Vital signs monitoring for anesthesiologists, explained

[@wulfgar9119]

You should be a Professor of Anesthesiology.... you teach this subject very well. Your students would love you!

[@harveypraz7962]

Professors need to have crazy high research outputs, nothing to do with teaching ability.

[@marcusfelten8823]

@@harveypraz7962 I would also guess they have to be very well established as well with research and work and stuff, probably makes it were mostly only older people get hired as professors

[@NickzAndMikz]

@@harveypraz7962 not entirely true. Depends on the institution

[@hospitaldrive1232]

@@harveypraz7962 Not necessary true!!! Research is being done somewhere in this world every second. A professor educates you and it's your job to take in what you've learned and also continue educating yourself.. From your comment I take it your in the medical profession so you should know this is why we always have "Conferences often in multiple states" ",Meet the standards of continuing education yearly" etc. I've seen many Anesthesiologist and others who teach within a year of graduation. As you know there's levels to education. Honestly Max is doing an awesome job at what he's doing. He's educating on levels that many can not do no matter how much "Research" they do. Some are phenomenal at their profession however they can not delivery information to others.. Kudos to all of us in the medical profession!!

[@benbookworm]

An important aspect of all medical practice is teaching! Starting even in medical school, students that are further along instruct/tutor/mentor younger students. Doctors are always teaching other doctors and medical professionals (for example, attendings supervising residents and interns), as well as their patients.

[@robertmatheson9542]

I used to work in an OR as a young man at 20 years old, as an orderly. When I had some free time moving patients back and forth to the OR, I used to stand and watch the anesthesia and the surgeons working. On my first day on the job. Dr. McNamara was doing a lung resection. He called me over to the surgery table and had me take a look into the chest cavity at the heart beating inside the patients chest. I was just so amazed I knew right then that I wanted to become a surgeon, though I did not become a surgeon it was an outstanding experience that will stay with me for the rest of my life.

[@csc1641]

Last year, I had two surgeries in 24 hours. So thankful for the skilled doctors during this scary time. You are so smart . . . much respect.

[@spongebob1849]

Love your videos! I don’t understand why some people are like Max is just staring at a screen thinking about vacation while the surgeons do all of the work. You’re labeled as the “guardian angel”. I think they don’t get enough credit like the surgeons do. Without them, the patient wouldn’t be alive.

[@obstressed1193]

Literally, they don't receive their due credits instead receive some kind of inferior behaviour in some parts of world. Anesthesiologist is working all the time, not getting distracted despite of having a live surgery in front of him he keeps monitioring all the things. Little bit of negligience and person is gone, anesthesia is like controlling all the vitals of person and giving the surgeon a ready field to just work, but the great field is made by anesthesiologist, maintained by anesthesiologist and no batsman can success if the field only is bad.

[@megyoung9303]

Each staff member in the surgicAL suite is a TEAM member. Always keep that in mind.-

[@rormarina9610]

No :231: /7

[@daniellefennessy5198]

I had major surgery months ago, and had so many questions after I woke up. I’m just in utter awe of science and all that you and surgeons do. It’s been so much fun learning from your channel!

[@chrisp8856]

Max, you’re also a great teacher. I hope the hospital appreciates what you’re doing. Your videos not only inform the patient, but lessen the fear of a surgical procedure by understanding the different steps and why they’re used. Thank you.

[@akickedable]

Spent some weeks in an icu after a bike crash and for the part i was off sedation i got the chance to observe doctors and crna's in action for about 72 hours, before i was discharged to the trauma block. I cant find words to explain how impressed i am with what you guys are doing, its just amazing. Plus everyone was super friendly and talking to me, which really helped me with recovery.

[@robhtwo]

My wife of 21 years is a surgeon and I like to watch things about her job so I can understand better when talking with her about how her day was or at a table with her doc friends at home or at conferences. Your videos are funny and very informative, some of the best I have seen. Keep up the great work!

[@MaxFeinsteinMD]

Thanks Robert I appreciate that!

