The cost of anesthetic drugs for spine surgery

[@BestSpatula]

I had no idea anesthesia was so complicated until I discovered your channel. Mad props to you, your profession, and your hospital for letting you make these videos.

[@edshepherd3256]

As a patient, I find this video very interesting. I've had 4 spinal procedures. I'm allergic (have very adverse reactions) to all narcotic pain medication and Zofran. With my last surgery the anesthesiologist used propofol and ketamine, and I had the smoothest recovery of all of the previous surgeries. I have another surgery scheduled and am hoping for the best.

[@minutemangangplank8599]

good luck mate

[@vevenaneathna]

if your allergy status was due to a single reaction while you were receiving different opiods and zofran, you might want to be very specific when describing ur allergies to providers. ive seen this same situation where a patient thinks they are crossing everything bad off of a list of potential meds they will get, but instead forces the providers to give them a much more harmful drug. for example your description at a glance might cause u to receive a bunch of ketorolac which makes your heart explode, kidneys shut down, and blood pressure spike if u get too much.... maybe that is a bit dramatic of an explanation.... many people have allergies that are specific to one subclass of narcotics, such as a synthetic opioid vs natural opiate.

[@ejm6122]

I have a few coming up, I'm about 11 months post OP from my gastric resection due to excessive tumors reoccurring and paresis and a slight hemorrhage. My latest ultrasound showed tumors had already spread to my gallbladder and left kidney and liver. I actually enjoy my surgical visits... great naps! And great team of medical experts. USC keck and Norris

[@vevenaneathna]

@@ejm6122 dang. can remove everything except for the liver. god be with you man. I worked at a cancer clinic for about a year and wouldnt wish it upon my worst enemy. just dont loose yourself in your fight. Ive seen liver mets shrink to nothing before. we have come a long way. I currently invest in VEGF drugs and they have a lot of promise in liver mets. keep your strength up and get your b vitamins. maybe google d webber's studies on the benifits of a ketogenic/minimal carb diet. almost all cancers can only live on carbs.

[@ejm6122]

@@vevenaneathna appreciated your concern and support. I intend to make this a difficult fight for the creature devouring my inside. Lol I've been told that I have a tenacious attitude especially when things are taken from me I refuse to allow myself to be taken advantage of. A couple of years ago I was at Starbucks and when I was leaving I was mugged. I jumped up and chased the little guy . I caught up to him and he took swings at me and shoved me into oncoming traffic but I grabbed hold of his sweatshirt and pulled him into traffic with me. He kicked me in the head and ribs and ran. I jumped up again and caught him in front of someone's house as a police helicopter and a motorcycle and 2 squad cars pulled up. We found 6 new iPhone's in his pocket and drugs and a knife. But I caught him and got my iPad and phone back.

[@edu.M.A.0077]

Your presentation shows how complicated anesthesia is, and the education, training, skill, and professional nature of physicians. Physicians are scientists! And it's great when a physician has a great sense of humor as you have!

[@tamasmihaly1]

Interesting way to calculate cost. I'd like to know how much the hospital _actually_ charges though.

[@tretre1692]

Same!!

[@aninebula6985]

tack on a 10x multipler and you got yourself a ball park

[@SolopsistSocionaut]

@@aninebula6985 100x

[@Demonoidph]

@@SolopsistSocionaut probably closer to 1000 times lol I put a money bet insurence company was billed over 200k a patent but paid Pennies on the dollar where if u had no health care you can consider yourself in debt for the rest of your life.

[@TriforceOfCourage97]

@@Demonoidph ONLY in merica

[@rcjeffrey74]

I found your comments very informative. I administered my first anesthetic in 1971, and I am now semiretired after giving 52,000 anesthetics by actual count. You are wise to closely follow the reasoning of your various attending physicians; you will have your chance to make up your own mind later. My first comment is that you mentioned meeting your patient, but not starting your own IV. We were taught never to go to the OR with less than an 18g IV and that that was on the small side! It is important to know that the IV is a good one, and that it is connected the way you want it, taped in a secure way, and that you have a second one if the patient is completely covered and the anesthetic is TIVA. I have noticed that the newer anesthesiologists watch the monitors; we always watched the patient first. I noticed that muscle relaxation was somewhat vague. This is very important because the technician can tell you (and convince the surgeon) that the monitoring of evoked stimulation is adequate even though you gave a medium dose of rocuronium at the start of the case. Minor movement of the patient is something that you should notice before anyone else as it is the first, and best, sign of patient awareness. Some surgeons are good at local until they move to the spot that isn't numb. I like to have something from the gas machine going or at least highly anticipated because our feedback from the gas machine is so good and feedback from the detached IV dripping on the floor ain't so good. By the way, I laugh at decision trees and best practices. You should learn that in medical school. The nurses were taught that everything was in the book. We were taught that the book was out of date and it was our job to write the next book. Now go out there and get 'um! God Bless.

[@silasketgaskets8709]

er doc out of the loop for a while here. good points on adequate iv access and similar to how we think for trauma, surgical potential surgical cases. tell me what is current ststus with etomidate? am aware of side effects but is it still used, on crash cart?? thanks in advance

[@anchovietonie]

oh wow, i’m a veterinary technician and i’m actually shocked at how many of the same medications we use! biggest difference being that i don’t legally have to do any schooling to do anesthesia monitoring lmao

[@julesmpc1314]

Absurd you dont need schooling..hope that just cause you dong have to does not mean you wont remain ignorant and will actually learn properly, specially as animals can not tell you if they feel or felt anything during proceedures!! Its awfully common fpr animals to seem to be out but are actally feeling pain walst most technitians only know to look for heart beat alterations as signs of this but many many times there are no signs

[@nadeembaig978]

same.. anesthesia to both...

[@nadeembaig978]

i m vet

[@MsggieB.6870]

No training for that? Then WHY IS THE BILL SO DAMN HIGH THEN?? My cat got an infection, and died. But the medicines and bill were ridiculous!

