Methadone: the surprising (and controversial) drug used in anesthesia

[@Zadreko]

In vet practice we use alot of methadone for management of pain. The fact that it last so long its a bonus, and offers overall better clinical effects/benefits then the others like buprenorfine, butorfanol, fentanyl or morphine. + i use it as a anesthesia plan combined with medetomidine and ketamine for induction and propofol or iso for maintaining for some routine surgeries like neutering/castration. Great video as always Max! (1 quick note - im not a huge fan of the green screen , you actually being in the room makes the videos more..alive? )

[@NDMD]

Your videos are slowly evolving into NYSORA aesthetic 😂 the transformation is almost complete

[@darriontunstall3708]

That’s what’s up! I learned a lot, I always learn a lot from you! It takes a special person and skills to be a anesthesiologist or CRNA and you’re one of them, 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! I have always wanted to be an anesthesiologist ever since I was a kid! You rock man

[@LauraBlair-ut5ns]

I had a totally different experience.I was gonna have a lung biopsy and when the anesthesiologist found out I was on methadone he leaned way over and in my ear he whispered 'it's good you took your methadone this morning' and grasped and gently squeezed my hand.Now, when I woke up next morning my doctor had told me he would give me my daily dose.When he saw my dose which was 120mg.he flipped and was shouting how nobody should take that much.He said it would kill him.I later talked to my counselor and she told me that problem was that these Dr.s are trying to treat the disease and not focusing on what they're supposed to.I have ran into more ignorance in the medical community than anywhere.Oh, law enforcement as well.But my counselor was right about them trying to treat the disease instead of what they need to be focusing.I'm forever greatful for that anesthesiologist.

[@SuperStrik9]

If that doctor went nuts over 120 mg being a high dose, it just shows how clueless he is about methadone. Especially with the fentanyl crisis i've seen doses WAY higher than that and there's nothing wrong with it. People need to mind their own business and stop talking about things they know nothing about like that doctor you dealt with. Sorry that happened to you.

[@noncompliant209cali]

​@@SuperStrik9 you are 1000% correct. The government needs to reevaluate regulations on methadone limits with the fentanyl crisis. It takes a higher dose and sometimes multiple doses a day to keep someone comfortable when quitting fentanyl

[@kathyfullarton8126]

Great video! I received methadone at the start of my lamenectomy and PLIF surgery 10 months ago. Other than 1 dose of analgesia in PACU, I required no opiates during my hospital stay. Went home on first day post op, as I was ambulatory and felt no pain. Thanks to your video, I now understand why I received this med. Always enjoy your videos, Max!!

[@sophieloren9454]

I am registered veterinary nurse and we use methadone for the majority of all our pre-meds prior to induction of general anaesthesia in animals

[@MistySprinkle-f4y]

I cracked up at the South Park clip depicting controversy amongst anesthesiologists. I was a subscriber before this video because I work in a neurosurgery practice with two brilliant doctors of anesthesiology on staff who provide amazing care with minimally invasive procedures. I’m also an MMT patient so it’s super cool to get a video that was so useful and informative for me personally.

[@ilovetotri23]

I am always so impressed with your videos! I think few people have the respect they should for anesthesiologists! You keep us alive and comfortable! That is huge! I do not if it is by design or not, but every time I have needed to meet with an anesthesiologist prior to surgery the meeting was super short. They have always been super kind, responsive, and open minded. They seemed rushed, but so kind! And since I have never died and had zero memories during surgical procedures, they are my hero's!

[@henriquelaydner4080]

It’s not intended that we have such a short period of time to get to know and talk to our patients. Unfortunately it’s a setback of our specialty that we can overcome with much less frequency than we would like to. To compensate that, or at least minimize, we generally develop the ability of quickly establishing a deep linkage with the patients, in many cases recurring to humor, which may be the main reason why we are generally seen as the most easygoing doctors in the surgical environment.