[@brendaeberwein8338]

​@MaxFeinsteinMD your videos are very informative. I've never known about the EKG and all of the things that go on but always wanted to understand. Now I know something about how you anesthesiologists keep your patients alive in surgery. Thank you for all you do. ❤

[@Ro.Lin13]

This was amazing, gave me a good reminder as to why I’m even studying for the MCAT to begin with. You’re a godsend Dr. Max, in the future can we get more day in the life content and maybe in feature a few cases?

[@DavidMorseMusic]

I watched a bunch of your videos before my surgery, and when the anesthesiologist brought me in he was extremely impressed when I basically narrated all the prep he was doing. Made my surgery much less stressful!

[@AroundSun]

I had an emergency laparoscopic appendectomy a few years ago during Covid, they had to quickly assemble a team at like 2am. I was very impressed by the anesthesia team and the surgeon who did the work as well as the helpful nurses. When I came back to from the propofol I felt like I was falling from the sky on my back and the second I hit the ground I jumped up in the bed and they held me down for a minute. Then I quickly remembered what had happened and why I was there. I thought they didn’t start yet but they were already done and I felt great. I apologized and they laughed at me saying they expected that reaction when I came to. They then said nighty night and injected something in my IV and out I went for another few hours or so. Very respectable at the perfection and attention to detail that goes into this line of work that is dealing with the very essence of life and pain, and threading the needle with the very delicate balance of life and death. putting in the years and life dedication to learn it all, master it, and respect to those who put in the time to teach it so the knowledge may continue to be passed down to each generation.

[@paulamucinga118]

Absolutely love your humbleness...

[@BuickDoc]

Are you talking to me? Well I am humble... Perhaps the most humble man in the World! (Stolen from the movie, "Camelot", Lancelot to Guinevere.) BTW That is one of my favorite movies...

[@phyllojoe5346]

I'm not sure why but you starting this video wearing all the monitoring equipment was the funniest thing I have seen in a long time!

[@JJ-dt2vb]

Your videos are awesome. My 13 year old son is interested in a career in medicine and we've been watching all your videos. Very informative and my son loves to see and hear about it all.

[@MaxFeinsteinMD]

This is so wonderful to know! Wishing your son all the best, hope to see him in the ORs down the road.

[@amalexander7711]

Your videos really helped me to get over my fear of general anesthesia. Thank you so much!

[@MaxFeinsteinMD]

I'm really glad to know that!

[@hixiegirl]

Retired OR RN. I really enjoyed your presentation. Your manner is calm and reassuring for patients. Very matter of fact. You could put me down any time!

[@ProbablyBees]

Thank you for making such wonderful and detailed videos. I have a surgery in 2 weeks, first time I'll ever be under general anesthetic, and watching through what the preparation is, what devices will be used and how my doctors will be sure I'm OK has greatly reduced my anxiety over it all

[@muzala_pm]

He seems to love what he does

[@jackiemainard2576]

You make everything so understandable! I'm not going to be a Dr but I always feel a little smarter after watching your videos!

[@googlelocks4131]

Your humor is so natural and effortless. MORE MORE MORE!!!!!!

[@keeneyeful]

Anesthesiologists; not just the pre-game show :D I had no idea the depth of what anesthesiologists do, thanks for the entertaining and very informative vids!

[@paigeb5107]

I love your videos. I am in nursing school studying perioperative nursing for lecture. I enjoy getting a chance to see it from an anesthesiologist's point of view.

[@George-ni5ic]

I was on the core team from the beginning that developed the patient monitor used in this OR. My role was the user interface design. The team in Milwaukee that did the development on this was spectacular without exception. I’ve never worked with a group as talented as this before or after. It’s gratifying to see this in use!

[@medic2021]

That’s awesome I wonder how you guys compete with Philips which is popular in my area

[@charlesperry9521]

Excellent video. A mature, friendly, common-sense delivery. A credit to yourself and your hospital. Keep up the good work.

