particular reason why this video use of gloves?

[@MaxFeinsteinMD]

No particular reason for using gloves in this video, other than to just keep everything extra clean since Dr. Fagelman was handling quite a few vials of medication that will be used for many other patients.

[@proudsanatani461]

Great video🎥 ❤

[@navysealteam5584]

I want to become a nurse! What are the highest paid nurses for the littlest school time? I am planing to go to the navy first tho!

[@MaxFeinsteinMD]

I'm not very familiar with careers paths for nursing, sorry!

[@navysealteam5584]

@@MaxFeinsteinMD oh ok that’s fine

[@passion5554]

BSN nurses can make good money while only working 3 shifts of 12 hours. Average salary of a BSN RN is around 70-80k w/ experience. Graduate level nurses get paid more depending on the speciality. Hope that helps.

[@navysealteam5584]

@@passion5554 That’s for the Info! I need to update the post because I’m going to join the Marines!!

[@pistolannie6500]

Freaked out deer in the headlights look... LOL

[@Juandinggong]

I will have some Ketorolac. Best stuff to revealing pain.

[@vaibhav1374]

Good video

[@MaxFeinsteinMD]

Thank you!

[@rachelmoore3931]

Me watching this video like I don't stock anesthesia stations at work everyday 😅

[@mikeschulte4271]

Those r small ass vials wow thought they were bigger. Very interesting thanks for the insight

[@FezCaliph]

Small vials, but highly concentrated

[@menelausjonliboon7488]

what's the best pre med for Anesthesiologist?

[@Obgavin10]

Essentially the same for any premed path -- biology, biomedical sciences, neuroscience, stuff like that!

[@jameslong9564]

I saw haloperidol. One dose can mess you up for a long time. Better known as Haldol.

[@brendaeberwein8338]

That's so interesting

[@nitramluap]

Not much of a fan of everyone giving dexamethasone as a first line anti-emetic these days... we seem to be forgetting it's still a decent corticosteroid dose and not without lots of other unwanted effects.

[@michaelcapdevilla7872]

I have to large scrotal hernias I'm seeing the general surgeon Tommorw morning .I'm very scared of this. I know there are many risk from the beginning to the end to trying to come out of this .

[@rjyeezy76]

Hello Michael. General Anesthesia is quite safe. I would not worry. Increased risk of having an adverse reaction is more commonly seen in patients who are either elderly and/or have a serious pre-existing health problem. The doctor will administer a medication beforehand to help you relax. And when the procedure is complete you wont recall any of it.

[@michaelcapdevilla7872]

@@rjyeezy76 well I don't want anything. Before surgery. And I have asthma High blood pressure high cholesterol enlarged prostate

[@michaelcapdevilla7872]

@@rjyeezy76 I don't want to be so drugged up I don't know what is going on before the surgery even starts. That's important to me

[@michaelcapdevilla7872]

@@rjyeezy76 that s another concern memory loss of cognitive function. I do have a life and I don't some surgery to make it worse for me .I'm fairly active I work at Dunkin doughnuts here in Daytona beach Florida and I want to get back to what I was doing before surgery I'm hoping he can do robotic surgery there are loops of small intestine on the left side in the scrotum and right is higher up but still at top of scrotum

[@rjyeezy76]

If your blood pressure is already being managed with prescription medication it won't be a problem. The same goes for asthma. For example, my father has athsma and had had three surgical procedures over the last five years- No problems.

[@abddfa5234]

No pyxis or codonics?

[@MaxFeinsteinMD]

No in-OR Pyxis at my hospital, but we do have them in the PACUs. We get our controlled medications from the OR pharmacists.

[@abddfa5234]

Max Feinstein, MD Ok thanks for the info!

[@michaelcapdevilla7872]

I many other concerns that go on in the or after a patient is under

[@MaxFeinsteinMD]

While it's true that a lot can potentially go wrong, there are many precautions taken to minimize risk in the OR!

[@michaelcapdevilla7872]

@@MaxFeinsteinMD yeah they have to less or no complications is better. And the skill of the surgeon and other or staff but more weighs on the surgeon and you guys .plus the patients overall health

[@mustlovedogs5569]

Where are the muscle relaxants and emergency drugs?

[@ReclusiveMountainMan]

subscribed.

[@MaxFeinsteinMD]

Thank you!

[@nathanbarnes3969]

I saw a Haloperidol label at the back of the drawer, and I’m deeply concerned: I’m pretty sure that it is strictly forbidden to administer antipsychotic medication to someone that is unconscious? Or do anaesthesiologists have special authorisation to use it in some circumstances? If so this is news to me. If I woke up and learnt that I’d been given antipsychotics under anaesthesia I’d be furious

[@MaxFeinsteinMD]

Haloperidol in low doses can be an effective anti-nausea drug. It can also be an important medication for keeping delirious patients calm on emergence from anesthesia, which can be a dangerous situation for the patient as well as healthcare providers taking care of them.

[@nathanbarnes3969]

@@MaxFeinsteinMD Ahhh okay this makes sense, thanks for the info Max