[@ilovetotri23]

@@henriquelaydner4080 Thanks for your response! Clearly you are the next anesthesiologist I hope to have!

[@DillonScottDVM]

Veterinarian here and former RVT anesthetist.... LOVE me some Methadone. It's always interesting to see the differences in reported side effects of some of the shared medications we use.

[@bradpnw1897]

God bless you thank you for being a veterinarian. People that have been on methadone can have a lot to share and tell you also. God bless you 🙏

[@frotoe9289]

Good stuff. The phrase "for outpatient surgery with next day discharge" caught my attention. Doesn't that make it inpatient surgery? When does out become in?

[@mursegeller]

The patient would technically still be "observation". This is indicated by medical necessity and also has an impact on how the insurance is billed (U.S. only). If patient is admitted for >2 midnights, then the surgery is considered inpatient surgery.

[@quinceylane1885]

Cant wait to watch this video on my study break !

[@kgrfirdjy]

i was surprised to hear a while back that injectable methadone was expensive. i have been on oral methadone for neuropathy by pain management and remember a 1 month supply having a cash price of $7-$10 at my local pharmacy when I lacked prescription coverage. The added bonus beyond pain relief was the fact that methadone was a very long acting medication.

[@bradpnw1897]

Injectable methadone is much more rare than the oral form from what I know. Hopefully the methadone is working for you for your pain relief. God bless you 🙏

[@eievui]

I just began taking an MAOI (selegiline) and my doctor told me to get a medical alert bracelet. I feel a little awkward wearing it, but I know there are several drugs I might be given for anesthesia that are contraindicated - just didn’t know methadone might be one of them. I’ll keep wearing my bracelet!

[@toni6194]

Thats very important there are more drugs that i can think of that are dangerous with an maoi

[@ngocvo405]

I'm really love your channel , I'm also anesthesialogist ,hope you will up more emergency case in anesthesiology department

[@d-meth]

Methadone is also used in pain clinics and in veterinary medicine, I've had cats come home with methadone syringes. Buprenorphine too.

[@SJR_Media_Group]

I was prescribed Methadone for chronic pain, instead of Oxycontin. It's a slow release medication and needs to be tritated over several months. I was also prescribed as quick release for breakthrough pain.

[@jeremiahlovestrand88]

As someone watching who is currently on rotation I would have loved to hear more about what patient demographics you choose to use methadone on. Whether you never use it for ambulatory patients etc.

[@henriquelaydner4080]

Max has a sharp sense of responsibility and he knows exactly where to draw the line between giving educational instruction and providing clinical advise. Nevertheless, I can say that a particular type of surgery that I consider suitable for administering methadone is vertebral arthrodesis, which can elicit a lot of long lasting pain. I’d rather go with methadone instead of oxycodone, that is not as potent and I judge as having a greater risk of developing addiction because it has more euphoria-inducing effects. Proof of that is the opioid abuse crisis in the United States.

[@bradpnw1897]

​@@henriquelaydner4080very interesting I really appreciate your input especially with your experience. As somebody who has been an oxycontin for 2 years and methadone for over a year and a half I am so glad of the sublocade and Brixadi shots. Those are true life-changing amazing medications that are revolutionizing opiate treatment disorder. Along with the Bernese method of cross tapering to get people from methadone to Suboxone then on to the sublocade and Brixadi shots for most patients then completely NOTHING😎. That is for the patients that are not dealing with reoccurring chronic pain issues. God bless the people with chronic pain issues especially those that aren't getting any treatment they truly need God's blessings and pain Management truly. God bless you and thank you for your input 🙏

[@drsaadnaeem]

Love your videos, very informative. Could you make a video on your expertience with Precedex? Both for sedation and general anesthesia

[@MrOrthodox13]

I'm a little stupid, so I have to ask this, do you administer it only when a patient is asleep, or also for day-time, short surgeries when the patient is awake?