[@TheCatlover1968]

These videos are very educational for those curious patients. Thanks Max

[@d4rk0v3]

When I was 13 my GP and ENT ended up determining that I needed a tonsillectomy based on the threat to my breathing at night, my tonsils were frequently so enlarged that they caused sleep apnea. I swear this is a true story. I remember it vividly. The anesthesiologist picked up quickly on how inquisitive and hungry for knowledge I was and my effort to understand what was happening. The last thing I remember before going under is that she asked if I wanted to knock myself out. I said that sounds cool! She held my hand and guided my thumb as I pressed the plunger on the syringe. I only made it about 1/3 of the way into the dose before my next memory which was talking to someone that definitely wasn't in the recovery room and they were wiping tears from my face. They said everything went well and that I would be moved into recovery soon. From then I don't remember anything until I was coming to again in the recovery room and the nurse offered me to sip some sprite.

[@megyoung9303]

Sounds like good medicine..the staff treating you as a 'grown-up' and offering you some real warmth!

[@jamestamu83]

I've learned a lot in just watching a few of your videos. Had no idea so much was going on, and the number of drugs that can be administered! Thanks for doing these informative videos and talking at just the right level of technical speak so that the average person can understand what you're saying. I've subscribed and forwarded links to my friends. Fascinating stuff!

[@intrepidtomato]

These are so good. I am having a series of small procedures that require general anesthesia, and I love understanding the setup a bit better because I'm (besides really scared!) also very curious about what happens during surgery and the waking up phase before you make proper memories again.

[@marciaricksgers2018]

You really rock! If I’m having surgery in my future, I’ll review these videos to grill and impress my anesthesiologist, lol

[@MaxFeinsteinMD]

Nice let me know if that ever happens haha but hopefully you won't have a reason to meet an anesthesiologist

[@MSUSpartansRock]

I'm a veterinary nurse, and our anesthesiologists at the teaching hospital taught us that monitors are great tools, but nothing is better than your own senses. We were encouraged to use our ears by inserting esophageal stethoscopes, our eyes by looking at the patient- eye position, color of mucus membranes, is the chest rising and falling. We should touch the patient- how tight or slack is the jaw, are they warm, cold, hot? At the teaching hospital we had all sorts of monitors. In some private practices, they may not have anything! Love the content!

[@MaxFeinsteinMD]

Yes you're absolutely right. Even in an academic setting at a big hospital where we have an amazing amount of equipment at our disposal, sometimes issues come up and we can't use the equipment so have to rely on foundational physical exam skills.

[@pilotmark2861]

When I started working in the OR 50 years ago, I remember charting under anesthesia used “PANIS” Pentothal, Atropine, Nitrous, Inovar, Sublimaze. Anesthesia machines had N20,O2, with their bottles hanging off the side, Cyclopropane ( highly flammable), Flouthane. Ethane and Penthrane for the halagenous gasses. Monitor equipment was no more than a manual BP cuff and sphygmomanometer, Bird PR-1 ( old green ) respirator. non disposable rubber masks, breathing circuits, Datascope EKG monitoring. Even the old Puritan Bennett suctions were reusable glass bottles, rubber tubing and metal Yankauer suction tips. ET tubes and airways all reusable. Anesthesia techs would decontaminate them using Cidex.

[@samuraisoul2]

I enjoy your videos! Great sense of humor and professionalism and great explanations! As a stroke survivor, I would be very comfortable with you monitoring my anesthesia. You represent your profession with honor!

[@r.v.niddrie9111]

Hello from Chilliwack Canada. Cancer will soon result in my bladder and prostate removal. Hope my Anesthesiologist is as fantastic as you. You rock

[@ALdawg1994]

Hey Max, love your thoughtful, informative videos. As an M1 interested in anesthesia, I was just wondering if you'd be able to make a video of tips and advice for med students interested in going into anesthesiology and what we can do at each stage of training to help prepare(e.g. pre-clinical years, clinical years, research, etc.). Would love to see it!

[@MaxFeinsteinMD]

Hi ALdawg this is a great idea, I'm adding it to my list. Thanks!

[@okirokoth4446]

I'm an Assistant Physician Anesthetist in Kenya and I find your teachings good

[@lisamorrison4636]

amazing video, really hope you continue this throughout your residency and beyond

[@MaxFeinsteinMD]

Thanks Lisa, I appreciate that!

[@benburns5995]

Great video with helpful information. Never thought of a persons Oxogen rate decreasing when the Blood Pressure is being taken on the same arm. It is very interesting to watch these videos and find out all the Anesthesiologist does while you are knocked out cold for surgery.

