What the anesthesia "cocktail" contains & why it's given

[@markg3025]

Max is no longer the Resident but the full blown Anesthesiologist. Congrats to you.

[@AMWAYISHILISIAH]

He's mastery of anesthesia meds n procedures is great

[@Jukkala]

You know his mother is very proud. 🙂

[@joefranks4235]

You also have to be VERY good at chemistry. I was ok with organic chemistry, but I would not have made a good anesthesiologist.

[@Jukkala]

@@joefranks4235 I have a STEM degree, but what kept me out of life sciences was Organic Chemistry. P-Chem was no joke either.

[@BrentGardner-b3i]

He's a very well spoken fella

[@malekodesouza7255]

I had an upper gastrointestinal endoscopy. I asked the anesthesiologist what was “on the menu today?” She answered Versed & Propofol. I answered “Oh…like Michael Jackson”. She replied, “Yes…but I’m giving you the correct amount”. 😂. I appreciated her humor and detailed approach. 😉

[@Eman1900O]

Is that a sense of humor? She literally just told you the truth

[@malekodesouza7255]

@@Eman1900O 🤔. Well we both laughed and so did the RN prepping/positioning me, so yeah…it was funny. 🙄

[@smokeytwitchsmokey]

​@malekodesouza7255 it was funny I laughed 😂

[@REALcatmom]

LOL…I said the same thing to anesthesiologist when she said I was going to have propofol, for a minor procedure, and she replied the same thing, “Yeah, but you’re going to get the correct dose, and Michael didn’t.” I bet doctors get that Michael Jackson comment a lot.

[@Eman1900O]

@@REALcatmom I give anesthesia for a living as a CRNA. Every week I bet I hear about Michael Jackson and Propofol. I’m just like yeah but we are trained to use it and how to catch things before they go bad

[@annaraab8853]

In January my anesthesiologist was awesome! On her 1st visit I told her I was very anxious - she fixed that with a bit of fentanl. We discussed my brachial nerve block. She gave me just a bit more fentanl, let me watch the nerve block administration on the ultrasound screen. She escorted me to surgery, helped me move onto the table and then wished me sweet dreams. The best anesthesia experience I've had.

[@TheGreatWhiteHope209]

fent for anxiety is kinda weird.

[@selmaahmed5199]

​@@TheGreatWhiteHope209try it.. it works really good. Minor dose only.

[@davinawonderling9361]

annaraab8853, way to go 👍

[@ptrs559]

@@TheGreatWhiteHope209correct, versed is much better for anxiety

[@davidmack4495]

this stuff fascinates me...I'm a retired firefighter/paramedic, and when I was going through ET training in the OR, I had the coolest anesthesiologist training me to do ET's... one of the patient 's I was intubating was another doctor he worked with. We had to ask his permission for me to intubate him...He had no problem with me doing it, because his colleague would be right there....boy, was I nervous.

[@Eman1900O]

Wow that’s insane

[@juliemanarin4127]

I'm a retired RN...fascinating to me too

[@michaelquillen2679]

Good video. In my first 3 surgeries (knee, prostate, hernia), Came out of anesthesia sicker than a dog and combative. I've shared that with my anesthesiologists in my later surgeries (knee and shoulder) and was told by them that they had "medicines" they could use that could prevent that. Fantastic! I came out of both of those surgeries feeling like I had the best sleep of my life, with no ill effects afterwards. The field of anesthesiology is complex, and fantastic and a good anesthesiologist can make it happen!

[@benjigray8690]

I've had enough surgery requiring various anesthetics to last me a lifetime, and if I never have another it'll be soo soon. However, I've never had a bad reaction. In my opinion, Australia has the best hospitals, and the best doctors and nurses. They've saved my life, more than once.

[@ElectronFieldPulse]

I hate the nausea after painkillers, I was on a morphine drip after some of my shoulder surgeries and that was the worst feeling ever. Didn’t want to move my head, everything spinning, it was terrible.

[@Demetri450]

I just had two procedures; Endoscopy and Colonoscopy five days ago. The anesthesiologist was very informative, attentive, and she made it a very relaxing experience; both her and the other three nurses. The last thing I remember was one nurse placing something in my mouth to keep it open and me staring at the monitors, when she said she was administering the drugs. When I woke up I was back in my room, all of the medical attachments removed and feeling fine as though nothing had happened, but tired and drowsy.

[@Myworldmymind908]

​@user-wz6gd1qv4iwas in there getting loose with it😄

[@shellderp]

Funny story, I remember before a major surgery I was extremely nervous to the point of shaking uncontrollably as I was being wheeled into the OR. Was talking to the anesthesiologist and she says "ok we're giving you the midazolam now", next thing I know I'm super relaxed and screaming in the oxygen mask "lets do it!!"

[@SurprisedCentaur-xh5cp]

How they invented half of these things and the ability it has to completely block the pain and memory of it all is absolutely mind blowing

[@oilman1758]

I had Bucket handle issue and my anesthesiologist walked in introduced himself by his first name and made sure I was relaxed. I am not one to like being knocked out especially if I won't have any memory of it. He had a sense of humor and went out of his way to make sure I was calm. I hate hospitals especially operating rooms. My anxiety level was though the roof but the medical team was excellent and had a great experience. Being a Dr. is not always about the procedure but to make the patient relax, calm and understand what's going to happen. When I went into the operating room all I saw was lots of people and equipment all around. I was ready to run out of there and say I'll live with my bucket handle issue. The nurse explained everything and why there was so many people in there. In the end I made it though thanks to all the great people in there.

[@roytetwart]

I'm in my late 70's. A couple of years ago I was brought into an operating theater where I was scheduled to have some sort of procedure on my stomach. In the theatre at the time was the very aimiable Surgeon and a very pleasant lady Anethsatist. We had an enjoyable conversation and they made me feel quite relaxed, (I was feeling very nervous just prior). During the conversation, the lady was pushing buttons etc. on a box next to me (about the size of a microwave oven). I asked her if that was her box of tricks to knock me out. She said it was, then said "In just a moment, you'll feel like you've had a lot to drink and may feel a little drunk." Within seconds I felt quite drunk. I was about to say, "Blimey you're not kidding". But I never got those words out! The next thing I was aware of was waking up in a room with a nice Nurse sitting next to my bed! That was my one and only experience in an Operating Theatre! Have you any idea, what would have made me feel drunk so quickly?