[@camillelapalme4950]

Hi! I have an idea for a topic that could be interesting for an upcoming video! Would it be possible to make a video about Buprenorphine? Are there any differences or similarities to methadone during anesthesia? Could it interfere with anesthesia? By the way, I really love your videos! They’re all important and interesting topics. Keep going!

[@bradpnw1897]

Oh boy there's so much I could say about these topics but I'm sure the anesthesiologist can describe it better than me. God bless you 🙏

[@JButt-]

It can definitely interfere but there are ways to manage it. I’m not a doctor I’m a patient, in my case I had a 9 hour planned abdominal surgery and was on a serious combo of epidural for numbing the area, local anesthesia to numb the area, plus general anesthesia using fentanyl and other drugs. My team at Mayo Clinic was fantastic and I had zero aesthetic complications during surgery (thank god). I was very apprehensive it would interfere but thankfully it can be managed successfully in my experience. The golden rule, never lie to doctors about anything.

[@wendyl1277]

I’m having my wisdom teeth removed later (5 altogether)this morning and I’ve been on methadone maintenance for 23 yrs and I’m down to 10mg. A little stressed. They weren’t clear about what the IV sedation will be (versed, propofol or ketemine) so I’m a little scared. Your video made me feel better. Thanks. BTW Can I take my dose tomorrow morning like usual with the sedation meds still in my system?

[@linnsoltwedel]

My mom had terminal lung cancer and her base pain-medicaiton was methadone.

[@bradpnw1897]

Hopefully that was enough to keep them pain-free in their final days. God bless your family members and God bless both of you 🙏

[@thomasbeatty9496]

Great video Dr. Max. Very informative. Thank you.

[@brettlamont4965]

Many years ago i was prescribed metal one post intensive spinal surgery. I was concerned just about what you said, the addict reputation. When i filled it at the pharmacy, i felt like i was doing something wrong. But it worked well and i was surprised how inexpensive it was. Is it still reasonably priced option?

[@MaxFeinsteinMD]

Yes methadone is pretty inexpensive!

[@TimothyStander]

@@MaxFeinsteinMDwould you administer methadone in a patient you plan on also administering ketamine to, considering they are both NMDA antagonists?

[@PeterBornAgain]

@@MaxFeinsteinMD Not for me, I pay an annual $100 a year. The perks of Canadian healthcare. 😀

[@jamesbuttery3862]

How about this one Max...Im a Suboxone patient for many years and went in for a Urethroplasty two months ago. The morning of the surgery the anesthesiologist came to me and said "okay james what do i need to know about you?" I mentioned i am a Suboxone patient and he asked if I had taken it that morning. I said no..and he would have rather i had because it seemed like he was saying the IV pain medications wouldn't really work for me(because of buprenorphines partial blocking effect of opiates). So he was trying to get me Suboxone from the pharmacy before the surgery but couldn't get it in time.. My understanding for patients on Suboxone/Methadone going into surgery is that you would taper the dosage of Suboxone/methadone down prior to surgery so that the opiates during surgery would actually be effective. And be effective if needed after surgery. Am I right in my thinking or do you know why the anesthesiologist would want me to have taken it the morning of surgery? I dont have any medical experience so not sure.

[@-Chooka]

I am using Methadone, I take a tablet once a day and also some oxy for breakthrough pain a couple of times a day. I have compression fractures on my L2 related to multi myeloma which was just diagnosed. So I am receiving chemo treatments at the moment aswell. The Methadone has proven very effective and has reduced the total medications I have been taking as I have issues in my neck as well, my C5 and C6 have been fused but I have another disc causing problems.