[@jeffersonviverosjaramillo370]

I appreciate all the time you spend making these videos Dr. Feinstein. These are really useful videos, I would like to see more videos like this. I am just starting my residency of Anesthesiology. Greetings from Colombia.

[@MaxFeinsteinMD]

Qhubo! Thanks for the nice feedback. Where are you in residency? I spent a year doing research in Bogota (la PUJ) and Cali (la ICESI) back when I was interested in infectious diseases, before I saw the light and did anesthesia.

[@jeffersonviverosjaramillo370]

@@MaxFeinsteinMD Q'hubo, jajaja... I can see that you didn't learn about infectious diseases exclusively, that's nice. I'm doing my residency at the "Universidad del Valle" in Cali. keep going with your channel, I like it.

[@MaxFeinsteinMD]

That’s awesome man. My anesthesia mentor in med school happens to be Colombian and also studied at UniValle. Best wishes on your journey to Anesthesia!

[@DianaCollins-kf7vu]

Love your videos. As a Board-certified Ob/Gyn I diagnose and care for many breast cancer patients. It would be informational for a lot of us as Ob/Gyn attendings as to how you adapt anesthesia procedures for mastectomy and reconstruction patients. For example, where do you place BP, temperature, and ECG monitors given the surgical site would preclude the usual placement of these monitors. Also how do you keep the patients warm given the exposure of the surgical field. In Ob/Gyn, a Pair Hugger device is placed on the upper body and keeps the patient warm while we operate in the abdomen or vaginally.

[@MaxFeinsteinMD]

Hi Dr. Collins, thanks for your feedback! There's always a place to attach monitors, sometimes we just have to get a little creative. For breast surgery, EKG leads go on the back. If we can't use a patient's arms, BP cuff can go on the leg (or we can place an arterial line). Temperature probes can go basically anywhere-- nares, esophagus, axilla, temperature probe on a Foley, etc. In addition to upper body Bair, we can either do lower body or underbody.

[@davidcoyote8921]

Thanx for a great quick education. The true art in your job is establishing every individual baseline which can rapidly change with every surgery. With so many different ages, races, general health status only experience can teach. Thanks.

[@donotcare330]

1:39 "THE MATRIX" - That was a really nice touch, max :D .

[@Nitroprusside]

Thank you for your vids man, I've taken an interest in anesthesia and your videos are great for getting to know the specialty better

[@MaxFeinsteinMD]

Glad you like them!

[@aben5366]

Your channel is awesome! As an incoming M1 interested in anesthesia, these videos are everything to me. How about a vid about anesthesia's role/plan of action during intraoperative emergencies like patients crashing, MH, code hemorrhage, difficult airways, etc. Keep it up!

[@philorida]

I've been enjoying your videos. One thing I really like is which finger you choose for the oximeter. It makes sense but I noticed some other people don't do that. I love learning little tricks that stick with me.

[@brasschick4214]

It’s a great video for non-medical people. I thought about anaesthesia as a specialty until actually acting as the anaesthetist (as a senior med student under supervision of course). It was a cycle of constant checking, relief, increasing anxiety leading to checking, relief continue ad finitum. The surgery went well, patient was fine… me, hmmm it was an experience 😂

[@insomniaperennis3949]

Thank you so much for another video. Love the way you teach and explain the procedure. Great Doctor

[@frankieo3479]

Wow your amazing ...and hold everyone's attention.. Your great

[@explorer914]

I think you got a great employer that allows you to make your videos i their facillities. 😊

[@KD0LRG]

It is a win win for the hospital, great teaching video and also a great resource for patients to get informed.

[@MaxFeinsteinMD]

Yes, the anesthesiology department at Mt. Sinai has been extremely supportive of these videos, including letting me use equipment (which costs money) to film.

[@markfitzgerald7760]

When I had surgery to fix a distal radius fracture the trainee (not sure exactly what they were) put the pulse oximeter on my operating hand. The surgical nurse politely called it into question, and the trainee quizzically stated that it needed to go on the opposite arm as the blood pressure cuff. The nurse gently got them to realize that a pulse oximeter on an extremity that had a tourniquet cuff on it wasn't going to work during surgery...