[@terismith4512]

They didn't put lidocaine in the Propfal, when i had a procedure my pain was over the moon. Had the same procedure 3weeks later, they put lidocaine in the profaful, so much better

[@Jauphrey]

I really appreciate your straight forward videos, Max. I'm a healthcare compliance officer and seeing a sort of day in the life of providers is super helpful background education for me to better serve and support my staff. :)

[@KABNeenan]

As a pharmacy tech that prepares and delivers these drugs to the OR and throughout the hospital, it is really cool to see the context they're used in! It's also good to hear anesthesiologists always have cost in the back of their minds as well. Although we're not explicitly told to be conscious of cost as technicians, it's something I've always been aware of and I do everything in my (miniscule) power to reduce waste. Thanks for video!

[@ngs5554]

I had thyroid surgery done a few years back, and was taken care of by two resident anesthesiologists in addition to the actual anesthesiologist. The residents opened up a tube that they thought I would need, and the big boss full on yelled at them in the OR! I still remember it clearly, he said it was a $600 tube and I did not need it. I thought about turning around and telling him to mind his manners, but got scared that maybe he would numb me a little too well 😂😂

[@ejm6122]

I have been impressed with Max's character as a anesthesiologist...

[@ejm6122]

@@ngs5554 I'd rather still give him a piece of my mind. Lol I'd probably take a page out of that scene from TERMS OF ENDEARMENT... you know that scene where the mother screams at everyone for her daughter's pain medications. Lol that's my spirit animal...

[@HobbyOrganist]

Yeah, but this $244/$800 for the drugs is nothing compaired to the $100,000 total bill! the first day's cost for an ICU on average is $10,000- one MRI is $3,000, sure makes $244 look like chump change by comparison! My heart valve surgery was about $50,000 at a non profit hospital

[@Polymathes]

@@HobbyOrganist Yes, and I believe these prices quoted in the video are acquisition costs that don't really give an accurate picture of the final cost to the patient or insurance company. There are probably 50 or 60 pharmacist and technicians involved in getting those meds to the anesthesiologist and lot of administration/clerical costs that have to be added on. I wonder if some money could be saved for these two patients if the tranexamic acid could be mixed by the pharmacy instead of using premade bags?

[@dab7963]

So amazing to live at a time in history where doctors like you can sedate us during surgery. It is sad however that an asprin in a hospital costs like $200 dollars. Medicine should be between doctors and the patient. Insurance companies should get out of the way.

[@DarkZerol]

Welcome to America. Pretty much anywhere else in world already have a comprehensive healthcare system including countries like the UK, Canada, Netherlands, China, Singapore, etc. etc. The US is like the only only oddball that lack a healthcare system but rather have a healthcare industry where private healthcare providers are free to nickel and dime everyone till the last drop where a simple life saving a single insulin vial can cost up to hundreds of dollar.

[@joeglennaz]

I agree they need to redo the insurance system I will say though a lot of other countries they will not sedate you in force people to go through a lot of unnecessary pain.

[@linhl4710]

My heart hurts for the USA :( Here in Canada I've undergone numerous surgeries, biopsies, scans, followups, etc. and the only fee I've ever paid was parking overnight for $20 max or a recovery room upgrade which was around $50. No one should ever have to sign their life away just to survive. I hope changes start happening within our lifetime for you guys down there.

[@TheMegatuz]

It's because in USA patients are not patients - they are customers.

[@RHt09]

Insurance companies are not why hospital drug prices are high

[@Teefs]

As someone who has had two spinal surgeries (and will likely have more in the future), this is an amazing video. Thank you.

[@MagisterGentis]

It's interesting to see so much differences in practice for the same type of surgery. As an anesthesiology resident myself this would be my general setup for a spine case with neuromonitoring: 1) Blood warmer + Bair hugger (which also costs for the insert used) 2) Armoured ETT. 3) IV induction and maintenance medication: Propofol 2% if i was inserting a central line. (1% if i was going the 2 peripheral 1 art line route) we induce the patiënt with the TCI pump (Marsh or Shnider models) instead of freehand. Fentanyl. Remifentanyl for maintenance and bolus dose for intubation. I keep a RSI dose of rocuronium (+ vials of suggamadex) steady if CICO situation . Morphine or Piritramide for post op pain. Depending on the case I also use intra-operative (es)ketamine (also because it enlarges MEP amplitudes). We (almost) never give MDZ for general anesthesia. 4) Extra: Tranexaminic acid bolus + drip. Dexamethasone and ondansetron. Where I practice we never use hydromorphone or methadone (even though a recent BJA (?) article also promotes it's use in day care surgery. Funny to see how your teaching environment shapes you!) Also the centre where I work really doesn't like succinylcholine because - apparantly because of pesticide use - a lot of people in our region have pseudocholinesterase deficiëncy!

[@gg6k]

Pseudocholinesterase deficiency is rather intriguing. I’ve heard of anecdotal stories of it lasting from 12-24 hours. I know it’s variable but if you have seen it, what amount of sux did you give and how long did it last? Thanks in advance for the reply.

[@ejm6122]

Whoa, you both are experts in your field. What hospital are you working your magic? Impressive!

[@snikrepak]

Yeah I will wing it with some whiskey or something else that doesn't involve having the most important part played with like a steak.

[@legoslicerfilms1028]

@@snikrepak okay awesome, have fun living 6 feet under as well.

[@johnl.38]

I believe there is only 1% propofol in the US to my knowledge. We also don't use TCL pumps for better or worse. We will often use rocuronium and usually it just wears off sufficiently before MEPs are actually obtained and can be reversed with sugammadex easily. I don't like use succinylcholine for a variety of reasons but some people do. Some people also do non paralytic inductions with remi for intubation but I find it much less hemodynamically stable. Midaz is practitioner dependent. Ketamine is pretty common but for analgesia not because we care about signal amplitudes. Hydromorphone is probably way more common than morphine at this point in the US, but both are used as long acting IV opioids. I've done these cases with sufentanil as well but I kind of hate it.

[@stifledbabsie]

I had spine surgery in 2018 under Dr. Lenke at NY-Presbyterian and was under anesthesia for about 18 hours total. That was a long surgery. I had severe kyphoscoliosis due to being born with VACTERL, so I came out of that surgery a new woman who could wear button-up shirts for the first time. Also, I love Dilaudid. It was the only thing that worked for pain when I had MRSA in my spinal incision during a (failed) spinal surgery I had in 2007. That stuff is amazing. Thank you for sharing the rundown of costs! Some of that stuff is so expensive! And thank you for being an anesthesiologist. You guys don't get enough credit!

