Liver transplant anesthesia - operating room tour

[@msbaird1961]

Fascinating stuff. I underwent a liver transplant in October of 2019. The anesthesiologist is the last person I remember speaking to before I woke up two days later. He must have done a good job because I did wake up and I'm doing fine.

[@jamesgreen3417]

I hope 🤞 your recovering well, I’m awaiting a Liver transplant atm

[@msbaird1961]

@@jamesgreen3417 Good luck! I wasn't happy when I was going through the process, but I feel fantastic now. Just keep moving forward.

[@verykittypretty]

@@jamesgreen3417 liver disease sucks hope u find a donor soon!

[@jamesgreen3417]

@@verykittypretty thank you 🙏🏼

[@zubia740]

My mother died after 16 days of liver transplant for wound debridement in ot due to medical negligence by anaesthetists

[@Kristen_michelle0515]

I’m a liver transplant recipient, 2018, so glad i found this video, gives me more insight into what happened that day. I had acute liver failure my liver died in 12 hours. I was listed right away with a meld score on 48, was put into a medically induced coma on sept 3, 2018 had my transplant sept 8th 2018 everything happened so fast i woke up and didn’t know what happened i just woke up with a new liver, talk about scary.

[@emmaleary3767]

Same thing happened to me.

[@Kristen_michelle0515]

@@emmaleary3767 kid you don’t mind me asking, what happened?

[@emmaleary3767]

​@@Kristen_michelle0515it was a virus.

[@drsuessl]

😮. I’m so glad you’re here. My situation took years (A massive GI bleed, liver cancer twice and then the transplant). The GI bleed was frightening. I came much closer to expiring then than the transplant. I’m so glad you made it ❤

[@Thwarptide]

Watching these videos presented by Dr Feinstein has given me an extremely heightened appreciation for Anesthesiologist. Its very rare to meet and greet an anesthesiologist let alone get to know them in the manner we would our surgeons. The last time I had surgery 10 years ago was for a 5.5 hr cochlear implant. Anesthesiologist are frick’n busy busy just prior to being taken in, so if you meet the anesthesiologist for 3 minutes, you’re lucky. I knew then that its pretty much a thankless profession. You never see them afterwards. In fact you never get to meet the surgical teams too. So on that day as the wheeled me into the OR, completely bombed out of my mind (good stuff) barely able to speak coherently, I fought to speak clearly and loud enough “in advance thank you everyone for your help today “. The last thing I remember was a few “you’re welcome(s)”. So when you first meet you anesthesiologist, thank them, its the last chance you’ll get. 👍

[@jamesamoh7340]

Wonderfully done and I know Anesthesiologists are paid well but watching this, I think it’s fair to demand even more. Haha

[@drsuessl]

This was really cool 😎. I don’t remember my anesthesiologist for my liver transplant. I remember the room was large, in the Jackson building in Massachusetts General Hospital. The nurse was fun. We had a hard time getting my special earring out. I heard that things went smoothly during and after surgery. I remember my surgeons. Post op, for a couple of days, I got psychosis. I thought that I was dead and in hell being mistreated. Those meds were hard on my brain. I know that I was being taken care of by so many. I was off the pain medications by the time I made it to the transplant unit. I so appreciate everyone. ❤️❤️❤️❤️❤️❤️

[@mikennastephenson3863]

I'm waiting on a double lung and liver transplant. Very cool and informative to see what this room looks! Going in not knowing what all the machines are for can be overwhelming.

[@pewpewpewkaboomz]

as an anaesthetic dr in australia, glad to see the exact same equipment are used at the other end of the earth 👍

[@MaxFeinsteinMD]

Yes just upside down versions of everything.

[@larryjohns5516]

All this reminds me of the DEDICATION it takes to be a Doctor as well as specializing in any field. Smart, hard working people all of you !