[@u4riahsc]

I never get to feel the happy cocktail, I just blank out completely.

[@kyleregan302]

A solid dose of versed (medazolam) . (Former level 1 trauma patient. I've had a lot of surgeries sir)

[@juliemanarin4127]

Versed

[@roytetwart]

@@juliemanarin4127 Thanks Julie. I'd never heard of Versed. I've looked it up now!

[@MMMMM-v5m]

@@kyleregan302 may you stay out of the trauma center and healthy for the rest of your life!!

[@nadionmediagroup]

“It’s just a KZbin video” - that you even need to say it 🤦🏻‍♂️ This is a fantastic channel.

[@diode_wow]

I believe it's required when giving out medical information, same thing with ads.

[@shellderp]

Well it is a doctor explaining medical concepts, who cares that its in a video? It is a legal defense

[@nadionmediagroup]

@@shellderp understood. the problem is that he needs to do it. taking med advice from KZbin should disqualify anyone from being able to sue. I get that isn’t reality, and folks do sue all the time, but it’s still dumb he has to do it.

[@nadionmediagroup]

@@diode_wow I get it. There are people who do stuff because KZbin videos said so. I understand why he has to do that, but he shouldn’t have to, really. He’s protecting his medical license and his bank account. The criticism is that it is goofy that it’s even necessary.

[@SeekingTheLoveThatGodMeans7648]

@@shellderp I'd probably say something like: It's a presentation of a description of some common medical practices and the reasons for them and the most likely outcomes, but any discussion of matters specific to a patient must be personal with their doctor or prescriber, and this presentation may or may not match what that would be, "so don't depend on it, and if you have questions always ask your doctor or prescriber."

[@natashak3387]

Having another major surgery October 10th and I am so grateful that I have been able to advocate for myself. I'm finally getting my right upper extremity deformity fixed after 20ish years of pain and immobility. Thank you for this video. Coming back to watch again.

[@ml9867]

I hope you're doing well.

[@kathyfullarton8126]

Thank you for mentioning the importance of telling patients that they may loose consciousness after receiving the midazolam. I received midazolam while my stretcher was being pushed down the hallway to the anaesthetia room. I was told it was a med to just help me relax, so I did not expect it to put me asleep. My last memory pre op (before PLIF surgery) was slumping over to one side of the stretcher and slurring my speech. Not the quiet, relaxing induction i was expecting. But all went well, with great results for my back. Enjoy your videos.

[@Eman1900O]

I always ask before i give it. Never would I give it without telling a patient or asking if they want it

[@philippal8666]

The problem is that these things are like a shot of whiskey. If everyone was given one shot of whiskey, someone would be passed out, someone composing work emails… give 3 shots and some would be asleep, some have no noticeable effect, some throwing up, some just chilling, some laughing, someone possibly screaming. The same dose of a substance has a totally different effect on everyone, and on each person depending what they have just done. Pain, size, body enzymes, DNA, immune system, liver, kidneys, blood volume, mild dehydration, it’s totally bizarre.

[@gnormhurst]

Your voice is very calming. Kind of an anesthetic in its own right.

[@lisalaunius7389]

After a previous terrible experience with a mask induction, the anesthesiologist for my knee replacement listened, believed & was generous with 2 doses of Versed - 1 when he did the nerve block & 1 as we rolled to OR. He then did spinal & Propofol. I will forever love that man

[@stevebot]

I had similar recently, he asked me if I was nervous and I said not at all but I’m not going to say no to a legit dose of a benzo. I don’t remember anything until postop and being cath’d. glad the block was still working for that.

[@AmyBarnes006]

I've been put under a number of times for procedures and surgeries and Valium that was used in the past was awesome. I'm surprised that it's not longer the mainstay drug that it was 20-30 years ago. Doctors made a giant mistake and did not pre-medicate me with a sedative prior to taking me back into the OR for an eye surgery when I was a small child, probably because I was so quiet. I was spooked when someone uncovered an instrument tray, and I jumped off the gurney and ran for the door. People went running after me and had to forcibly restrain me to the gurney while the drugs they put in through an inhalation mask took effect. So now I tell the anesthesiologist that they absolutely need to medicate me before I can see the OR. It helps everyone involved enjoy a peaceful, productive procedure.

[@BuickDoc]

Anesthesiologist here: the problem with Valium: it is long acting drug. People are sedated for hours after getting a dose. Versed, or midazolam, is a chemical cousin of Valium that lasts about 1/3 the time that Valium does.

[@AmyBarnes006]

@@BuickDoc Ahhh, there it is. I do recall being sedated and pleasantly at peace for much longer on Valium. After versed and propofol procedures, I've snapped awake with astonishing alertness that has left nurses startled and saying I wake up real fast.

[@colb9260]

​@@BuickDocmidazolam does that to me. I'll take the valium

[@chrisgreene9745]

It lasts too long and its Ph is 11

[@ConnorYamsek]

Interesting perspective... read the comment I just posted of the exact opposite experience!! I think they need to definitely listen to what the patient says because in both of our cases, it seems they just did what they thought was best (which was the wrong thing).

[@KytexEdits]

I found your videos just over 2 years ago as someone who has some pretty big health anxiety (ahead of surgery, in this case) but also is interested in learning about all kinds of things and I have to say it makes me so happy to hear you say "Max Feinstein, anesthesiologist" and not resident! Congrats!