[@bradpnw1897]

Glad that it's working for you and I'm glad they gave you something for breakthrough pain also God bless you 🙏

[@idirisahmed2483]

The best pain relieved pain killer methadone

[@idirisahmed2483]

Methadone best painkiller

[@RaciePSB]

I would be very interested to know what you would advise for a pt on a high dose of methadone (say 150mg/day) for post op pain control, given the blocking effect of other opiates by methadone. (Also, in this video you say lower doses of other opiates are needed when methadone is given during surgery but wouldn’t the opposite be true with this blocking? Thank you in advance . ❤

[@KendrasEdge757]

I’d LOVE to see you do a video on anesthesia on a patient, like myself, who’s been on opiate pain medication for decades and has a high tolerance for pain medications. I’m worried about that myself as my Osteoarthritis is going to require two knee replacements and possibly shoulder and back surgery and I’m really worried about the pain control and if it’s even possible to give me any pain control without knocking me completely out of commission. So I’d respectfully request a video on how you would handle a case with someone that’s been on high strength pain meds for over two decades. I had a liver biopsy done two years ago and I told my doctor my history and he gave me more than the normal iv meds and local than he normally does and I still felt the procedure and to ME it felt like I wasn’t given ANYTHING at all. That’s why future surgery’s worry me. I’m currently on 110mg methadone daily once a day, but was prescribed 125mcg fentanyl patches, also been on morphine, OxyContin, etc etc. so I think that would be an excellent video for a lot of people in my similar situation. Appreciate your videos doc! God bless~

[@SJR_Media_Group]

I can relate... I was in an accident resulting in broken back and other injuries. It required me to have 6 back surgeries over extended period fusing 12 levels of my spine. Another accident required fusing 3 levels in my neck. I belong to the 1 meter club; over 1 meter of incisions. I was on the Oxy Family both fast and slow, switched to generic MSContin and MSCodone. I have a high tolerance so doses have to be high to get barely get any pain relief. Had Fentanyl, Methadone, Morphine, and just about any pain meds pain meds out there. Each change of new meds always started at too low dose, then ramped up. I quit taking meds and have dealt with pain using Tylenol and Ibuprofen. for almost 3 years. Recently I had a surgical procedure that required General Anesthesia. I was joking with my Anesthesiologist just before 'Lights Out". I told him about my high tolerance and he said he has that covered. I also told him Propofol, Fentanyl, Ativan, etc need to be high dose. Again he said he has that covered. He starts Propofol in my 20 gauge IV, count down from 100, after hitting 72, I said 'see I told you so'. He laughed and said we have that covered. He hit me with another dose of Propofol, more Fentanyl, turns on the Nitrous, and said try counting now. Made it to 50 and next thing I know I am in different part of hospital. Good luck and hope your surgeries bring pain relief.

[@mallardtheduck406]

I have been suffering for 35+ year's post chronic cancer pain, and the most they will give me now is a .25mcg Fentanyl/Duragesic patch which does next to nothing, but better than nothing. I hate Methadone, I will remember to tell them not to give me Methadone during surgery.

[@SJR_Media_Group]

​@@mallardtheduck406 They tried a Transdermal Fentanyl Patch (didn't work), Methadone (didn't work). What did work in prior pain management was Oxycodone 20mg 4x day, Oxycontin 30mg 2x day, Valium 5mg 4x day. This worked and was lowest dose for any pain relief. Would have glad they prescribed 2x more in later surgeries recoveries.

[@KendrasEdge757]

@@mallardtheduck406 that’s funny I hated fentanyl. Gave me a weird feeling unlike any other pain medications and I’ve been on them all. Hope you’re getting some relief anyways!

[@KendrasEdge757]

@@SJR_Media_Group lol yeah every anesthesia doc I’ve had was funny as hell for general surgery. When I had my ACL replacement I woke up crying the pain was so bad. The nurse had to call the doctor in and I’m begging him for pain meds. I said can’t you give me the machine thing?!!? He said yeah, but it can’t give you what I’m going too now and I can’t give you anymore than this. I believe it was either 18.5mg or 28.5mg every 45min. They’d give me the dose through my IV and I’d be knocked out immediately and wake up half an hour later crying in pain for 15min until the process repeated. That was before my tolerance got really high. Hopefully they give me a pain management doctor for my recovery. I’ve got another decade before they’ll think about my knee replacements and was told by two neurologists not to have back surgery until I either couldn’t control my bowls or had constant sciatica. Said it’s 50/50 any time for better pain and mobility. Either get better pain relief and worse mobility or vice versa rairly both. I said yessir. They both told me not to let ortho do my back and don’t let anyone convince me. I’ve yet to meet anyone that had back surgery and was glad they did 100%. Some had benefits in areas but worse in others, but wouldn’t have done it over again if they had the chance. Hope that you’re finally getting some relief! God bless~