[@nicholasmartin297]

There are a LOT more medical staff involved in liver transplants than just the surgeons and anaesthetists. Think of the scrub nurse for instance, standing there for the length of the procedure. Keeping track of all the sutures used, the swabs and instruments etc. If something gets left in the patient it can be fatal. Also don’t forget all the backstage people. Those who maintain the filtered ventilation system, those who ensure that blood and blood products are available, Those who maintain the O.R. medical gas supply. The lab technicians who do all the tests the patient needs perioperatively. The team who procure the new liver. Etc. etc. etc. They are also smart and hardworking and vital to the liver transplant team.

[@dieteradelmann3950]

Great Job! Greetings from the UCSF Liver Anesthesia Team 😀.

[@musman9853]

The machine that recaptures the blood and gives it back to the patient is fascinating!

[@haydenmartin1197]

When I got to watch a surgery everybody called it the washing machine 😂

[@sunder1983]

Cell Saver

[@MaxFeinsteinMD]

Yes Cell Saver is another brand

[@queenbunnyfoofoo6112]

Those machines are great. They used one on me during trauma surgery ( broken rib got my splenic artery...ouch!). I'd like to put in a thank you for all blood donors too. While I didn't need any outside blood, I'm grateful to the six people who donated a pint had there not been a machine.

[@sophiasocal68]

Dr Max Feinstein, what a great video. I appreciate your dedication to educating people. I'll be having surgery again in November and these videos always help put my mind at ease!

[@phiberoptik232]

What a gas, getting this info in this manner through the lens of technology. Anyone not in the profession would be awed by all this marvel yet clueless about what and how it's all used. Good stuff as usual.

[@56Spookdog]

Fascinating I’m a double organ transplant (SPK) this year will 32 years.

[@fahimlodhi4170]

As a physical therapist, who loves all things ICU and other complexities in a hospital setting, it was a real privilege to witness how the medical team works together in a complex operation. I myself got to witness a CABG x3.

[@cheechmarin4812]

Very intresting Dr.Feinstein! Keep it up, I'm sure thousands of people are very grateful for you and your sensitive work with these potentialy dealdy drugs. Your a very talented person! If i ever have a life saving surgery I would feel at ease with you in the operating room. Much love from Texas!

[@Rebander1549]

Thank you Dr. Feinstein! Your videos are informative and easy to understand! Knowledge helps me to understand the procedures and not be so nervous.

[@virginiadavis2933]

Thank you for taking us on this tour. I will be getting a liver transplant and it is nice to know what is there

[@queenbunnyfoofoo6112]

Excellent and informative video! You have a natural teaching ability.

[@sturgislawler2611]

Knowledge seems such a small word to use when, one becomes aware of how far we have come in healthcare provisions, that transform & Extends lives. In the1800's it was a Bottle of alcohol, a surgeon, & an amputation. Now Look! To those who truly Study & Love this work, Thank You is also a heartfelt, yet small word.🌷

[@andybub45]

I have biliary atresia (a liver disease in which I was born with a bad bile duct) and I underwent a Kasai surgery when I was 2 months old. I’m 19 almost 20 now and I am doing great, but it’s still possible I may have to get a liver transplant at some point in my life. Really interesting to see the equipment they use for the procedure. Hopefully none of it will ever have to be used on me fingers crossed 🤞

[@rashaashraf6827]

I never forget this room ...in my life

[@suthrnbelle72]

I love this vid, Dr Max! One of my faves!

[@hammadmukhtar1913]

I am Liver Transplant Donor ! (18-09-2023) From Pakistan Kidney And Liver Institute Lahore ! The team was So Genius ! May God Give Them Higest Reward!

[@chucklongora6099]

I miss doing my Liver Transplants at Houston Methodist Hospital In Houston. The fluid warmer and Bair hugger was not mentioned as it is two of the most important devices to have as patient's Temps are highly monitored. Great video. WOULD LOVE TO COME JOIN 😍

[@patrick39140]

I loved that Bair hugger when I was in SICU post-transplant, those things are wonderful!

[@MaxFeinsteinMD]

You're right, I did not mention the fluid warmer or Bair hugger but they're both very important! I'll point these out next time I do an OR tour video.

[@chucklongora6099]

@@MaxFeinsteinMD no problem. Team work..