[@Bettinasisrg]

Ah the "milk of amnesia" I was a vet tech and we used quite a lot of that. I had general anesthesia at a small, very small hospital. My anesthesiologist said he was giving me something prior to surgery but then reached into his pocket and said "I forgot it". I expected him to get it or call a nurse but he said "don't worry about it, you don't really need it anyway". After waking up I had 4 day migraine and have suffered with both migraine and cluster headaches since. I don't know if it's related just food for thought. Changed my life though, pain is unbearable. Thanks for the video and my theory on the use of the word " cocktail " is probably a throwback from the days when cocktails were a lot more prevalent and everyone knew how the made you feeland were considered safe and acceptable putting a patient at ease.

[@24bellers20]

I was put under anaesthetic for a hernia op. When the Doc came to see me afterwards I asked him who was going to the Caribbean on holiday and he looked somewhat shocked. Apparently that discussion went on during the mesh being screwed into my abdominal wall. Heaven knows how that occurred because I never felt a thing.

[@gaiaorigin9569]

I got midazolam as a kid before a minor surgery - I remember that suddenly I saw two noses on everyone and I thought it was hilarious 😄 A couple years later as a teen, I screwed up my knee real bad while playing soccer (dislocated my knee cap -it literally went 90° to the left side and basically ripped everything in its path. I received fentanyl and midazolam because I was in severe pain and the doc wanted to put my knee cap back in place before taking me to the hospital. Within a minute or two, the pain was completely gone, I was super chill and relaxed and started vividly hallucinating beautiful pink clouds. I remember telling the doc "I think it's working, I'm seeing pink clouds" - and then I was out and my next memory is waking up in the hospital like 30 mins later 😄

[@laineybugger]

So interesting! I’ve had over 20 surgeries and I don’t think I’ve ever been told exactly what I was given.

[@billkea7224]

They have never told me before hand or during, even when I asked. It wasn't until I looked over my paperwork that I found out.

[@pgrevstad]

Thanks for explaining this. I'm Canadian, and part of a great hospital system called UHN, or the University Health Network, in Toronto. Colonoscopies required. Recently the team changed the cocktail from Propofol (a very dirty high and nasty recovery) to Fentanyl, and honestly I was kind of shocked when I heard 'the F word' given its street reputation. Happy to say that it was a MUCH better experience than Propofol. Not quite 'fresh as a daisy', but waking up as if from a delicious sleep.

[@matthewlocher3041]

Thank you so much for acknowledging the paradoxical reaction. I get severely aggressive and black out for a long period of time. I feel so terrible coming out of it because I have done or said awful things.

[@BW12149]

Two weeks ago, I underwent bilateral Radio Frequency Ablation on lower spine, L1-L4. My pain management doc is an anesthesiologist and I’ve had this procedure multiple times before. But this time, I got Versed, fentanyl and propofol! I woke up at home in my bed not remembering anything after I got on the procedure table. took two to three days before my brain returned to full function. Turns out he really got busy with a lot of nerves and it took over a week before the RF started working. He has amazing skills because this is the best my lower back has felt in several years.

[@bettylouturner4491]

Versed makes me “combative “, but actually I am trying to tell them I m awake and it PAIN! Terrible anesthesiologist ruined my cataract surgeries and left me with COPD. Allergic to latex and I bet they used latex during surgery. Took forever to recover.

[@Patriciahappy-w-fox-o8d7w]

I had surgery yesterday. The Anesthesiologist was fantastic, she explained all the drugs used and how i might feel when i wake and that i would have a tube down my throat, but it would be done after i was "out". Your lectures have reassured me.

[@ilovetotri23]

Great video! You raised some very interesting questions at the end. As a patient, I want to know as much as I can to help relieve, "the fear of the unknown", and I am just naturally very inquisitive. I can totally understand how that may stress another person out, though. To your point, anesthesiologists should be sensitive to individual patient needs, and ask what those are. I have nothing but the utmost respect for the job you do! I have always had amazing anesthesiologists!

[@michaelwillis9449]

Great video as always Dr Feinstein. Your channel has become one of my favorites. you do a great job explaining everything. I've had 13 surgeries and I always told my Dr I wanted to know exactly what he was doing step by step and why he was doing it. For a few reasons. 1 it made me more comfortable 2 it just interesting stuff. I can tell from your videos that I would have been very comfortable with you doing my case. That's important for me to be comfortable with the Dr. You seem like a great Dr who cares about people

[@Scrobbles5683]

I'm glad I didn't get anterograde amnesia the last surgery I had. The anesthesiologist was not much older than me and we were chatting while things were getting ready to start and we got on the topic of video games and we talked about Fallout for a few minutes. After that I knew I was in good hands and I cannot praise medical workers like him that try to make you feel comfortable enough!

[@thetowndrunk988]

Both times I had general anesthesia, I had no clue it was kicking in. I was talking to the doctors, then I was talking to the doctors, without any idea the procedures were already done.

[@darriontunstall3708]

Great video man, I learned a lot about the Anastasia cocktail, my eye muscle surgery is Thursday, it’s a eye muscle surgery to strengthen my right eye muscle it’s crossed because of my cerebral palsy, I’m a little nervous. 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 a anesthesiologist physician, it takes a special person and skills to be a anesthesiologist or CRNA and you’re one of them! You rock man!!

[@jacobthiessen7027]

Don’t forget this excitement during those long hours of residency! Congratulations

[@Lehmann108]

Midazolam is amazing. All I remember is waiting for the elevator to go to surgery and the next thing I know I wake up in recovery. I asked the surgeon if I was conscious when I was wheeled in for surgery and he said I was fully alert and making jokes with everyone!

[@VagaBond-m6w]

As someone who has had both 'awake" procedures and "general anaesthetic" procedures, I was given drugs that I did NOT consent to ahead of time, and had ACTIVELY refused in the case of my general anaesthetic pre-op list of med. Doctors in Canada just give their "usual" cocktail and rarely consider the patient's wishes or concerns. I was not told, in either case, which drugs I'd be given, what the effects would be, or how long they'd last. Sadly, when we consent to a procedure, it seems we are blindly handing over our bodies. And yes, I DID question the surgeon after my general anaesthetic procedure, asking why I was given a drug I actively said a BIG "no" to before the procedure, given that I had volunteered in an ER for years before and knew how some things were done. He said he didn't know why I'd ben given that drug, as it was under the discretion of the nurses and anaesthesiologist. My future advice would be to tell medical professionals you are a recovering addict and NEVER to give any drug (name them) that you are not comfortable with. Maybe then they'll take you more seriously. THANK-YOU to this medical professional who provides with the information we need to make informed decisions.