[@jennmcgraw7878]

Thank you for these great videos. I love the info on the variety of vitals monitoring, within the surgical procedure. Would you consider discussing vitals and responses in the recovery room? I had hand surgery during which, everything was fine during the surgery but a little different in recovery. Once I was more "awake", the nurse kept asking me to take deep breaths and not fall back asleep. Then came o2 via nasal. They ended up calling anaesthesia because come to find out I kept desating, even with o2 support. A few minutes later I had a whole lot of bedside visitors including my surgeon, anesthesiologist, and just a mess of people. Things get a little muddled at that point but obviously I came out just fine! I woke up again in a different part of recovery, nrb,and a nurse who wouldn't leave the monitors. Hours later I was much better and begrudgingly sent home but with a warning to tell any future anesthesiologists that this happened. Though I'm not Sure what 'this' is. I'd love to hear about some post op scenarios where this could happen. Thanks!

[@halsmee]

Your presentation is very interesting and readily understood. Things have come a long way since the days of ether on a folded piece of cloth (the only thing I remember about my tonsillectomy in ca. 1945). Keep up the good work!

[@michaelburatovich3199]

Wonderfully clear, cogent explanations. Well done.

[@tedk2814]

Hello Dr. Feinstein, I just came across your channel and enjoyed watching and listening. I am 74 years old and retired from a 42 year career as a nurse anesthetist. Since retiring in 2016, I truly missed the operating room activities and anesthesia. I have been truly blessed to have had that career and miss it to this day. So I live in one of those exotic far away places named Florida.. Retirement communities abound here and are affectionally known as cataract farms. I'm wondering if it was ever your department's policy to include BIS monitoring ? We went through a phase here where it was required on all GA cases. Thanks for making these videos as I read in the comment section, many have expressed appreciation for an inside look at anesthesia monitoring. Well done! Ted in Sebastian, Fl.

[@ShyAnn291]

This is such a great video, I’ve had several surgeries so I’ve been under anesthesia quite a lot.

[@angie0719721]

One of the most important people in the room.

[@bfg9000d1]

I was drinking ice tea when you said some strange place like Florida or something I practically blew all of the tea out of my mouth and onto my laptop screen. hilarious

[@MaxFeinsteinMD]

LOL I was trying to think of an exotic place and Florida is the first one that came to mind.

[@medic2021]

As someone who knows some Floridians I approve this message

[@Elliot6060]

Dr. Max Feinstein, thanks for ALL your videos! Now I understand better why I did “NOT” become a physician (anesthesiologists). I was very interested in anesthesia and maybe you should think of explaining the difference between a Nurse anesthetist vs. MD, or anesthesiologist ! Besides the obvious! Thank you again for ALL you done with these informative videos! Elliot N. Herzel

[@MaxFeinsteinMD]

Thanks for the nice feedback and also suggestion for a possible future video!

[@Ps119]

Thanks for the video. Helps me understand my surgery.

[@LaurenE1991]

I'm glad you mentioned Malignant hyperthermia. I have to explain it to so many Dr's when they ask about allergies.

[@FreelancerFreak]

I'm just a EMT but I love your channel

[@megyoung9303]

Freelancer...do not forget.,..each team member is important to pt. care. Starting out, I did numerous hours as a student EMT in the ER. Asked a bazillion questions, learned to closely observe and report s/s, saw some very interesting surgeries (most plastic surg) the staff didn't want me to leave. Be proud and be the BEST EMT ever...frequently leads onto higher level spots in the medical career path. (Paramedic?, nursing, etc......) Best wishes to you, Meg

[@shetom6353]

You are highly intelligent. I love your videos. Amazing information.

[@sherrydawson6253]

I agree. U should be a professor at least part time as iits obvious u love your field. I love your videos. Not sure how I missed this one.your so awesome.

[@davidadams9391]

Kool video Dr Max. Very informative! Keep them coming! Good to see you!

[@jerrysabatella8881]

Very well explained takes a away some of the anxiety of surgery great job !!!