[@brandywilleford9157]

Hi!! I had surgery with dr.lenke in 2017 for scoliosis revision.Hes amazing as is the entire staff❣️Traveled from AL to NY and would do it all over again if I had to.

[@stifledbabsie]

@@brandywilleford9157 How was your recovery from surgery? Mine has taken about three years. I am doing very well now, but there are still days when I'm in a lot of pain. I would definitely do it all again, too. That was a life-changing surgery!

[@brettlamont4965]

Glad to see you prenumb before the propofol. I have had a bunch of surgeries and it is about 50-50. Much prefer the numb. I asked for it one time as I had a migraine and he said suck it up for 20 seconds you will be out of that. Not cool. It does burn pretty good.

[@brettlamont4965]

@@dm7uy no I had a migraine right before surgery and I asked for numbing meds to stop the burning. Sorry for the confusion. Propofol burns like crazy. Mayo numbs before but not too many local docs. I think it should be standard practice. But, hey, I’m just the patient. Lol

[@christinan.6117]

I think it should be standard practice, too. The only memory I have before my emergency gallbladder surgery was me screaming from the very intense burning, like my arm was on FIRE! Doctors, PLEASE use lidocaine before propofol!

[@lisayeary4256]

@@brettlamont4965 it makes me scream and try to pull of nurses faces if they don't push lidocaine first

[@SJR_Media_Group]

Very refreshing medical based video. Plenty of terminology splashed with humor. Learned a lot of things I didn't know before. I have had 6 back surgeries, 1 neck surgery, and a hernia repair. I know what the different medications are for, but always mess up their names. Always amazed me how I lost track of time, from going under to waking up in recovery. It was like 5 minutes before is all I remembered. Everything else is just gone. A couple of surgeries lasted over 7 hours and all I remember is counting backwards. Guess the meds worked pretty good. Last lumbar surgery was worst, 22 screws in spine, 2 giant ones from Sacrum into hips. Still remember the worst pain in my life in recovery. Even worse than when I broke my back. So glad my Anesthesiologist and post surgery care team were proactive and helped with pain management. I was supposed to have a 7th surgery, but I got tired of being a living cadaver. I still need that surgery, will do it soon. I am a member of the 1 meter club, over 1 meter of incisions. Some areas were cut 2 or 3 times along old incisions. After my surgeries, I was in Pain Management for several years. The head of department is an Anesthesiologist and has years of practical experience in and out of operating room. He certainly worked with me to manage long term chronic pain between surgeries. We used Methadone as a slow acting analgesic along with Oxycodone for breakthrough pain. We did some injections directly to pain sites on spine. We even tried all day infusion of Ketamine. Subscribed and will catch up on your videos. They all look really interesting.

[@CynthiasTikka]

Man, I feel your pain. I’ve had 10 back surgeries and going for my 11th on October 4 in 2 days. Fusion from T5-T12 which will connect to the rest of my current fusions T12-S1. Also they’re lung to reconstruct my lumbar spine at the same time, by doing a Pedicle Subtraction Osteotomy which removes a large wedge shape chunk of the vertebrae to create a lumbar lordosis. 10-12 hrs long surgery and up to 2-3 weeks in hospital. Hope you do better and keep as active as possible. You can heal your back with PT and commitment to lovingly take care of your spine. Even I’ve gotten somewhat better and it’s been 24 years since I broke my back.

[@jbt8922]

We use Methadone a lot in veterinary medicine for anesthesia. Also Hydromorphone, Buprenorphine, Ketamine, Propofol, Midazolam, Dexmedetomidine.

[@LeroyBrown]

Methadone must be produced by the tanker truck load for all the free clinics to load up on. Government can get straight out of my health and wealth! Animals injection medicine options are more freely available to them than people. The government controled medical cartel, values animals more than people.

[@AMERICANPSYCHO73]

This is actually really fascinating. It would be interesting to know the retail price that was charged to insurance, versus patient-pay. These medicines were surprisingly inexpensive. Well-done video... looking forward to others. Cheers...

[@nothingnamezero]

Incredible how expensive drugs are in the USA. It really isn't a developed health care system if you look at things like this. 100cc of propofol probably costs around 10€ in Europe, instead of 120. Remifentanil is 5€ here instead of 70... it's just crazy.

[@rayclark474]

Because the US absorbs the R&D cost that the rest of the world doesn't. IOW we pay it, you don't

[@nothingnamezero]

​@@rayclark474 IOW the pharma companies take advantage of less-wealthy American citizens to be able to make profits, through a system of lobbying? Yup.

[@eisgeistschiller5244]

When people have spine surgeries they aren't thinking about the cost. I have had 7 already, with just spine. Never have I ever worried once I get rolled in the back have I worried about the cost of drugs. I'm hoping my doctor doesn't fuck it up and the IOM tech is doing their job and not playing on their phone.

[@AdrielScott-8588]

I got my surgery for my spinal cord stimulator replacement tmrw. I'm glad I'm seeing this so it puts my mind at ease.

[@darkydoom]

I was surprised by how fast my spinal surgery was. I had an anterior discetomy and spinal fusion with bone graft from my left hip. 1 year later I'm doing great. Very different to my 360 that had me under for 10 hours, but that also was very good. Amazing work by both teams

[@anti-ethniccleansing465]

Out of curiosity, how long ago was your “fast” surgery and why did they choose a bone graft from your hip versus using BMP? Did they give you an option? My anterior double discectomy with fusion left me mostly bedridden in terrible 24/7 chronic pain/disabled. They used BMP for me, but they also did a non-FDA approved surgery where they left a good disc in between the two discs they removed. Ofc I didn’t find out until years later that I was used as a guinea pig (I didn’t have proper informed consent), and my corrupt surgeon was getting tens of thousands of dollars in kickbacks per every surgery he did from the company which made the metalware he put into my back. I believe the BMP stuff was also very experimental when it was used on me (my surgery was in 2004).