[@richardgoddard37]

I had a hernia operation and the anaesthetist was showing off to his friend from another hospital. He promised me my best sleep ever. He succeeded.

[@chasehicks7465]

To me when getting anesthesia i ABSOLUTELY want to know when its being Administered... i had an Anesthesiologist not tell me before and it wasn't a pleasant experience. I tell every doctor multiple times i want to be kept in the loop. Thats my opinion at least.

[@homesbymatt8053]

I like what you said about not wanting to surprise patients, My last procedure the last thing I remember is the staff telling the nurse "I just gave him something to help him relax". It would have been nice if I had been told before hand.

[@chasecarter8848]

I like what you said about not surprising people with IV meds. When able, I always ask what the medication is and how much is being given. Typically I'll recognize the medication, and the reason for it will be contextually obvious (ie I'm complaining of pain and they want to administer, the reason is self evident), and recognize the dose as therapeutic. Anything I don't recognize, I want to implement I'm getting it, and if the explanation doesn't make sense, either I want education or I don't want the medication, although that's never happened. It unfortunate, but I sometimes feel providers don't want to discuss it, possibly to avoid a long conversation with a confused or medically naive patient, but it's not just good practice, it's really the only way to practice ethically and safely.

[@michkaza]

Hey Max, perfect timing! I'm getting set for my Anesthesiology residency starting April 1st here in the Philippines. Thanks a ton!! 🥹

[@russellh8702]

I trusted my anesthesiologist with his decisions because he’s the consummate professional.

[@SkydivingSquid]

I was given Versed (Midazolam) prior to anesthesia from propofol. I had no memory loss up until my eyes shut. After that, zero idea.. But I do remember getting to inject (push the plunger) of the propofol after it was already twisted into the IV or whatever.. I also remember being concerned at watching the site grow from how thick it was and asking if I need to slow down - but nope, push push push.. My concern was I would damage or blow a vessel. I definitely didn't get the plunger all the way down before I woke up in the recovery room. Lots of people feel strongly that the anesthesiologist let me do that.. but I really don't see any issue with it. It was pre-measured by the doctor, set up and ready to go by staff, and all I did was push the plunger. Definitely pretty cool.

[@ERfan91]

I am someone who has a paradoxical reaction where it makes me anxious! I also don’t get the amnesia. I had my first endoscopy in fifth grade and I remember the nurse giving me that med in a syringe to put in my mouth and she said that she bets I won’t even remember that conversation. Well im 32 years old (will be 33 in july) and still remember so clearly I DO remember! I most often get MAC sedation for the types of procedures I get (I’ve only had general once) and I know my cocktail and I have it on a sheet of paper I always bring a couple copies with to the surgery center. The anesthesiologists and CRNAS love my sheet. It doesn’t have the doses for most the meds but it has the names and such of what has worked well.

[@GreggBB]

Really good information. I'm guessing if I tried to tell an anesthesiologist what I'd like to be given, they's just laugh at me and give me what they felt was best.

[@Eman1900O]

There’s only one drug for this. Just ask to get Versed. It’s not uncommon for patients to ask

[@Healthyhealings]

Great info doc- I think your point about the doctor NOT “ warning “ you that a certain medication is about to be given is an important one. After 14 spinal surgeries, rarely has that been done and not doing it just makes me more anxious….DOCTORS TALK TO YOUR PATIENTS!!

[@autumnmoonfire3944]

I had propofol for my most recent colonoscopy and it was highly superior to the versed, morphine, Benadryl mix they’d used in the past. When I came around after the procedure there was no dizziness or nausea at all, just “oh hey! Done!” The state I live in requires an anesthesiologist for propofol, so I gather there was an extra charge, it was worth every penny!

[@YuckFoutube-e1z]

How much did it cost if i may ask?

[@OfficialRyanx]

Midazolam has honestly changed my entire life view of GA. From the age of 8, I’ve just fallen apart in the anaesthesia room to the point my veins have all but reduced to nothing; when I was younger, I’ve fought off anaesthetists. After hearing how anxious and upset I get, one anaesthetist at the start of a series of planned surgeries put a plan in place for me to have IV midazolam on the ward and another dose in the anaesthesia room. I’ve been able to have proper conversations, not stress about my heart rate being up and even when we had to use a tiny vein in my hand and infuse the propofol extremely slowly, the burning etc didn’t phase me. I’m having my hip replaced in a fortnight and have already stressed how much I want this to be repeated to be as calm as possible.

[@OfficialRyanx]

@user-wz6gd1qv4i Nah. Surgeon has ruled it out. Wants me under GA with the amount of work that needs doing.

[@AwkwardSquirrel13]

It's been about 2 weeks, so i thought I'd check in, hope the surgery went well and you're on the recovery journey. Thinking of you! Much love

[@OfficialRyanx]

@@AwkwardSquirrel13 everything going well so far! Initially said no to midazolam and then relented in the room because I was nice and they thought it would make it easier to try get some spinal in place. They tried to do a spinal lower limb block before they put me under but weren’t able to get into the spinal space. They said they put a spinal in once I was under, but I could feel every single burr and bony growth they shaved down when I woke up. Rested up with some oxy, physio >16hrs is the protocol this surgeon wanted but I was off the zimmer frame and on crutches within 10. Asked to stay another night to ensure analgesia was sufficient. Am now hobbling about the house without a crutch or using one single crutch. Seems to be very positive!

[@MikeGervasi]

Propofol has a strange feeling during onset. Creeps up your neck until it hits your head and then..nothing. My last surgery they used it and when I came to I immediately tried to hold on to the feeling of where I had just been, which was nowhere and time meant nothing. Made me unafraid of death from that point on.