[@donotcare330]

I play pipe organ. Then I worked for a a CDL. I thought that was complicated. Then I looked at a pilot's license later and perhaps will skip that. Then I see this. Keeping humans ALIVE is the most complicated thing ever and always will be! Those that take up the call and do this. WOW. Much respect.

[@TheKdizzle1971]

your voice is like Propafal- puts me to sleep, very calming

[@lucyscherbakov111]

This was so cool to see!! I am getting a liver transplant soon and am really glad I get to know more about the behind the scenes of it! - ps love the channel!!:)))

[@ec8687]

So so happy for you🥰🥰 I’m a post kidney transplant patient of 17 years. I wish you all the best!!♥️

[@MaxFeinsteinMD]

Glad you enjoyed! Best wishes for your upcoming surgery.

[@denali9449]

Best wishes!!! Your life will become amazing. My 'borrowed' kidney will be twenty years old soon.

[@PollyNitroRocket]

Love your videos! My interest in anesthesia is growing. How do you defibrillate when a patient is in active surgery? Where do you place the defib pads?

[@MaxFeinsteinMD]

Great question! We try to anticipate when defibrillation may be necessary, so in those cases we place pads on the chest and back before a patient goes to sleep. Then if we need to defibrillate during surgery, we make sure nobody's touching the patient and then go ahead. If pads aren't already placed, we quickly try to get them on, but as you can imagine that's more difficult when the patient is already draped for surgery.

[@MaJBe1319]

This is so similar to the room I was taken when I was donating part of my liver to my son

[@kyleconley3834]

ABSOLUTELY AMAZING 👍🏻👍🏻. EVEN MORE IMPRESSIVE ARE PHYSICIANS LIKE MAX FEINSTEIN WHO WENT TO MEDICAL SCHOOL TO LEARN HOW TO OPERATE ALL THIS WHILE HAVING THE PATIENT IN A CONTROLLED INDUCED COMA ( if you will ) AND BRINGS THE PATIENT BACK FROM THAT STATE OF COMA TO AWAKE AND CONSCIOUSNESS, AMAZING !!

[@larryjohns5516]

Fascinating and well done Thanks Dr Max !

[@ryanchen4112]

Woahhhh this is so cool, thanks for the tour!

[@eveningstar1]

Fascinating! And hopefully something I'll never experience. Of course, now I want to see the liver transplant.

[@PuenteAJ]

So very interesting, amazing detail. Thank you

[@tamarinmangold1414]

Could you perhaps do one of these for major spinal surgery (like a multi-level fusion with instrumentation for scoliosis/kyphosis), please?

[@eisgeistschiller5244]

I'm an IONM student and HOPE he sees this. Seriously my class was supposed to get to see our first live case back in July, but the patient got cold feet. I took my first "practice" CNIM exam today and A LOT of Max's information helped me. In the mean time if your craving spine stuff. Dr. Scott Blumenthal our the Texas Back Institute has a GREAT Cervical ADR, Jack E Zigler Anterior Lumbar Fusion. I usually watch these for fun, but mostly pre op research.

[@jaseshields8749]

Good. For. You. Fam

[@emgs413]

That’s my Runner label! 😎

[@MaxFeinsteinMD]

Thank you 🙏🏼

[@takingafatdump]

isn’t there usually an “airlock” room in between the hallway and the surgical suite so the doctors can scrub in and to equalize the pressure since the or is kept at above ambient pressure?

[@franciscovizcaino4869]

Love the detail in this video, keep it up!

[@jg8104]

Hi Max, love the channel! I didn’t see a video on anesthesia for trauma surgery and would be very interested in learning more! Also, I saw it discussed briefly when you were interviewing the Chief of Neuro Anesthesia, but would love to hear your thoughts on TIVA vs. Inhaled Anesthesia. And finally (sorry) would love to see a video on MAC Sedation vs. General Anesthesia for minor procedures (I realize it depends on the procedure and a host of other factors, however, I’m assuming the Anesthesiologist would make the final call if they believed it was in the best interest of the patient to convert to full GA even if MAC Sedation was planned for and even started…I think it would be an interesting topic for you to discuss anyway). Thanks!

[@debbiejones6265]

How many anesthesiologists are there for that surgery?