[@madison8568]

I took it from age 14-19 for chronic pain due to my disease. However because I was opioid naive I took 3-5mls 2x a day. That’s all it took to control my pain. I had no issues getting it from the pharmacy. However once I had to switch to an adult doctor it was impossible to find a doctor to prescribe it for an adult so I had to find a new pain regimen that would work with other opioids

[@rodneymclaurin1891]

Methadone has saved my life. People forget how they lived before methadone, then turn on the drug/clinic because they are mad that they have to go there, can’t travel etc. they forget that fentanyl and heroin kill, they didn’t have any freedom as an active addict and they probably still fail their random drug tests and don’t get takehomes. Methadone is the only drug that keeps me halfway sane and free from cravings.

[@spiritmediumclaytonsilva649]

we can't forget that all opioids contain black box warnings i.g. concomitant use of Benzodiazepines and the risk of respiratory depression (which as you said your specialty doesn't really have that problem). Not just methadone!

[@mallardtheduck406]

I use both, I always have excellent BP and Pulse Ox levels. There is so much misinfo out there, DEA, CDC, FDA needs to let Dr'.s treat their patients properly and with dignity.

[@spiritmediumclaytonsilva649]

@@mallardtheduck406totally agree!! ❤

[@spiritmediumclaytonsilva649]

@@mallardtheduck406also all my EKGs are always fine I get them every 6mos.

[@jamesbuttery3862]

​@@mallardtheduck406I agree. If you regularly take benzodiazepines and need opiates your body is going to be used to the benzos and not effect your heart rate much. They did go a little overboard with that benzos/opiate warning. Th

[@bradpnw1897]

​@@mallardtheduck406if those work for you and you're able to make them work and get them legally God bless you. Especially if you get them legally and they truly work for you and you want to use them for the rest of your life I hope to God you never have to come off them. Either way God bless you 🙏

[@spiritmediumclaytonsilva649]

Max, can you make a video of why you would use remifentanil over just regular fentanyl thanks Max. Love your videos!

[@pseudoMIMS]

This is a good one. Love Max's videos too. Remifentanil has a context-sensitive half-life of 3 mins which is independent of the duration of infusion. This is very different with Fentanyl where an infusion lasting roughly 2 hours would have a context-sensitive half-life of roughly 50 minutes, whilst an infusion with a duration of 8 hours would have a context-sensitive half-life as long as 5+ hours. As Remifentanil has a small central volume and rapid clearance, it's rapidly cleared no matter the size of the peripheral compartment or infusion duration. It accumulates in the periphery but speed of recovery almost is meaningless to the speed of recovery because it's clearance is so fast (non-specific plasma esterases). Fentanyl has a much higher volume of distribution (Vd), higher central volume and increased lipid solubility where accumulation can occur and elimination is slower. Remifentanil is almost the pharmacokinetically ideal continuous infusion intraoperative opioid for these reasons, particularly when you're using a TCI syringe pump that has the Minto PK model, where you can make precise changes to the target plasma concentration and time to equilibration is extremely fast. Otherwise, many just do intermittent Fentanyl boluses depending on the level of surgical stress or changes in haemodynamics which is more phasic and imprecise but simple. Otherwise, the only problem is that given Remi's extremely short duration, if you're using high doses for long cases there's the potential for Remifentanil-induced hyperalgesia requiring extra consideration when administering pre-emergence analgesia.