[@benjigray8690]

Thank you for making this interesting and informative video. I'm like reading the reports that the hospital give you after surgery, in them they give all the details, including what stuff they give you to make you "comfortable". It prolly wouldn't interest some folks, but I appreciate it.

[@timc333]

I have had several gut surgeries and will say without any doubt at all , that Midazolam is the first drug that I remember being placed within the IV in the prep area , Midazolam is the Mercy drug with the surgery as it calms and relaxes and generally placed me in a very still and easy state , yet and maybe because I am a medical Cannabis Patient , I never once got any memory loss after administration , as a matter of fact the memories are very clear (photographic) of entering the OR and looking around (I always want to see the Or room I will be in ) and none of the memories are scarry either . so the BRILLIENT Anesthetist got it super right every time for me . Most interesting to me is how clearly I can remember a good deal of the prep and also always wake up fast after and in good spirits . They just always got it right for me .

[@davidadams9391]

I love to look around the OR too. I especially look for the trays with instruments…I know some of the machines around the wall are being stored and are not for my procedure. I have been told to lie down a few times, and been asked “what are you doing”. I am always obedient to my instructions. They seem okay when I tell them that I just like to look around the OR

[@timc333]

@@davidadams9391 My last surgery for Belly button (umbilicus) hernia repair , The Surgeon was already in the room , I was looking around spotted the robot along the wall , said " cool " The Dr. said Meet , I forget the name but it ended with a " Y " , I said " Oh " and continued to look around , the Dr. gave me a look like " well that was very under climatical " The robot was all draped with plastic sheets and the arms all had different tools in them . pretty cool .

[@Eman1900O]

@@davidadams9391some patients do like to do that. Some are scared and don’t want to see anything

[@andream9470]

I napped once given it until I was being brought to surgery and I remember the room and all the instruments (I'm guessing in case they needed to convert from davinci) and getting scooted over etc. It was rather lovely.

[@nootherthan]

I always have talked to the Anesthesiologist before any surgery. I like to see all the people involved in the Operating Room & therefore I am most Calm by that alone. In my past I have purposely wanted to see everything but of course I will go under just before Intubation for General Anesthesia... 😎👍

[@estelleadamski308]

In Nov. & Dec. just 16 days apart I had 2 surgeries and had general anesthesia both times. I had Versed, Propofol & Fentanyl plus a bunch of other meds. The first surgery was 20 mins In & Out, the second was 2 hrs., long. I always remember the second I go under, when I wake up. The Ortho came in to talk to me soon afterwards and the nurse said you probably won't remember that he was here, but, I did. I've had 15 surgeries and he's the first I ever remember seeing. I think I come out of sedation pretty quickly.

[@hectorelmexican4014]

15 surgeries...ur doing lots of things wrong....bet u you've had all blood clot shots😮😮😮

[@estelleadamski308]

@@hectorelmexican4014 That's been in 40 yrs. Mostly routine, 2 carpal tunnel, 2 C, -sections, gall bladder, etc. but , I tore my meniscus and had surgery. I did have a total hip replacement. But, NO blood clots in my life, ever. I have no cancer, heart disease or diabetes, no high cholesterol, so it appears I am doing lots of things right.

[@estelleadamski308]

@@hectorelmexican4014 Plus I have never smoked, never had alcohol, or ever took drugs. Pretty clean living, most ppl don't do.

[@headlibrarian1996]

I don’t have balance issues post-anesthesia, which aggravates the nurses because I stand up more aggressively than, or so I assume by their reaction, most other people can safely do. I also sometimes need top-up doses during awake procedures. For example I had a BCC removed from my face during which I started to feel the cutting. It wasn't instant pain of course, it took about a minute before I was certain the doctor needed to stop.

[@estelleadamski308]

@@headlibrarian1996 That must have been scary. I awoke when I was having all my 4 wisdom teeth removed. They put me back under immediately. I don't want to be awake for anything. U R brave!

[@Wacky_Whimsy]

So this is probably why I can remember that "fuzzy feeling" before going under, and sometimes I can't. Sometimes I don't get the fuzzy feeling at all, and start to panic that I won't fall asleep before the doctor begins! (I hate that, LOL!) So interesting, thank you!!

[@SeekingTheLoveThatGodMeans7648]

The time that I underwent such surgery, I went from being aware to simply out like a light within seconds till I woke up seemingly minutes later, the operation complete.

[@zovjraar]

Me too. One second I'm freaking out about the IV in my arm (fear of needles), the next I'm irritated about someone waking me up.

[@headlibrarian1996]

@@SeekingTheLoveThatGodMeans7648 That’s how it always works for me. About 15-20 seconds of “hey nothing is happening” to waking up after the procedure.

[@delawarehistory1675]

I have a midazolam story. They gave me the first dose, felt a slight change, slightly relaxed, but memory remained intact. They brought me into the OR. I informed them I was deathly afraid of being put to sleep. Out came more midazolam. I remember nothing else. What set this apart from normally being put out, is that I usually go from a single dose of midazolam directly to the Propofol. The old "breath this oxygen and you might feel a sting"

[@emil1063]

Anterograde amnesia from the midazolam hit me HARD when I had surgery. Have to say I'm a little bummed I don't recall any of the OR as I probably found it fascinating; last thing I remember was my surgical team wheeling me into the hallway, asking me if I was feeling the sedative yet, to which I replied, "Yeah, a bit." .... Next thing I knew I was waking up in a hospital bed 4 hours after the operation with the third movement of Shostakovich's Violin Concerto No. 1 stuck in my head. 😂 (Interestingly, I don't recall the recovery room at all either, save for some vague sensations and sounds. Couldn't tell you what it looked like or how long I was there before being transferred to my room.)

[@donstor1]

I have Kaiser and when i went in for a thyroid removed full of cancer, i told them that i was very anxious. They told me that they no longer give anything except gabapentin and that did nothing to relax me. For pain they offered a little codine that didn’t touch the pain.