[@davidadams9391]

Awesome video! More wires than my tv setup! 😂

[@joykiser6673]

Great video as always. 🥰

[@pleximan2008]

Hello dear dr.Feinstein my brother has seizures post stroke. He is relatively well controlled with the drugs he takes but i wanted to know if he needed surgery can he undergo general Anesthisia safely?

[@MaxFeinsteinMD]

Hello, I cannot give medical advice to people who are not my patients. Your brother will need to speak with his doctor. I can say that in general, patients with a history of seizures can safely be taken care of when receiving general anesthesia.

[@kymberleyanne]

you showed a liver surgery what about a double lung transplant? What kind of equipment do you use and what is it like??????????

[@alinazakharchuk3468]

Hey! Maybe a little bit dumb question but how many sockets does this OR have and where is the coagulation machine? Because from shadowing surgeons in my home country at one of the best hospitals here in every OR where I’ve to they have special stand(bench) with maaany sockets, laparoscopic equipment and coagulation tools as well. This sockets are also being used by anaesthetists as well (its like 20 of them) and also there are multiple monitors. This construction can be easily moved and put aside, it can be adjusted for every hight and seems incredibly comfortable to use. How do you survive without this in your ORs? 😮

[@sherrydawson6253]

Holly smokes all that is done by 1 Anesthesiologists? Dang seems like they should have 2 at least. Love how u show us everything! Your so cool

[@lizzapaolia959]

Nice hospital your employed by.

[@jarls5890]

How many people will be involved in the operation - manning all the equipment? Seems like a lot of stuff to keep track of! Regards, from Norway

[@MaxFeinsteinMD]

Between nurses, techs, doctors, and cleaning staff I’d say up to 20 people will have played some kind of important role in the direct or indirect care of the patient in a liver transplant surgery. Maybe 5-8 people in the OR at a given time during surgery.

[@elizabethleona3758]

Can u do a short on anesthesiologist degree and school vs. Crna? I know there are pros and cons, can u explain them please?

[@MaxFeinsteinMD]

This is a good idea for a video but I just don’t really know much about becoming a CRNA. Maybe at some point I could do a collaboration with a CRNA, we’ll see.

[@randybennett2989]

Your awesome..love your videos..3 yrs ago I was given succs ..anectine..it sent me into arrest..so ..im having surgery next week. I'm nervous. Bad..what is the next go to med for its place..thank u sir

[@MaxFeinsteinMD]

Hi Randy, thanks for the nice feedback! Best thing you can do is talk with your anesthesiologist and let them know what medication you received and what reaction you had. They'll be able to pick out an appropriate medication to safely be able to take care of you. Best wishes for your surgery!

[@jacobbornstein3273]

Are normothermic perfusions machines commonly used before the transplantation, like Transmedics or OrganOx?

[@markarca6360]

1:04 - Central line = PICC (Peripherally Inserted Central Catheter)

[@MaxFeinsteinMD]

Actually these cases do not use PICC lines. We place Central catheters in the internal jugular vein.

[@Mangold2865]

What are the emergency medications specifically and what would they be used for?

[@notapplicable2636]

By "central line" do you mean one installed on/somewhere near the neck..? :/

[@Aristotle2000]

What happens if one of the machines is not functional? Is there always a backup readily available?

[@MaxFeinsteinMD]

I can’t speak for other hospitals, but yes Mt. Sinai has multiples/backups of everything shown in this room.

[@Ahn-mu3db]

The way u said if pts are positioned incorrectly can lead to nerve damage so casually had me shooketh lmao I didn't know that 😮😅

[@shellyelly]

that’s fascinating

[@jenniferaustin8362]

Great video!!!

[@MrCoolibe]

is it normally that dusty inside an operating room?

[@Robby334]

Amazing

[@Jacobsupercard]

Is liver biopsie similar do you have a surgery for it or

[@MaxFeinsteinMD]

Liver biopsies are significantly less invasive than liver transplants. Those biopsies are often done by interventional radiologists with minimal amounts of anesthesia.