[@darkydoom]

@@anti-ethniccleansing465 what is BMP? I don't think you mean doner bone from a corpse? Because I was offered that but I know that using my own DNA (bone) would mean great success (almost no way to fail). I had my surgery January 2022. He'd seen my November 2021 to book it in, and my first consultation was November 2020 when I was at my worst. He said, "lose 10kg and ill see how bad you are in 12 months". I was still a mess, had to have a discogram first to prove that the disc compression was the source of my nerve pain, it proved it with flying colours. Also, my surgeon doesn't do it for many people. He says he only does maybe 12-14 patients a year. He wouldn't consider it for patients with disc degeneration throughout the spine, but he was happy for me because my spine was healthy, my only issue was that one disc. I was fit, healthy, and a patient that would comply with care He did that anterior approach, so from the front, sliced through the abdomin, pushed organs to the side, to the bone from my left iliac crest, removed disc from spine, did all that jazz and out again. I woke up with zero spinal pain. Took 12 months for nerves to heal. Walking the next day with pulpit frame. Back to work after 4 weeks, no more meds since that day. I'm what... 18 months post op now, running, lifting weights (80kg free weight olybar squat), doing muay Thai. Like, can cry thinking about how I went from chronic debilitating pain to this and so quickly.

[@darkydoom]

@@anti-ethniccleansing465 I'm really sorry for the experience you went through. Surgeries are so scary. I have a patient at the moment in my ward (I work as a nurse on a surgical orthopaedic ward) that went for what should have been a straight forward procedure and now she's 4 washouts in, months in bed, can't weight bare on her legs, can barely feel from her knees down, and she's still in such good spirits, a lovely lady and I really hope she gets well soon. Were you able to report this doctor of yours for what he did to you?

[@jeremylowe2309]

Also, why do I get another bill from the anesthesiologist additional to the hospital and surgeon bill? Health care is a racket. He just told us how much these drugs costs and then the bill is 300x’s more. Sad.

[@IslemTav]

I’m about to start my pre-reqs to become an RN and your videos have popped up in my KZbin in my search for learning more about the field. I’ve become obsessed with your videos, though. My goodness, you have awesome content. Prior to watching your videos I didn’t know anything about anesthesia and I am now so fascinated by it! Thank you for these incredibly well-done videos. You’re a natural educator and as a fellow NYC’er, I hope for the opportunity meet you one day and shake your hand! Hopefully not as a patient, unless I’m giving birth by c-section!😅 High respects for you, Dr. Feinstein!

[@Schrodingers_kid]

You're like any other doctor on social media,but you'll be helpful for med students and those who are here to LEARN

[@07Convertable]

Very interesting, Doctor Feinstein. Thank you for this video. Having had L5/S1 fusion performed on 11/21/22, it is nice to see much of what the anesthesiologist could use during the surgery. You guys are miracle workers, taking a patient to the brink of death and bringing them back. Once again, thank you for this video. ~John

[@eddavanleemputten9232]

Having just had a spinal procedure a few days ago, I found this extremely interesting. Granted, my procedure was a short one, it was scheduled to take an hour and ended up taking an hour and 45 minutes. I’m based in Europe and am constantly hearing about the high cost of medical care in the US. My country’s system of mandatory medical insurances and the added insurance I have for any hospitalisation causes me to not have a clue about how much my procedure or the medications used actually cost.

[@tinybubbles3724]

I had a spine surgery 5 years ago and umbilical surgery 2 months ago. Both went well. I had no idea that it was quite the cocktail that made it so pleasant.

[@rodwallace6237]

Just curious, did you ever see an itemized bill for the drugs used in your surgeries? Being on Medicare, I don't see a thing.

[@tinybubbles3724]

@@rodwallace6237 no, the bills don't spell out what was used.

[@666Kelso]

I've had 4 surgeries within the past 6 years. 3 cardiac ablations and 1 hybrid ablation. I've also has a dozen (or so) cardioversions. For some reason, y system sent me the operating room records from the ablations. I was absolutely dumbfounded by the amount of stuff I received. especially the fentanyl when I was clearly out like a light. Your explanations of this was succinct and very informative.

[@starfishgurl1984]

Thanks for another great video! I thoroughly enjoy seeing things like this because my dads an accountant so I have a thing for numbers, but also my sister’s a clinical engineer in charge of equipment installations in hospitals so I like seeing the behind the scenes too of how her job effects yours, fascinating stuff!

[@Buskyb]

Im so glad i live in a country with free health care, my spinal surgery cost me about 20 dollars or 50 dollars if you include the medication i got after the surgery(pain killers, anti inflammatory and bew dressings for the wound

[@ARSZLB]

being a nationally certified pharmacy technician (CPhT), it was fascinating to see exactly what drugs you use and how many drugs come in injectable formulations! awesome video!

[@rodwallace6237]

As a pharmacy technician do you get to see the prices of the drugs being prescribed? These appeared to be wholesale prices because I have never paid prices this cheap for any hospital visit I have had.

[@natalietrick2874]

As an inpatient pharmacy tech this is so fascinating to learn the differences between the different meds we stock in the OR!

[@rz5b1qszkdf44]

you are impatient? 🤔

[@draftwood]

Max, back in the 90s as a healthcare outcomes analyst at Tenet healthcare our team re-engineered the typical overnight lam-disc procedure of the era into a same day outpatient procedure. The intent was better pt. outcomes and lower costs for our managed care contracts. I remember costing every single step of the procedure, materials ,labor etc. and eliminated non value added inputs. Anesthetic supplies were of course part of this. One really neat finding was that one of the reasons patients stayed over night was post procedure nausea especially when combined with a late OR start. We switched to drugs that minimized nausea with great success along with expanded pre-procedure patient education. Patients ended up with better functional outcome measures and we saved cost to payers. Won a regional quality award for that one.

[@sharonread7674]

Very interesting. I had no idea it was so complicated and expensive. I had a bone graft Lumbar Spinal fusion in th uk over 30 years ago. I vomited so much and for so long after the intensive care nurse called the anesthesiologist out in the early morning. Nothing helped. A little Irish nurse saved the day and me from horrific persistent upchucking. She proposed suppositories called Domperidone that she had witnessed help chemotherapy patients combat rebellious stomachs. I will never forget her. Bless you wherever you are now.

[@KyleORorke]

As someone doing neuromonitoring i always wondered how much money is lost when drugs are "wasted". Thanks for the great vid!