[@auburn886]

Thanks. I recently had surgery. The anesthesiologist said he was going to give me versed. He did. I don't know how much time passed, but I heard him say, "He's still talking. Give him more versed." I was having surgery almost two hours from home. The next thing I knew, I was on my bed at home. You can't ask for more than that.

[@matthewmartin5763]

I had an abdominal hernia surgery a few years ago. It was my first ever time going under fully. I really wasn't nervous going in. When they administered the first drug, which I assume was an anti-anxiety medication, I started to feel aloof. Like you said. Smiling, cracking jokes with my family. I remember being rolled the short distance to the OR, I was rolled under all the lights and everything. I recall the anesthesiologist was talking to me about.... something. I'm am naturally a very curious person so I was looking around at all the cool stuff they were about to use on my insides. I could see all the Doctors, Nurses and other staff going about their preparations. It was dead silent. I looked back as far as I could and just blurted out, HI EVERYONE!!! There were mixed reactions. Then lights out.

[@chrisbilling]

Awesome information. Thank God for these awesome medicines

[@tylervalentine6401]

I love the video, It would be really cool to see another day in the life video.

[@VintageteaCher56]

Always enjoy your videos. I know what questions I need to ask my anesthesiologist about their plan for me.( they are surprised). I have had 7 ortho surgeries, my experiences ranged from so-so, to terrifying to excellent. I now ask and discuss my plan. Thank you, Dr. Max for empowering me.

[@renwoman101]

Nice informative video. In the near future, I probably will be getting a cranial cervical thoracic fusion and this gives me an idea of how the anesthesia process will be like

[@Eman1900O]

They may or may not give this drug. If you’re not nervous before surgery then you don’t need it. If you are, feel free to ask for Versed (aka midazolam)

[@annfillion4405]

I have hyperpyrexia; anesthesia nearly killed me when I was much younger. Thank you for your video. I may not be so frightened next time.

[@Wazup4177]

Truly enjoy the videos doc. Thanks for taking the time to make them.

[@NebbieNZ]

I had midazolam before my basic surgery for anxiety it was wonderful defiantly helped with the anxiety. I have no visual memory's but can remember talking for a few minutes after including sliding onto the operating table I only made it halfway and was told by someone I didn't quite make it and to scoot over just a little bit more.

[@darbstews8926]

I had two surgical procedures done this year. The first in February. I'm no stranger to surgery as a child, but as an adult that I've had an iv before I'm brought to the OR I'm at 4 now. Back to the one in February. Inwas on the table and I feel something enter my arm through my IV and I'm like what did you just give me? And he said oh just something to help calm you down, and started feeling fuzzy and I don't remember anything after that. I remember waking up feeling very uneasy and just it didn't feel right. 9 months later for the second part of my surgery I asked them again in the OR after he gave it to me, if this drug makes people fall asleep and he said usually not, and then starts putting the monitors on me. And that's all I remember. I'm not very happy that there weren't much explanations for that. But this video made a lot of sense for me and I will ask if this medication was used on me in my post op appt thats coming up.

[@6.8SuperDutyDriver]

Versed is great stuff. I just had my spleen removed last month. They gave me a big shot of it before they gave me the stuff to knock me out (I have no idea what that was). I had a blast when they were moving me around in the OR before the other shot. I also get spinal injecting's and radio graphs a few times a year. They give me small dose of Versed and Fentanyl. It works fast and wears of fast. Helps a lot. Another medicine that is really good is liquid Tylenol that goes in the IV. After surgery they said they were gonna give me Morphine and Tylenol. I told them not to bother with the Tylenol thinking it was pills. That liquid stuff worked great!

[@robwhite6057]

Thanks for this, I am about to have a growth removed from my kidney. Will be meeting the anesthetic team next week to work out a regime to accommodate complex needs as I also have heart failure

[@soup8977]

I'm aware this is quite late but I partake in ECT treatment (electroconvulsive therapy) and the anesthetist asked for any song recommendations and I asked for MGMT-Electric feel got quite a few laughs out of that one hopefully made their day brighter considering what they were doing.

[@davidtatum8682]

Amazing the faith we put in something that we don't really understand how it really works.

[@ConnorYamsek]

I specifically requested no Versed for one of my surgeries (I am comfortable in the OR and was not nervous). It was a very cool experience to remember what the OR environment was like. A few weeks later I needed a revision surgery (a bone fractured) and asked for the same thing. The anesthesiologist understood but said "it was a very strange request". A few minutes later the resident was about to put something into my IV when I said "wait... what is that?!" it turned out that it was, indeed, the Versed. I explained to him that I didn't want it. He had not injected it yet and took it out. I thought I was safe at this point, but as I was being wheeled into the OR I felt something go into my IV. I remember entering the OR and filming a quick video (which I have)... but sure enough... nothing after that 2 minutes or so and looked at my paperwork and they indeed, gave me that injection at the exact time the video is timestamped. I was so bothered by this... clearly I felt comfortable without it and maybe it is "different" but I think they just didn't want to follow the "waste" protocol or whatever, idk but there was no reason I should have been given it. Haha.

[@blondy2061h]

Benzodiazepines make me very anxious. I've had super bad experiences with versed waking up having no idea where I am and panicked, trying to bite staff. I have requested no versed since then. I had a bronchoscopy and made it very clear I didn't want versed and the first thing I heard when I woke up was "We had to give her a little midaz." I was so angry and now list it as an allergy.

[@blondy2061h]

@@saskiajakabfy8232you can be asleep without versed. There are lots of other drugs.

[@delawarehistory1675]

I am not sure why you are so hung up on being given this. You are going to sleep either way. Generally versed does nothing for me, and I still remember everything up to them putting in the propofol and having me breathe the oxygen. I actually remember slowly losing consciousness as propofol goes in, its a rush followed by nite nite. Its weird they let you bring a video into the OR, the places I've been would never allow it.

[@deborahchasteen3206]

Because this woman said no. She knows her body and made an informed decision. It is her right to participate in her medical care. Period. Being given that drug previously caused trauma. She is absolutely right to have been angry. I would have filed a complaint and followed it up.