[@refractor007]

Hey max, love the videos, I have a weird side interest in anaesthesia because I'm MH susceptible. It'd be great to see a video on the different ways you prep and precautions you take for MH susceptible or risky patients some day. Keep up the great work! ❤️🇦🇺

[@MaxFeinsteinMD]

Great idea for a video! Thanks for following along.

[@cookiesandcoffee6269]

Hey Max, I was wondering if you could make a video with tips for studying during intern year/residency. I am a fresh intern and am feeling overwhelmed by the sheer amount of things I am supposed to know. What did you do? Read some pages of the go-to textbook each day after work? Keep a notebook? Do qbanks? I'd appreciate any tips!

[@MaxFeinsteinMD]

Hi cookiesand coffee, great idea. Would it be more helpful to see a video about intern year doing non-anesthesia rotations, or PGY2 year with a focus on starting the anesthesia training?

[@cookiesandcoffee6269]

@@MaxFeinsteinMD Hmm, both would be helpful, but PGY2 maybe more so, because the knowledge we are supposed to have is more specific.

[@katwelch3042]

I have a minor spine birth defect I didn't even know I had until it was mentioned in an x-ray report. When I mentioned it in passing to the anesthesiologist during a pre-surgical conference he said I should avoid any spinal anesthesia as it would be higher risk for complications.

[@katherineejessup]

I’m wondering if the complication they meant could be arachnoiditis? I have that myself but I’m not allowed to have any spinal injections including epidurals. It’ll be basically cause more scar tissue to develop in the arachnoid layer of the spine which would cause more scaring and more pain.

[@sherrydawson6253]

I love when u show your equipment! I always wondered what the wave line on bottom of monitor was. So can u do a video of normal co2 looks like compared to abnormal ones and from what conditions and your response would be. Love your videos! Thank u

[@MaxFeinsteinMD]

Hi Sherry, thanks as always for following along! Great idea to discuss different capnography waveforms. In the future I may make a video like that.

[@sherrydawson6253]

@@MaxFeinsteinMD awesome!

[@AJohnson0325]

A normal waveform looks almost like a square but a little slanted on the left and top. If the waveform is flat then most likely the ventilator circuit is disconnected somewhere. Cardiac arrest could also cause this. Another one is a shark fin shaped waveform where it’s very sloped on the left. This is from a bronchospasm. If the baseline is elevated and the FiCO2 is elevated then either you have an exhausted soda lime or a broken valve that’s causing you to rebreathe CO2. Usually it’s the soda lime and it will be all purple too. Those are the most common ones. If the EtCO2 is unusually high of course we would have to. consider malignant hyperthermia.

[@sherrydawson6253]

@@AJohnson0325 wow thank u.

[@sherrydawson6253]

@@MaxFeinsteinMD oh yes do one. Not only will help nurses who aren't aware, med students as well as me. I just got a education from 1 of your followers. But would make fir a good video especially if u have pics how it changes and why. Love your videos! I swear if I get 1 more nasty anesthesiologist I will refer him to your channel!

[@starfishgurl1984]

I love this! At some point in the future I finally want to have post weight loss skin removal surgery as my excess skin’s been bothering me for the last 3-4 years, but having never needed surgery (other than one to reattach my cut nose as a toddler), it’s nice to know personally what to expect as a patient!

[@gracier2718]

Can you do a video about nerve blocks if you do those? I got an interscalene nerve block for shoulder surgery a few months ago and I am wondering if they leave the catheter in during surgery and if they can administer more meds through that during or after surgery. I'm pretty sure my anesthesiologist taped something to my neck but not sure because he gave me something to relax. I also could move my index finger slightly after surgery but when I got home I was not able to move it so I'm wondering if he gave me more. You should also do a video of a simulation of anesthesia before during and after so we can kind of figure out what happened when we were in la la land

[@MaxFeinsteinMD]

Great idea for a video, I'll look more into it!

[@gracier2718]

@@MaxFeinsteinMD Awesome!

[@lisamoroney3036]

I have a question. When I had my orif surgery to my boxer Fx the anesthesiologist said she had to give me a breathing tx during the surgery , and that I had COPD. How did she know that ? That’s new for me !