[@rswyltk]

Do you know why insurance doesn’t cover neuromonitoring? I had a couple of Rhizotomy’s and test shots done at the beginning of the year, and insurance denied paying for the monitoring, the charge was $12k each time. I did the samething a year or so ago, and it was the samething with a different insurance company. Back then I asked the doctor if I was going to get billed for it, he said “we do it no matter what, it’s a charge we throw at the wall just to see if they will pay us anything, if not we just write it off” PS make sure the patient is out before you shove those needles in, I wasn’t out the first time, and that kinda hurt.

[@nickl2852]

I have no reason to know this information, however I found it incredibly interesting to see it broken down like this. Good work and great video!

[@Bravo_Alpha]

Have or can you cover equipment cost per use per case? I am curious if the ventilator is a fixed cost to each patient, or cost per time used, etc. Thanks for the videos.

[@ERfan91]

I am on methadone for chronic pain. I was really surprised when my pain management doctor had suggested it. I first was worried he thought i was an addict but then he explained how it can also be used for pain.

[@MrBurstfire99]

Great idea for a video! Nice to see it all broken down and quantified. I’d love if you did this with different types of surgeries to compare costs. Comparing Ortho to Urology to C-sections.

[@freight_train13]

This was great! I was an implant rep for 3 years and always wanted to talk to anesthesia more but I was mostly focused on praying to god there were no holes in our set wrappers or planning for what random thing the surgeon might need from an unrelated set to have ready in the core. Good times though, miss it (well, parts of it).

[@rachelmoore3931]

Hi Max! I'm a pharmacy technician that stocks the anesthesia stations every day. I'm just curious if your facility encourages you guys to use the lidocaine syringes like that. Mine stocks them, but they're only supposed to be used for arrhythmias (for cost reasons). We have the vials that are supposed to be used with the propofol.

[@Braddeman]

Glad you actually got a break in this episode. Wife works in the OR and so many days she doesn’t get any time to herself. Usually just a short lunch.

[@jasonwickens0813]

NO patient ever receives 'Wholesale' drug pricing. LOL. There is a hefty hospital markup. Wholesale gives the billing dept a 'base' cost to apply the markup said drugs. My spine surgery - I am going to go back and look up what all i was given. Interesting video Dr. thanks

[@MaxFeinsteinMD]

You are right, however cost varies so much depending on insurance and a number of other factors that the wholesale price seemed like the most standardized way to make an assessment.

[@jasonwickens0813]

@@MaxFeinsteinMD I've had 2 spine surgeries 5 years apart and my med cost between the two was quite high, just the difference in hospitals. Love your videos, very informative.

[@bradgrier4228]

WHAT A GREAT DOCTOR / RESIDENT TO NARRATE THIS VIDEO. HE IS SERIOUS YET HAS A SENSE OF HUMOR. BEDSIDE MANNER IS SOOOOOOOOOO IMPORTANT!

[@BureauKat]

Maybe I missed it, but is listing out all the meds you gave during surgery a normal part of the process, that is, does this info become part of the patient's medical record? Some of those drugs are expensive--as an anesthesiologist, do you ever have to worry about the formulary from the patient's insurance? Another great video!

[@comcastjohn]

If you work, you helped pay for it! It’s called TAXES! If ya don’t work, others paid for it.

[@rodwallace6237]

"formulary from the patient's insurance" If it is not on the list, the sky's the limit.

[@ccoop3774]

Harper, I'm going to say no. I was an OR RN for many years. We used our share of medications too. We never had to search for the patient's insurance, or lack of, when drawing up our meds. It made no difference.

[@p53k]

Meds: 500 $ avg. (based on this vid) Spinal decomp surgery total cost: 23.5 k US average Would be interesting to do a breakdown of the remaining 23k (material & personnel-costs, hospital-profit)

[@goaski474]

And the important questions are: How much did Mt. Sinai bill the patient for these drugs? And for your services?

[@marcydonnette1970]

Yes, good question. I saw a print-out of my anterior/posterior fusion with all the instrumentation, It was an l-4 to s-1, and thank God I had great insurance. Omg, I would have died if I knew how much it was going to cost.

[@X0X0LFertilizer]

80,000 and your first born child , plus a generous donation of both of your testicles and one eyeball

[@LeroyBrown]

It's all paid in government approved debt slavery money. Taxation of the next 1000 year's of debt slaves still won't pay it off. The Federal Reserve debt slavery notes should be redesigbed to have an image of the coming resurrection of everyone, bought and paid for by using them.

[@yehhshhs]

PLEASE MORE OF THESE VIDEOS WHERE YOU SHOW US HOW you PREPARE FOR A SURGERY AND POST SURGERY THESE ARE THE MOST INTERESTING ONES

[@danmason6116]

I've had 2 l345 fusions and a Nero stimulator surgery to and i know it cost a cool quarter mil for each one

[@eisgeistschiller5244]

You have L3-5 fused? How long is your doc giving you till 5-1 breaks down? Did the first one not work or did they put the stimulator in on that second one? How's it working for you? I already have 4-1 fused. I hope I never need to go through that again. Its a horrendous recovery

[@joeylantis22]

What an amazing doctor. I feel like my anesthesiologist try to cut corners, don’t give any medications except propofol before

[@maxlobos504]

Great video as always Max!, very surprised on the cost of succinylcholine vs rocuronium. It would also be interesting to see the cost of gas anesthesics and maybe look into how much each of them contaminate.

[@GabrieleElaborati]

T

[@ejm6122]

I haven't even considered that, OMG... I can't imagine having to need this brand of surgery and subsequently have zero insurance.