[@henriquelaydner4080]

@@pseudoMIMS, congratulations for the technically perfect response, but I wonder if it is the best in case who’s asking is not at least a medical student. I’d simplify it by saying that remifentanil is as potent as fentanyl, but it lasts just as long as it’s being administered, whereas fentanyl lasts longer even if given as a single dose. Choosing between them has to take into account many factors, from the nature of the procedure and the patient’s general health to even the economic impact, since fentanyl is cheaper than remifentanil (at least here in Brazil).

[@pseudoMIMS]

@@henriquelaydner4080 Haha I am actually a medical student (and a pharmacology researcher too). Yes, more or less. However, I felt the need for people to have the rationale as to why there's a major difference in duration given the nuances of context-sensitive half-life. Otherwise, for the purposes of a TIVA-TCI anaesthetic then Remifentanil is central. But, yes, it costs significantly more than Fentanyl.

[@JMcdon1627]

I remember a Methadone/Anesthesia trial about 1972, maybe 1973. A large red sticker was pasted on the Doctor's orders page of the chart stating that no pain medications were to be given until "fill in the blank." There were problems. There were more anesthesia complications in one week than were observed in the previous 12 months. The trial was halted.

[@bradpnw1897]

With what I know about methadone that doesn't surprise me. God bless you 🙏

[@patricenagel9442]

That's about the time Methadone was first being used for Maintenance, and detox. They had no idea what they were doing. My husband was old than me, so he got on Methadone in the mid 1970s. I went on a bunch of 21 day detoxes that never worked. In 2001, I got on Maintenance and I haven't used since 2002. I go in once a month so it's basically like a doctor appointment. Counseling is on the phone since COVID

[@tomaszstarling]

I take methadone since 2009 and i use it for pain management after a botched surgery.

[@SuperStrik9]

Methadone also works great for people with diabetic neuropathy. Methadone gets rid of the constant burning and tingling feeling completely.

[@Robby334]

Very interesting I do like your videos Are you not at Mount Sinai Hospital New York anymore?

[@starfishgurl1984]

Wow, thoroughly fascinating, I had no idea! Thanks so much for sharing 🙂.

[@jeremylowe2309]

I like how he uses the exact terms for meds. Hydromorphone = Dilaudid or Exalgo. Strong stuff.

[@idirisahmed2483]

Methadone is one of the best painkillers that's a fact

[@patricenagel9442]

I have been on Methadone Maintenance since 2001. How would that ever work for me. I have been ion my highest dose 165mg, and right now I am on 130mg, and I intend on staying at this dose for the rest of my life. Methadone has never made me drowsy, I've never "Nodded out" so I don't get it. How would this work on a MMT patient

[@rayclark474]

I take methadone as a part of my pain control medication. I love it because for me it does reduce cravings for the percoset that I also take.

[@jakewhit9000]

I'm on methadone 120 MG a day...I was made horribly addicted to opiates about 15 years ago after I was hit by a car...and the doctors over prescribed dilauded and oxytocin...and kept increasing my doses over time instead of reducing..I was 22 and trusted them...but i became horribly addicted of course...been stable and off everything else for years now..but always wondered what what need to be done for me if I needed surgery since my tolerance is so high? Could you tell me if it's allowed...I'm 6' 185 38 years old... 120 mg methadone a day for 3 + years...what would I need or you would probably recommend for general anesthesia

[@killmewhileimahead]

I am in an MAT program and went under anesthesia 4x this summer. I was at a high dose like yourself when I started but I’ve tapered down to 10mg. The first 3 times the anesthesiologists were like “okay that’s no big deal! Good job by the way” they were the only ones that had any understanding of the dosage & how those programs work. The fourth time the anesthesiologist was a total dick, it was awful. He basically asked why I was on methadone so long and then said something like “maybe it’s not working for you”. I got pretty defensive because I have almost 6 years sober and I’ve done some amazing things during that time. My advice is if you have to go in for surgery is to bring your MAT doctors direct information and be ready to educate. I wasn’t ready for all the ignorance about MAT but I will say the anesthesia residents were way more knowledgeable.