[@Jacobsupercard]

@@MaxFeinsteinMD o ok thank you just was wondering because I have to get 1 on the 29th so at mount sini to

[@Lisa_RNHealthHub]

How long is this surgery and how do breaks happen? Thank you.

[@Muluguluisintown]

Where is your thrombelastography? We have 3 ROTEM machines in our Liver Transplantation theatre.

[@MaxFeinsteinMD]

Across the hall

[@paiget8058]

Once again.. I'm a teacher. Why am I here? I can't stop watching lol

[@mitchelltanner6306]

Wow. Always like your vid's .. but you totally glossed over the APC which is just as important in keeping the patient hemodynamically stable. Also I could not see your INR machine or setup for cutdown.

[@MaxFeinsteinMD]

The surgeons use APCs and do cut downs, so I’ll leave coverage of that info to someone else! We use thromboelastography not INR for liver transplants, and that equipment isn’t located in the OR so I didn’t cover it.

[@yehhshhs]

MORE VIDEOS PLESSS I HAVE ALREADY WATCHED ALL OF THEM AND I WANT TO SE EMORE UPLOAD MORE AND FASTER PLEASE HEHEHEHE

[@braydonschmidt7177]

You better check that zoll! Always want a green checkmark and not a red X.

[@lilbran1106]

How did the patient do?

[@swizzles262]

This might be a morbid question, but is it common to have trauma patients die while you're preparing for surgery?

[@dr-ozone]

Why do liver transplant patients need to be kept under general anesthesia for 2 hours before surgery begins? To my knowledge this isn't required in other surgeries.

[@MaxFeinsteinMD]

Prior to surgery, patients only need to be kept under anesthesia for as long as it takes to insert the necessary lines which should take significantly less than 2 hours.

[@yadeedhyamadiki2897]

Where is it located sir

[@philiplacey5430]

Note to self: take care of liver at all cost...

[@jacobgalipeau6872]

For these types of surgery’s wouldn’t a Foley have to be placed as well

[@jheanelledewar5134]

yes they are.

[@Bichonfrise369]

My husband needs a liver transplant I’m so scared.

[@Captsewer]

Two years post LT

[@lemmetellyousomething679]

Please share procedures for head transplant 🤭

[@daidong1]

Liver transplant....very veyr hard!

[@carsonfarist8590]

GOD is in control!!!! Amen

[@animoma]

I make medical analysis videos on fictional characters- like why Spiderman needs a prostate exam or why Yoda has jaundice. let me know if you would be interested in collaborating

[@animoma]

here are some examples: kzbin.info/www/bejne/nZWrgGuvhsSfZtU - wario kzbin.info/www/bejne/Z4rdfZ6ZYr9qiJY - Yoda

[@mercynamikoye9084]

I just found you....soooo basically the movies should show you more....so you're not just sitting around behind the curtain😅😅

[@babyblue7798]

this is scary!

[@shawnkimbrel3323]

Equipment machinery

[@shoaibulhassan7776]

SALUTE

[@MrCdrant]

how in the hell can a person process that much fluids?!

[@stevenpryer5880]

BILE🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫🚫

[@aidanglendenning]

have anyone ever dropped an organ in a surgery

[@MaxFeinsteinMD]

Probably, but not that I've ever seen or heard of.

[@fluffykitten992]

@@MaxFeinsteinMDis it still usable after an organ is dropped

[@richardbalabat2098]

so scared 😢

[@katieleighh]

So weird to watch this when you’ve actually had a liver transplant

[@erikak8187]

Because you do the same thing over and over unlike other specialtys

[@edwardbarden4722]

This surgery looks extremely involved. I think I’d rather die if in the case I needed one.

[@chuksrichard3598]

Does a surgeon need to know those medications? Being an Anesthesiologist isn’t a joke.

[@MaxFeinsteinMD]

Lol

[@maxtnuc]

daddy

[@IfYouSubMeISubYou243]

I. WANT. THE. OR. TABLE. AND. ALL. THE. IV. POLE!!

[@patrick39140]

After recently having a liver transplant, I'm thankful at least one of those machines, specifically the defibrillator weren't required. Although my surgery went well and I'm doing fantastic considering what I've gone through, it was really nice getting an overview of the room from this view with everything being explained. Thanks Dr. Feinstein for this video. Shoutout to Dr. Selvaggi, Dr. Shah, and Dr. Venkatasamy for my transplant surgery at Jackson Memorial Hospital in Miami.