[@HobbyOrganist]

@@ejm6122 You pretty much dont get the surgery if you dont have insurance, THE first thing they ask when you check into the hospital is for your insurance card. I know of a young mother, (Britney Williams) was in the news not long ago after being in a mud run event, after the event she had eye pain and went to the E.R. turned out she had a nasty flesh eating bacteria that destroyed her cornea in one eye, but guess what? she HAD insurance but decided she didn't need it any more and cancelled it, so now in the hospital they refused to treat her any further without payment or insurance once the bill was up to $100,000 "Williams had to spend nine days in the hospital before her eye stabilized. She said she stayed near the operating rooms because her doctors were worried she would need an emergency cornea transplant. They wanted to avoid that because the bacteria in her eye could then damage the new cornea." "The young woman went blind in one eye within 24 hours after catching a flesh-eating bacteria during a mud run in Dallas Williams said the debris cut her eye, allowing flesh-eating bacteria to destroy her cornea. "It just completely melted off of my eye. A mother with two jobs but no health insurance, Williams spent a week in the hospital. She now owes $100,000 in medical bills." "I've had health insurance before and I never used it. I never went to the doctor and I just spent lots of money for nothing. So I didn't see the point at the time when we couldn't afford it," said Williams." "Her family is raising money through a GoFundMe account for further treatment to prevent the bacteria from spreading throughout Williams' body." "You don't think you're going to go to the doctor and someone's gonna say you owe $3,000 for eye drops," said Williams, who compared her experience to a horror movie There's a chance Williams could eventually regain her vision with surgery. However, she says several local doctors have denied her treatment since she lacks insurance." Her GoFundme had only raised $23,000 of that $100,000 medical bill.

[@Kriddle1229]

@@HobbyOrganist This is illegal in the US since the EMTALA. You will be billed and will have to figure out how to pay it later, but they cannot refuse treatment upfront.

[@donepearce]

Here in England these costs are met from our NHS contribution in our taxes. Thus at the point of delivery there is no bill. By sourcing all these drugs in national quantity the costs are all very low.

[@MaxFeinsteinMD]

Yes, this is the most accurate comment that's been left.

[@TheOpinionatedYouTuber]

I love your videos and how detailed you explain complex topics. I’m not an MD and do not work in a hospital. But, I’ve had many surgeries in my life. The anesthesia bill is nowhere near as low as you’ve listed here in this video. Hospitals be like, “We can charge 20x the wholesale cost, by golly, let’s do it!”

[@elizabethleona3758]

Most of that cost goes to the professionals that know how to 1. administer the medication and not kill us, And 2. Keep us safe while under sp we dont wake up ect. Yes it is extremely more expensive than actial medication cost. Wth???

[@anonanon9489]

@@elizabethleona3758 Most of the money goes to hospital administrators and CEO, not the doctors themselves unfortunately. Many doctors are still in debt from med school despite the hospital charging 20k for an xray and 4 staples.

[@carloso6292]

@@anonanon9489 they earn hundreds of thousands per year, how the hell do they have debt

[@johnos3853]

@@carloso6292medical school costs hundreds of thousands of dollars

[@jeanbaker2087]

Last year I fell at my home and fractured the L2 part of my back. The hospital was overflowing with covid patients. I was required to stay in the ER for 2 1/2 days they kept the pain at a minimum, but repeatedly forgot to feed me. The 2nd day it was highly recommended that I have a new procedure to "super glue" the problem. During this procedure only a local anesthetic which they repeatedly missed that area. I was awake during the whole process, and YES it did hurt, but my recovery time was minimal. I did have to have physical therapy for which I was in a nursing home for about 3 weeks. My back still hurts some but not as much as I had expected.

[@dansaxe]

@max feinstein thanks for the video! Did you use any inhaled anesthetic agents for these cases, and if so, can you estimate their costs as well?

[@Screamingtut]

Max, I have had Multiple back & spine surgeries over the years. Plus, I'm still waiting to have surgery on my lower back (L5-S1) I cannot have my back MRI because I have a non-MRI compatible Spine stimulator (that has not been able to do anything to relieve my pain (it is a Boston Scientific Waverider put in in 2020)). I had a very bad reaction to Methadone in both oral & injectable meds. I also try to stay away from Oxycontin unless it is a low dose. I used to be an HHC-NYC-EMS Paramedic back in the early to mid-70s before it was taken over by the NYFD.

[@hawaiianprestigecars8493]

can you deadlift? maybe statt trying it very slowly step by step deadlifting honestly has made such a crazy amount of difference in spinal conditions its wild

[@mandymorrow5473]

The 2nd surgery's price and breakdown looks more like my standard EOBs. I've had 4 spine surgeries alone (which is only a few of the surgeries I've had overall) so those breakdowns are unfortunately familiar to me.

[@surgeon888]

I wish you the best in your recovery 💖

[@flypimpinogflypimp2126]

I have a surgery for a herniated disc next week, and they have to use a main line for me, and you are scaring this s*** out of me. I'm so scared to death to have this surgery

[@furies]

I tried to fight my anesthesia one time and when I came to, they informed me I said “f you, you got me you bastards”. Still cracks me up to this day.

[@HunterStephens-bj6jt]

That's funny.. I can't remember anything but I'm told I was a piece of shit, they moved me to another hospital 😂 I was so embarrassed lol

[@Moodtoodrude]

I have a Chiari Malformation Type 1. I was decompressed in 2012 at Harborview in Seattle, WA. I had a duraplasty, laminectomy, overall a "Chiari Decompression" (brain and Neck Surgery). I was in the neuro ICU for 24 hours, then normal room for another 24 hours. My bill for my 55 hour stay, was $249,550.

[@Stopsign123]

Great video Max!! I work on designing billing/revenue management software for surgery centers and am learning so much from your videos for my job!

[@anglophils645]

Thank you, another very informative video. I'd like to hear you discuss when to use an epidural for extra pain management, both during and after surgery. My experience with them is that epidurals can make it difficult for patients to wake up after surgery, particularly if they have naturally low blood pressure.

[@cptnmedic]

I might have missed it or it may have been implied. The cost of the rocuronium for the first patient, since it was not used does the patient pay for the specific medication or does the hospital chalk that up to a loss?

[@MaxFeinsteinMD]

At my hospital, that cost is not passed along to patients. Great catch!

[@bekr3473]

0:04 why are the labels pulled down?

[@MaxFeinsteinMD]

The labels for these particular bottles partially detach to allow the bottles to be hung upside-down by the label.

[@darriontunstall3708]

Great video man!! I always learn a lot from your videos!! You rock man!! That was very good info!! I’m gonna start Donating to the anesthesiologist Foundation in August since It was hard for me to go to college to be a anesthesiologist after I graduated high school in 08 because of my cerebral palsy, I love your new shoes 👟!

[@roadrules3671]

Had Spinal Fusion Surgery on Feb. 14th; 2022. Approximately a 3.5 Hr. Operation. The total Anesthesia Bill for those 3.5 Hours was $ 4800.00

[@jenatsky]

The cost doesn’t really come into play if you’re a patient with insurance. The amounts charged by most hospitals for these individual drug products are typically 5 to 10 times greater than cost, but are based on the “average wholesale price” which is how Medicare reimburses for these.