[@jakewhit9000]

@killmewhileimahead awesome..thank you for sharing your experience

[@biggaruddesly6015]

Is it OK if I don’t mention that I’m on methadone I’m only on 60 mg and I’m not going to take it the morning of my extraction

[@Former11b]

I’m in a pain management program after being hurt in iraq in 2006. I was put on methadone for long term pain over MS Contin in 2011. Had a serious hospitalizing injury in 2023 and the staff was losing their minds with how go manage my pain due to methadone tolerance. Finally here in 2024, I’m off it entirely. Not off pain management but managing it differently but getting off methadone entirely was brutal

[@Former11b]

How *to manage

[@parrotlover8547]

Hi Max. I’m getting an upper endoscopy next month and I was wondering what level of anesthesia you use for your patients for that procedure, if any?

[@Legalthccartstore0]

*The majority of studies have used a single dose of methadone at induction of anesthesia and avoided the use of other intraoperative opioids*

[@jessicacarbone2492]

Can you do a video about methamphetamine and or amphetamine and effects on anaesthesiology? Please? Have you had any experience with doing anaesthesiology on a patient who uses street drugs, such as methamphetamine? And the effects, and how it might affect your job as the anaesthesiologist

[@mallardtheduck406]

Max, it's been a while since I have been to your channel. I hope you're doing well my Friend!

[@spiritmediumclaytonsilva649]

also analgesia only lasts from 8-12 hours after administration. So yes much longer but all their effects don't last 24hrs such as how it reduces withdrawal for 24hrs.

[@danielledinenno8714]

Im on Bupernorphine and scheduled for gallbladder surgery, was told not to stop my medicine, only one i stopped was cannabis, i have card, and after surgery i can go back on cannabis

[@bradpnw1897]

I've heard that cannabis is pretty dangerous stuff. I'd stick with a methadone as that is federally legal, cannabis not federally legal. Have you seen reefer madness I'm just saying be careful! Reefer madness should be considered a must watch for every American.

[@sueembler5572]

Lmao!​@@bradpnw1897

[@pseudoMIMS]

Love me some NMDA receptor antagonism on the side.

[@MaxFeinsteinMD]

Yes!

[@neverlandproductions1262]

Ive been on methadone for 7 years from doses 95mg all the way to 4mg daily. I had a surgery and they seemed to make a big deal about me being on methadone. They told me not to take my dose that day at all etc.

[@FPRESLEY1]

What all can be used for narcotic free anesthesia? I’m 8 years sober without using methadone or suboxone and have had several narcotic free surgeries. Most of them minor, but one was a robotic hernia repair. Only thing I took postoperative was Tylenol and Motrin, but I’m curious what was used for anesthesia. The doctors in my area have been great with respecting my wishes to NOT use any narcotics. 😊

[@rochelle-xz8gl]

if your arm was blown off or you had a terminal illness, such as anaplastic thyroid cancer, you would be on your ass screaming for fentanyl, methadone, or morphine. I saw both of my grandmothers die of this type of cancer.

[@FPRESLEY1]

@@rochelle-xz8gl I’m sorry for your loss, but I fail to see what your comment has to do with my question or statements.

[@GreggBB]

thank you for the information---very interesting and good to know

[@loisrash2635]

I am glad you explained this. Very informative video. I really like your videos

[@toni6194]

What about buprenorphine, do you use that?

[@danielledinenno8714]

I think they do, I'm taking Bupernorphine and scheduled next week for gallbladder removal, was told not to stop Bupernorphine use, my doctor has a plan, but was told would still have fentanyl given during my surgery, that's if I'm in pain, but they also said Bupernorphine would also be administered.

[@stephenludlum9746]

Methadone is a good pain medication.