[@sherrihinton8567]

You went thru an incredible experience

[@failsafe56]

I had a liver transplant at Mount Sinai Hospital in NY on March 16, 2016. There's a chance I had it done in the OR featured in this video. As I was being rolled into the OR I was very scared. I didn't know if I was going to die or not. The last thing I remember I told the anesthesiologist that I was very worried. He said to me in the kindest way possible, "Alan we're going to take good care of you. " Those words meant everything to me and they put me at ease. The next thing I know I woke up in the recovery room and I am ok 7 years later. Thank you to that anesthesiologist, the transplant surgeon Dr. Arvelakis and all those kind professionals that helped me at My Sinai.

[@cooker521]

beautiful story

[@drsuessl]

I hope that you’re still doing well. I had had previous hernia surgery with Dr Hertl. I felt at ease with him and the team. I knew there was a chance that I may expire, but the waiting for the liver a nd cancer coming back a third time was my biggest concern. Now I’m approaching 11 years ❤

[@Rsthelen]

As a person that is headed down that road, that is extremely informative, thank you for that video.

[@jeffreyswisher5859]

Hey Max! Really good job. You accurately portray the level of complexity of this operation and the equipment that makes it possible. I am a liver transplant anesthesiologist at one of the few private practice programs in the country. If you ever make your way to San Francisco or are interested in pursuing a career here, give me a call. Keep up the good work!

[@drsuessl]

Jeffrey, I was told that it takes a couple hours to set up the patient once they are “out”. What happens between me arriving and the surgery starting??

[@hospitaldrive1232]

@@drsuessl We usually have a plan accordingly to the patient as a whole. Labs, other co morbidities, other organs involved, and each patient case requirements are different. We hope for the best but prepare for the worse. It is truly a very tedious surgery. The surgery is well planned out however your dealing with coagulation, hemodynamics etc. We aren't legally able to give you advice or speak on your case. However your surgeon, anesthesiologist and transplant team should be able to break everything down to you in great detail. Best of luck!

[@kendallevans4079]

I have a history of high BP, currently on 3 meds and it's still up there. Would I be difficult to have a transplant? Just curious because I was told by many medical professionals that the liver is highly vascular and maybe I would be tricky to operate on?....If you can't answer due to legalities I understand! THX!

[@BuickDoc]

Thanks for the video! It brings back memories of the first automated anesthesia record I ever saw, at Baylor Hospital, Dallas, in about 1987. I forget the Anesthesiologist's name but he was an early pioneer in liver transplant anesthesia in Texas. In the first transplants done at Baylor he had been overwhelmed trying to keep up with the Anesthesia Record. Huge numbers of blood products were given because there was no cell saver and surgical techniques were still evolving. This was before useful desktop computers so he had a terminal installed from the Hospital main-frame. He developed transducers from his monitors (A-line, SG, CVP, EKG, etc.) which, via the terminal, fed to an X-Y plotter, which drew out the record. He also hooked up a barcode reader. (BTW, he also had to write all the computer code!) He developed barcodes, in cooperation with the barcode gurus, for all the usual drugs. Tapes with those barcodes were attached to the drug syringes. When he gave a med he waved the syringe over a barcode reader. This caused the name and time of administration to be printed on the Record. He did have to manually enter the amount of drug. All the blood products had bar codes from the Blood Bank, so he could easily enter each bag via the barcode reader as well. At the end of the case he had a paper record of the anesthetic, accurate as to times of administration of drugs and blood products. I was impressed...

[@lilika6620]

These videos are so great! I'm aware that anesthesiology is a complex field and there's probably a lot to keep track of, but is there any chance you might be making a video about the major differences in providing general anesthesia for various types of surgeries? Hearing your thought process for specific procedures (precautions, types of things to anticipate, how you plan ahead) would also be really interesting.