[@midnightglitter]

This is amazing! Your explanations are very clear - thank you so much!!😄

[@84953]

Dr. Einstein, here's an idea for another video or two? Use of gas for induction: When and why ( dental work aside). The different types of airway used (mask with inhalation gas (gasses) laryngeal mask airway, endotracheal tube. Are there generally accepted standards for use of LMA or ETT? and examples that give a very generalized picture of what types of procedures like ORIF at a joint, abdominal hernia (small), cystoscopy. Just to share a memory from my childhood. Somewhere around 1965 I had undergone several surgeries. Among them were an atrial septal defect and opening of stenotic ureter. I still today remember the fear I wen through because of being taken down with inhalational anesthesia. I don't don't know what they commonly used in 1965 but I suspect it was either nitrous oxide or maybe the ********anes or ether. At 9 years old (not quite) I absolutely hated the high that I got. I used to be in respiratory therapy for some time but have gone to other work almost 30 years ago. What amazes me is how much technology has changed. 2 examples are the closest thing they had to the current LMA was EOA or esophageal obturator airway which was basically combination of mask and tube. The tube being usually a little larger than the ETT but looked very similar to it as it had an inflatable cuff. This tube went into the esophagus and the cuff sealed it. There were also holes in the tube just below the mask to ventilate with. The other thing that has now come about, I heard of in it's developing stages, was continuous ABG arterial blood gas monitoring in real time.

[@garyjsimm]

do more of these for all the monitors

[@MaxFeinsteinMD]

I may do a video like this for cardiac anesthesia, which includes several extra monitors not shown in here. Thanks for the suggestion!

[@garyjsimm]

@@MaxFeinsteinMD I’m a paramedic but also an anesthesia groupie. Love your vids

[@laviniafratila2677]

So glad when you post a new video! Keep going! :)

[@joeapple8449]

Max, you are a jack of all trades 👍😀

[@sandrapineiro2115]

Dr. Max, Just seen your video for the first time. Learned sooo much. Thank you. Looking forward to seeing your other videos. Btw, love your sense of humor!

[@rm-dc6tx]

Would love to hear your view on Malignant Hyperthermia.

[@dmc01]

Dantrolene and pray🙏

[@LaurenE1991]

Same! I have a long family history of it and have to tell every Dr about it and have to explain it so much.

[@marksmadhousemetaphysicalm2938]

I'm an ED nurse...not going the CRNA route...i know some people get all sensitive in the comments section about that...i just find the chemistry fascinating, and we do use many of these agents downstairs and you guys help out when we need airways our docs can't get or for trauma as we send patients up for treatment...you're an excellent teacher and I definitely see you as both a preceptor and a professor at some point. In any case, could you discuss the volatile anesthetics...I am interested in learning about them. Also Xenon as an anesthetic agent too...

[@ryanchen4112]

Woah this is so cool, thanks for the great video!

[@MaxFeinsteinMD]

Thanks for continuing to follow along, Ryan!

[@Agustin-ji2mx]

Doctor, could you make a video about the plethysmographic wave of the monitor? Thanks!

[@MohammedIbrahim-uc2nf]

Thank you very much for the video with kindness and respect

[@dennisjones3398]

Question: How do you monitor the depth of relaxation of the Rocuronium?

[@MaxFeinsteinMD]

With a nerve stimulator’s train-of-four function on the face or wrist/hand.

[@dennisjones3398]

@@MaxFeinsteinMD Thank you Dr. Feinstein. Wasn't sure if there was anything new to monitoring relaxation.

[@donricaforte2107]

Would you mind creating videos for care of patient on post-op phase 2, thank you

[@CaitieB518]

I just recently had a surgery last week and find it so fascinating that it’s possible to be sedated to the point of no memory of the procedure or pain. I was given MAC IV sedation with a local anesthetic. Can you do a future video on the levels of sedation? Also another interesting video would be how an Anesthesiologist can tell if the patient is sedated enough for the surgery or procedure.

[@MaxFeinsteinMD]

It is really fascinating! I actually made a video on exactly that topic, and I discuss different levels of sedation. You can see it if you search for "Waking up during surgery? The truth about general anesthesia & how awareness is prevented"

[@kathylieburn1059]

But should that "prevented awareness" and "no memories" carry over into the PACU for a full two hours after surgery? That must have been some pretty strong stuff pumping through my system after a really long surgery! 😳

[@macycolquette3949]

Do you know what fellowship you'll go in to, if any, Dr. Feinstein?