[@delawarehistory1675]

@@deborahchasteen3206 This is both true and false. She absolutely has the right to refuse to be given the medicine, however doctors have the right to refuse to give you medical care or perform the surgery. So you can say all day long you don't want a certain drug and a doctor is allowed to turn around and say "I am not comfortable treating this patient."

[@bradowen761]

I'm not sure this is something I should be happy to admit. Surgery sucks and everyone knows this. But for all the dozens to which I've unfortunately been subjected, my favorite part is always when I first get put under. It feels amazing. All your fear and worry vanishes and you feel, just for a few fleeting seconds, as if you are connected directly to God. When I was a teenager I had a major thoracic surgery at a very prestigous teaching hospital, and the resident pushed the plunger very intermittently over a period of perhaps 5 minutes while asking me a series of questions. Presumably this was to see the "stages" I went through. I've never abused narcotics in my entire life before or since, nor do I have the desire to. But from that one experience, I can DEFINITELY understand why people get hooked on such substances.

[@brxxxi]

In Serbia offten as premadication anesthesia procedure a cocktail is given of Midazolam and atropin and/or fentanyl instade of atropin..... in my most recent anesthesia experiens over ten yaers ago, during the upper endoscopy procedure.... I was given just popofol, and in Repeated procedure a few years later a I was "premedicated" wtih some Midazolam or fentanyl.... The only difference that I felt was when just "propofoled" my eyes were burinig seconds before I Iost my conscience. And when I was premedecated burning sensation was not present.....

[@slc1161]

I have been very fortunate to have the anesthesiologists in the pain clinic really listen and medicate accordingly. Many times, if my pain is high, they hit me with a couple of doses of fentanyl. It really helps get my pain down and my heart rate and pressure better. Then I'll be listening or humming to the music in the room and bam! Propofol on board and next thing I remember is waking up after.

[@Hyper_Boy27]

Hello Max, I love your vids and want to let you know that you are amazing at what you do. I want to be a anesthesiologist when I grow up too!☺️

[@duenge]

Going under for an esophageal dilation, about half of the propofol went in before the IV went sub-Q. What a great time had by me!....

[@adarcus4053]

I had to have jaw surgery when I was 27 because I accidentally cracked the last molar in my mouth. It was a tooth that to be fair we had been monitoring for almost 20 years at that point. The oral surgeon suggested that I only get enough sedation to basically make me super relaxed but I would remain conscious. I absolutely insisted that they actually knock me out because I recognized that I would have a difficult time with the placement of the tooth. I also by that point knew that I could insist on IV insertion location and insisted on it being switched to the back of my hand versus my elbow because I knew that I would be far more relaxed. Two of the best decisions that I ever made for self-advocacy.

[@kylehuff5150]

I just had a open heart surgery, 5 wks ago.(Full Root Aortic Replacement) I wish I had an anesthesiologist, or surgeon, who had spoken to me about some of these side effects, or expectations from such heavy sedation like this man. In the end, all is well. Just a traumatic experience made worse by way of lack of knowledge or expectation. (God bless the men and women in this profession.)

[@Heli4213]

I love to watch your videos. The stuff is so interesting. It's fascinating to me. Thanks for educating us

[@pleadthefifth]

Can you make a video on management of anesthesia for patients who use Buprenorphine/Suboxone or even methadone for opioid use disorder/MAT? How would you treat a patient on a 16mg/day dose of suboxone who needed emergency surgery for example? How about for a routine surgery where general anesthesia is necessary? What types of things would be different in patients who are on Suboxone than patients who aren’t? Are there any special precautions you have to take to make sure they stay “asleep” since their tolerance is likely going to be higher than usual?

[@sashboo1370]

Great video! Interestingly enough, I remember reading a study showing that midazolam can cause small amounts of retrograde amnesia!

[@painmt651]

I had a procedure before finals in college. I woke up, and to my horror, I had no memory of studying for the finals. I had retrograde amnesia, and I couldn’t form new memories for several days. I would read a paragraph, and have no knowledge of what it contained… nightmare for myself, being a 4.0 student!!! The procedure took six hours, and they had to keep redosing me with Versed.

[@LifthillMat]

20 years ago I was given "Dormicum" (Midazolam) just before my ERCP (Gallstones). I could not really tell the difference to a "real" anesthesia, though. I was just knocked off, but woke up quite quickly after the ERCP

[@Handleyman]

What a reassuring person.

[@grahamrankin4725]

I taught forensic drug analysis for many years. I always asked what i was getting so i could relate the effects i felt to my students.

[@ceebee23]

I had open heart surgery last year to replace a valve and part of my aorta. (I have a nice 8" chest scar to prove it!). I recall a man with glasses peering over the table as I lay waiting for the whole thing to begin .. he said his name and that ".. most people don't remember me..." the next thing I recall was waking in ICU with a tube down my throat! And guess what I do not recall the anaesthetist's name ... for a follow up procedure called a DCR where my heart was shocked back into to correct rhythm I was given propofol ... one moment awake next the procedure over and I was waking up. Thankfully no serious side effects with either anaesthesia ... except a metallic taste in my mouth. So I suppose the anaesthetists did a good job!

[@sarahann4007]

As a Peds Nurse I learned early on, how you go to sleep is usually how you will wake up (mood and behavior wise) I’ve seen this to be true. I had an Endoscopy at 15 and was asked if I wanted Twilight or General. I figured, seems like a good time to test out General. I was told the procedure was extremely routine, was all fine, then they rolled me back to the OR where about 15 med students were standing ready to observe. I was like, “wait? I thought this was routine!” Then I felt someone messing with my IV, looked over and said “what are you?…..” and woke up seemingly a second later and per my Mom, kept demanding water and not drinking it and interrupting the doctor as he explained what they found saying I wanted a burrito (apparently while he was telling her I might not want to eat or drink much for awhile). This is not my personality at all to be demanding or talk over people so I find it funny and think it’s an example of the adage, how you go down is how you’ll come out 😂 Now I get to do this all again this week but a different procedure. I’m a little nervous but I think I just know too much now. Ignorance is bliss as they say. I’m usually cool as a cucumber so we will see….