[@Bbftyjhaha-qi4ur]

What gives Methadone it's analgesic character since Opium 0r Morphine is NOT involved ? Or is it really ? I got 2 answers. 1) from a muscle relaxant: Recipavrin, a smooth muscle relaxant, not skeletal. 2) Butanol, and when your or if your in withdrawals , your getting both opioid & alcohol withdrawals all in ONE. Are these both right, I think #1 is. I've also heard an open-chain of morphine or Diamorphine. Care to explain???????

[@kazinaeemshihan6730]

Do anstheshya work on a methadone user? Or could face problem...? ..if any methadone user get anstheshya before any leg surgery ...will that work properly? Need Help comment. Thank you

[@twominuteanaesthesia]

Great video

[@jhhyuu_DaveIsNoProfessor]

What gives Methadone it's analgesic nature. It's not from opium or morphine molecule , so is it an alcohol, Heptane, Dimethylamine, Butanol..????????

[@ianshelton6662]

What if, instead of using a ton of opioids, the surgeon administered local anesthetic at the procedure site after the patient was asleep and intubated? In dentistry, for instance, general anesthesia can be combined with local anesthesia because It prevents the pain from reaching the sympathetic nervous system in the first place, and keeps the patient numb and out of pain for hours after they wake up, reducing narcotic use. Also, placing a local anesthetic lubricant on the endotracheal tube prior to intubation can help blunt the sympathetic response by reducing the pain of airway stimulation with significantly less IV opioid. It seems like local anesthetics are somewhat underused in many areas of surgery

[@steventaylor6027]

Most surgeons do localize the incision site, this alone does not provide adequate analgesia in the vast majority of patients

[@davidkruse4030]

There are risks of nerve damage

[@tonysproule3408]

I was on 300mg MAT, I My anesthesiologist had to go to the Zoo and get Carfentanyl and Sufentanyl,after waking up in OR screaming in pain! my anesthesia bill was 70k an hour, after that I made the concious and moral decision to get off Methadone forever!

[@mandingo1917]

Yeah no wonder I’ve never heard of anyone on that much methadone. They never should’ve let you even reach that dose.

[@kaninchen321]

Why dont doctors in Hospitals use Ketamine in a very high dose as a general anesthetic for surgeries?

[@MaxFeinsteinMD]

It would take an extremely long time to wake patients up from an entirely ketamine based anesthetic. It also causes hallucinations which can be unpleasant. There are untoward physiologic effects as well including significant increase in secretions from the mouth.

[@spiritmediumclaytonsilva649]

all CII narcotics have blackbox warnings

[@tony7782003]

Are you in your fellowship? Attending? The green screen looks cheesy. You make a much more fitting presentation when you're in an operating room or other real clinical setting.

[@Nicolef888]

Very interesting vlog! I am a chronic pain patient (connective tissue disease and Psoriatic Arthritis) and I see pain docs trying to push methadone instead of the ‘regular’ opioids people are given. I will not take Methadone! Luckily, I have an amazing pain dr who has supported me through the maize of chronic pain as there are no ‘cures’ for autoimmune disease.

[@kyraf7094]

Would love to see a video like this about ketamine as an anesthetic !

[@dannyquintal1791]

Can’t Methadone be giving to Alzheimer’s patients in the last stage of Alzheimer?

[@oshea2300]

I am looking for a free rapid detox center to get off methadone.

[@daviddowns7552]

I bet those shots are potent. I think it can be given into a muscle also by injection.

[@andrewpatrick4254]

If you were in a war zone and had only a few drugs, what would they be?

[@PeterBornAgain]

Sufentanil. As is a stronger compound analogue than fentanyl if you get your leg blown off in combat that is what you would be given for the excruciating pain.

[@davidkruse4030]

@@PeterBornAgainok and what is the risk of respiratory depression using that?

[@tyty-iu1sl]

#Free palistain

[@mandingo1917]

Learn how to spell it first

[@lillyvgutierrez9685]

Never take herion ever