[@MaxFeinsteinMD]

Probably pediatric anesthesia!

[@ReclusiveMountainMan]

love the intro. All hooked up to the good stuff. lol Still haven't forgotten that CT Scanner that had a donut facade in an earlier video. Actually had my first donut in over a year the other day. Yum.

[@MaxFeinsteinMD]

lol yes never forget the donut.

[@DestinyshanteMD]

Love that you're explaining the monitors! Thank you! So would you give fluids, depending, if the CO2 levels go down since capnography corresponds with Cardiac Output? Lower the capnography, lower cardiac output...

[@raremage]

I’m having surgery in two weeks and a bit nervous about the idea of general anesthesia. Thanks for these videos - they are a huge help!

[@jonnaborosky8836]

I really like listening to you. Thank you for breaking things down. I'm a retired nurse. It always bothered me that I didn't know how much more doctors knew than I knew, because of differences in medical and nursing schools. Well, you're showing me...there's not that much difference. Human bodies are human bodies. Nurses have to know the same info doctors do. Nurses aren't taught the vastness of diseases and meds for them. We're taught the minutia of patient care, prevention, treatments, recovery, etc. with basic diseases and treatment options, including meds. After the basics, each of us learns the diseases and meds for the specialty we've chosen in much more detail. You're helping me understand there's no real difference in what we're taught; doctors are taught the same info we are, but from a slightly different perspective. Both nurses and doctors are taught the same material, but with slightly differences in foci and perspective. Thank you for making that clear. I appreciate that.

[@semity]

Great video. In the movies, we always see awake patients with a tube into the nose. I've always thought that was a flow of oxygen into the lungs - Now I've learned it's a non-invasive capnography device.

[@MaxFeinsteinMD]

Sometimes those devices (called nasal cannulas) are just supplying oxygen, not necessarily capturing capnography. It can be hard to say just looking at it without examining the tubing.

[@semity]

@@MaxFeinsteinMD Would there ever be a situation when both tubes are present Max?

[@SaleProofCarReviews]

Thank you Dr Feinstein!

[@MaxFeinsteinMD]

Thanks for watching!

[@Anuradha_Sivakumar]

Hey doc! Great video as usual! You spoke about different sounds and alarms in this video. I've heard that some surgeons like to play music during surgery. In such circumstances, what are the measures you would take to ensure you hear all these necessary sounds and alarms?

[@MaxFeinsteinMD]

Surgeons and/or anesthesiologist and/or nurses commonly play music in the OR! Most important thing is that the volume is at a safe level where everyone can still communicate and hear alarms.

[@Anuradha_Sivakumar]

@@MaxFeinsteinMD Thank you!

[@prpltab]

Love these videos! Keep them coming! Thank you for sharing!

[@meghanalley1427]

hi! is this video of good use for someone wanting to become a nurse anesthetist??? thank you!!!

[@spaseagle]

Would appreciate it if you could do a video on the anesthesia machine with regards to the vent and vent settings!

[@xinshou2192]

Thanks for your effort. Also, could you please make an video about ETCO2 reading?

[@donricaforte2107]

Love your videos, educational and sound like easy though I know in reality it could be overwhelming! Good job and thanks for your service!

[@shelleykienel2454]

Very informative. Thank you for explaining in laymen’s words.

[@copperbittner2303]

Question for you. I've been told that the anesthesiologist cleans out a person's nose after induction. Is this true? And for what reason? I really enjoy your videos.

[@gashunta1]

Your videos are super useful! I'm an MS1 considering anesthesia. Just a thought: if you want your audience to be people outside of the medical community as well, you could maybe say heart attack and armpit instead of MI and axilla.

[@MaxFeinsteinMD]

Thanks for watching! I appreciate the constructive criticism. I go back and forth on whether to use more technical terms. The primary audience I'm making these videos for is medical students, but keeping in mind that non-medical people watch too, I may start adding more definitions while using medical terms.