[@SunQueen800]

I have a debilitating fear of being put under general anesthesia. I broke my arm (Galeazzi fracture) and needed an open reduction. I was near tears going into the surgery prep until I spoke with my anesthesiologist. I explained my fear of being put to sleep and that I felt out of control. He reassured me that I was in control here, and that I could be conscious if I wanted to for the surgery. I was given a nerve block that I would have had anyway for pain management after the surgery. This was given under an ultrasound near my shoulder. I was then given something else which I am not sure the name of, but he said it was kind of like a cousin of Ativan when I asked. I wonder now if I was given the medication you speak of in this video. I had no pain until the very end of surgery when I felt like I was coming out of a nice, warm fog. I could then feel the tourniquet and explained that it was painful. The surgeon (also an amazing person) was stitching me up at that time though and they asked if I could wait a minute since he was almost done. I am pretty sure that the anesthesiologist stopped giving me the IV medication at that time when I felt the warm fog lifting. I had a very pleasant surgery experience over all and I was able to peek over the curtain at times to see them working on my arm. I felt good, in control, warm and happy. I am so glad that my anesthesiologist saved me from the trauma of being put to sleep and worked with me, giving me as good of an experience as I could possibly get.

[@netto6681]

When I recently had conscious vascular surgery, I was given Remifentanil, which I understand is even more potent and short acting than fentanyl - it wears off instantly when it stops being infused.

[@JBoy340a]

Great information. So far the only procedure I have had that required anything was a colonoscopy. Usually I am up and ready to leave pretty quickly and feeling well rested. However, once they had a hard time waking me up. This was about 15 years ago though, so perhaps the anasthesia was different back then.

[@Virgochik]

I had an oophorectomy and enjoyed partnering with the anesthesiologist. I think it made his job easier. I was physically fit and had a positive attitude. I asked him to go heavy on Tylenol and propofol to keep me asleep. I preferred less opioids. He said, Sure! I'll give you the max dose of acetominophine and use fentanyl as needed. I was awake and lifted onto the surgical table, where I stared at the various instruments. Interesting, but I could've done without that! I had no nausea or issues in recovery.

[@RalphDratman]

I perceive your accumulating experience and maturation. Looks good.

[@Retiredtraveler1961]

Great video; I’m an RN retired and I’ve had multiple surgeries. Never had a bad experience except for once delivered by a Nurse Anesthetist. I have a question is there ever concerned about loss of bladder function using a certain anesthetic?

[@margerykirner5604]

Very informative and not scary like some of the others

[@TaylorWillis-f6w]

I was put under for a procedure last year, and it was the best feeling in the world when I woke up. It was a military hospital and they apparently used valium, propofol and fentanyl. As soon as I woke up they gave me Oxy via oral administration and I was on cloud 9 for the rest of the day playing COD at home. Slept like 16 hours that night.

[@jessebob325]

Been there, done that. 🫡

[@dc9039]

COD?

[@andream9470]

​@dc9039 Call Of Duty

[@dc9039]

@@andream9470 thank you

[@RickHowell89]

Prior to my shoulder reconstruction, the anesthesiologist said he was giving me a "happy to be here" shot.

[@robpeabo509]

I have had many procedures requiring GA as well as "twilight" sedation. In all but a few cases, the anaesthesiologist has told me they are about to inject the anaesthetic. In all cases I can feel a cool sensation traveling up my arm & then the next thing I know I am being awoken in recovery.. One of my surgical specialists used the term "jungle juice" instead of "cocktail". Probably a uniquely Australian term?? I have had different anaesthetics, including all three mentioned in this video.. I only have a few desired outcomes of the anaesthesiologist , they are: 1) I go to sleep, 2) I don't wake up during the surgery, 3) I wake up after the surgery and finally 4) I have no recollection of anything during the surgery, especially when sedated to twilight.

[@jerrybalko609]

Post throat cancer treatment has had me having Endoscopy procedures 4-5 times a year for the pass 10 yrs. along with about another half dozen surgeries for other issues I have had more Anastasia than most. That said, I've never had any bad reactions. Some times the anesthesiologist will even indulge me when I ask if they will give me "the Slow Drip" they say oh you what to enjoy it! and I say exactly. I noticed if everything is ready in the OR and staff is standing by waiting for the doctor to finish up with his laptop notes, they'll let me enjoy the ride for about 2 minutes otherwise it's lights out in about 10 seconds :)

[@psjasker]

Dr. Feinstein is one of those medical professionals that you know you’re in good hands with. A gift at that young age!

[@CuteCatsofIstanbul]

3 times out of surgery, I came out with a drunk, happy, come on, people let’s chat, lets laugh kind of mood. 1 time I woke with a horrible headache which no one took seriously. They finally gave me some Tynelol. And 1 time, I woke up drenched and as a late bed wetter, I thought I had wet the bed so started to panic. Then I noticed I was naked under the sheet panicked some more. It was such a horrible experience that I’m now scared of getting surgeries. 😢

[@DominicNJ73]

Only been under general anesthesia once, when I was 21. I have no idea what they gave me, I walked into the OR and the Nurse Anesthetist said he was going to give me something to help me relax since I mentioned being fearful of the gas mask. He gave me whatever he gave me and I became quite...ummm...flirty. Obviously those memories are hazy but I remember a few, one in particular involved an older nurse, I looked over at her and said "Well helllloooo sexy...wanna go on a date?" LOL I also remember telling, who I think was the surgeon, "your eyes are so pretty." After I was fully awake in recovery one of the nurses came in and called me "Casanova." LOL

[@Nunofurdambiznez]

Look at that sweet little angel at the end of the video! What a sweetheart!

[@drsaadnaeem]

Hi Dr. Max, love your videos. Please make a video on morphine and its current use in anesthesia / pain management