[@beequinn5204]

I have a bleeding disorder and during surgery and prior I generally get up to eight units of whole plasma and two of Tranexamic Acid that's before surgery, I also received eight units of blood plus more plasma and TMA. The last surgery was a reconstruction of my right hip and pelvis so I wonder what the cost would gave been. I also had a PCA for seven days for pain relief. In Ireland as a private patient you pay over a 1000 euros per day for your room and then the surgeon fees. I'm lucky to have insurance however even if I did not the maximum charge per day in hospital is around one hundred euros.

[@rorod3]

What are the costs for sevo, des, iso if those are used for maintenance of anesthesia? Is maintenance with propofol cheaper than with the anes. gases? Also how much is a BIS strip?

[@monicaperez2843]

Not a doctor or nurse, but I have been through a lot of surgeries. It has been my experience that propofol is used for short procedures, such as colonoscopies.

[@henriquelaydner4080]

@@monicaperez2843, you’re partially right. It is indeed used for short procedures because it allows for a fast recovery. But this very same feature can be useful when we want the patient to be as close as possible to his/her previous neurological status almost immediately after surgery or when we need neurophysiological monitoring during surgery, as it has less impact on the electrical signs obtained from the brain and nerves. Patients that have a family or personal history of a genetic condition called malignant hyperthermia cannot receive any vaporized anesthetic agent like isoflurane and sevoflurane, among others, nor succinylcholine as a paralyzing agent. In these cases we must use propofol or other hypnotic agents, no matter the length of the procedure.

[@monicaperez2843]

@@henriquelaydner4080 Thank you, Henrique!

[@darkydoom]

This is interesting to watch as a surg ward nurse, because so many times when I'm getting hand over in recovery, the nurse is telling me the drugs used for anaesthia and I'm like, "yep, know name, don't know action."

[@Gsavega2803]

I’m always amazed by your channel. I’m not in the medical field but appreciate and respect it very much. You make something complex……interesting and fun. I even got my internist to start following you. Lol . Keep up the great work!

[@thomash1]

I was expecting more for some reason! It's priceless considering what can be achieved using these drugs for patients.

[@JohnDoe-ji8bg]

Thank you for the video! You need to be a teacher or instructor! I’d be so honoured to be your student in clinicals 🥰👍🏻

[@dic5822]

In goverment hospital in my hospital indonesia low budget goverment insurance we use maintanance with inhalation agent isofluran + N20+ low dose ketamin 0.5 mg/ Kg BW/ hour durante operation we can use isoflurane 0.8 MAC with balanced anesthesia....at the end of surgery 30 mnt before end turn to sevoflurane.

[@jonathanmisener7844]

Hey Max, thanks for doing the work of looking the price of these common meds up, was an interesting watch. I also appreciated you sharing the article about intraoperative methadone. I would love to see more citations in your upcoming videos.

[@NikkieRoxxx]

Methadone is used as a pain killer more often nowadays. As "dolofin" for humans; and as "Comfortan" in veterinary medicine

[@jwenting]

For my mother the cost of misapplied anesthetics to the spine for surgery were a lost leg, paralysed lower body, 5 years in and out of hospitals and rehab trying to fit her with a prosthetic leg (which failed), and 12 years of 24/7 severe phantom pain before she died from another medical error by the same hospital. And all that because the anesthesiologist decided to save money by using a cheaper anesthetic drug than had been requested for her, one for which she turned out to be allergic.

[@jgalt5002]

I am so sorry

[@brettlamont4965]

How much do you determine the pain and comfort levels in a post op or recovery setting? I had two knee surgeries about 10 months apart and had two completely different recoveries given the same surgery and surgeon. So really wondering how that can be in relation to the many choices of case management.

[@henriquelaydner4080]

Brett, every case is different, even if we’re talking about the same patient being operated by the same surgeon and anesthetized by the same anesthesiologist. When you say you had two knee surgeries 10 months apart you don’t say much more than that. Were they both on the same knee? Were they both arthroscopic surgeries, or open? Even if they were both arthroscopic there can be huge differences if in one it was made the reconstruction of a ligament, for example, while in the other it was just a chondroplasty. That being said, when it comes to anesthetic techniques, we can go with regional (spinal, epidural or even specific peripheral nerve blocks that will anesthetize only the limb being operated) or general anesthesia or a combination of them. Everything will have repercussion on the postoperative pain management. There would be much more to discuss, but it wouldn’t fit in a comment.

[@bettyweimer394]

I am so impressed! Your patients are blessed by your thoroughness! May God bless you!

[@funnymoments1733]

I really enjoy your videos ❤️

[@NateKK7]

My endoscopy was just propofol I can't remember anything after they started pushing it its definitely a different feeling then general anesthesia which I have also had. Especially in recovery.

[@pegaseg70]

👋 thank you for this video, interesting as always Could you link the article about methadone you mentioned in the video please?

[@GeorgeDaymondLush]

There was a suggestion that the insurance company would influence the charge for drugs. This is never the case in the UK. National Health surgery is costed but the patient would have little notion of this. It is free Self pay surgery is costed but individual costing has not been listed for 20 years. So (for example) a HoLEP procedure was estimated for me at £7,500 (1 or 2 nights). So £1,200 for the urologist and £600.00 for the anaesthetist . This includes 2 consults with the surgeon. Nothing individually costed because it is too expensive to do the mathematics . 1 consult with the anaesthetist . Didn't like him - every question was answered with another question but he did redeem himself by inducing with sevoflurane. That was a bit of magic. Love your work Btw remifentanil is £128.00 for 5 mg in the UK

[@muimasmacho]

Cool video. I had L5-S1 fusion in 2013, after 35 yrs of sheer agony. My case was complicated in that my father died from malignant hyperthermia during kidney stone extraction. This condition is hereditary, so to play it safe my surgical team opted to use propofol, in quantities that were very hard to obtain during Obama's tenure as he rebelled against the death penalty - lethal injections specifically - even so far as to starve hospital supplies. It took six weeks for the surgical staff to beg, borrow, and steal enough propofol to sedate me for the 3-1/2 hours surgery. I was very fortunate to have such a great team in my corner. Great Backstabber, and Sandman. I would be interested in learning about how that whole process might have worked. I kept waking up. We talked about welding. 😂

[@petermescher332]

Obama had nothing to do with the Propofol shortage. That was the EU (and the manufacturers based there, which is all of them) refusing to ship Propofol to the United States if it was going to be used for the death penalty.

[@sinnexz]

one thing that still blows my mind away is that how cheap the supply costs are in comparison to the actual labor costs. thats why medicine is so expensive...

[@1hopefulcrna875]

Which PIA is your preference for lessening the impact on your SSEPs/MEPs? Edit to add that I love your videos, and thanks for representing anesthesia!

[@PatrickBateman191]

I found this video super interesting because I had spine surgery 2 weeks ago. Incredible how quickly he knocked me unconscious. I didn't have time to realize anything.

[@Aevykin]

Hospital cost: $215.47 Patient Bill: $125,000 ??????

[@mrgreen4688]

yes and insurance paid about $38,000. don’t forget the cost of the room, nursing staff, doctors etc. my recent appendectomy was billed at $110,000 - all-inbut that’s “list price” and cigna paid $29,000 thereboaut. my out of pocket was $1500. my surgeon net fee was $3500. very reasonable.

[@jeffreymurdock8366]

My old lady had back surgery June 10th. A 11 hour surgery fusing 4 levels of her spine. I feel sorry for our neurologist. Yes we both have back issues and my surgery was 7 years ago. Thankfully lesser of a surgery.

[@90w30n]

Hi, Max, great videos! Have a question, have you ever had a patient who was on an MAOI? Parnate, Nardil are two. I don't even like to think about being an e.r. patient. The evening before a minor surgery, my anesthesiologist got me to write "NARDIL" on both hands so everyone would remember. I thought that was pretty cool. :D

[@ejm6122]

Lol or a bit unsettling

[@megaether]

At 4:30 before you finished your sentence i thought you were going to say "you can check out the link below" to order yourself some methadone

[@joshbritton]

Based on those costs, it looks like I should go into the business of MAKING these drugs as opposed to administering them! Kidding of course, loved the video as per usual Max! Keep killing it

[@vancouveropenbsd985]

Why? They're all generic medications. There's not a whole lot of profit in that. Brand name, patented meds? Different story.

[@andyloescher2401]

We dont need more greedy pharma companies that price gouge patients

[@moniquefiorecna]

When i was a teen an oral surgent wanted to charge my family $128 an hour for Anesthesia for my upper wisdom teeth. We couldn't afford it. My insurance only paid for the Anesthesia for the bottom ones. The surgent kept pushing for my family to pay for it. We had to wait and rasie the money for it. A few weeks later i was having a cavity filled and the dentists said he would pull the top ones. I told him we couldn't afford it. He ran my insurance and paid for the local Anesthesia. I was soo relieved i didn't have to pay over $300 for Anesthesia. I had no complications from the top ones pulled. I was back on my feet in like 3 hours

[@thebenandfridayshow]

Please do a spinal surgery operating room tour thank you and I got your joke

[@eisgeistschiller5244]

The only difference is you have either C or O arm in the room and a set up for IOM, and all that is would be out stim box/motor box and our computer. You may have the Stealth set up in there as well but that's it.

[@lindad6223]

I've been on the receiving end way too many times! I recall the bill being a whole lot more than the medication prices. to paraphrase a company that likes you to spend money: Medication: $1036.63. Waking up after surgery: Priceless!!

[@MrMilarepa108]

As a European I’m lightly terrified by the thought that my anesthesiologist would have to think of cost while selecting the treatment that keeps me walking the fine line between life and death during a surgery like that.

[@salmathecopt7969]

Yawn

[@brtv3058]

You aren’t a European stop trolling kid

[@rdizzy1]

Methadone is actually being more frequently used for chronic pain or pain now than it is for chemical dependency. Suboxone is used more now than methadone. I've been on methadone for chronic pain for 5 years now, have not needed dose adjusted once, just haven't built a tolerance and much less roller coaster effects than other narcotic pain meds I've been on in the past (pretty much every single one in the past 20 years)

[@felix-antoinelavoie21]

Liked for the back to back surgery joke

[@robertdabbs2606]

Hi Max, I always find your presentations very informative and fascinating. However, assuming the similarity of two surgeries , I find difficult to believe that one assembly of medications, costs aside, would not be more or less effective than the other. I would not be happy if I knew that cost was the deciding factor.

[@forsaken696]

I don’t

[@DustinPlatt]

Hospital pricing really doesn't matter, we as non-doctors don't care about what hospitals pay for medicine. What, hospital's pay wholesale or at a 20%-50$ mark up buying from the pharmaceutical companies? Or some sort of discount via buying group. Then cost for patients is 500%-5,000% mark up on that because that is what the hospital want to claim to the insurance companies so they make money. U.S. health departments, hospitals, insurance companies, pharmaceutical companies are the greediest people in the world. And also, half the medication left over is just squirted into the sharps bin. I'd rather stay home and die than pay for the new MRI machine for the hospital. America.

[@jimybobjim]

Probably a lot

[@oryan4395]

I take methadone everyday for pain. It truly is a wonderful medication. This is also very interesting as I've had 4 spinal surgeries, so seeing this gives me some insight and that's wonderful. My first anesthesiologist had to be a wonderful man. I had unstable fractures at C-3 & C-4. So he was able to intubate me without paralyzing me. Also when they rolled the board I was strapped to in order to intubate me all the pain of my 15 fractures hit all at once. I demanded to be knocked out. I remember him saying that I needed to open my mouth and then me saying "no knock me out" through gritted teeth. That was the last thing I remember for a week and a half. So my stubbornness won the day apparently and he REALLY honored my request to be knocked out. 🤣 God bless that man. I was a horrible patient during that time.

[@jimybobjim]

$588 for one medication- Wow I like not living in America

[@bbvv2967]

it probably costs 10-30 dollars to produce, per vial

[@Eman1900O]

You pay for it through your high taxes whether YOU have surgery or not. And Remifentanyl is pretty much only used during spine surgeries

[@martinlanders6135]

And that was the wholesale cost! I’m sure it cost the patient a whole lot more.