Pediatric Anesthesiology - Operating Room Setup

[@lwolfstar7618]

Anaesthesiologists seem to always be the loveliest ppl for some reason. In my first surgery (i was a terrified minor) they just made it so much less overwhelming.

[@AnesthesiaGuru]

Dr. Feinstein, I am a board-certified pediatric anesthesiologist. Your video popped up on my feed and I watched it. You have done a nice job. Congratulations

[@edkensalexandre7043]

Hahahah. The shameless plug to program directors. I love it 🤣🤣🤣🤣

[@MaxFeinsteinMD]

😅

[@lilbatz]

Lol love the hustle!

[@Kopitskid78]

I found this particularly fascinating. I am a dwarf and one of the things I was tought at a young age was that anything medically relating to my dwarfism has to be based on my weight, not age. Anytime I have surgery I need to have a sit down face to face discussion relating to my specific anesthesia needs, one of the things I actually discuss is what works for me and what doesnt. It's fascinating to see what the behind scenes for pediatric v adult. I require pediatric intubation even though I no longer qualify as a pediatric in anything now. Thanks Max for showing us the different set ups an anesthesiologist goes through for each patient.

[@taylorclay2122]

The best anesthesiologist I ever had treated me like one of his own kids. I still remember him (I was in the hospital a lot as a kid). I also really liked when docs explain what they are going to do before they do it and how it may make me feel. Even as a young kid this really helped

[@paulamucinga118]

Very interesting. I like how you explain everything so thoroughly.. thank you! I can tell you have amazing bedside care skills, which makes a difference when one is nervous before going under..🤗

[@MaxFeinsteinMD]

I appreciate the nice feedback!

[@iamnotgoldenhar8645]

I agree.

[@jeffk7734]

I actually kept in touch with an anesthesiologist who I had several times as a kid when at Children’s Hospital in Detroit after I started volunteering there as an adult. I haven’t heard from him in a few years. It was really unique to walk into the surgical area and knowing that for once I wasn’t there for surgery. It was especially unique when I stopped up there after a job interview in a full suit and tie and dress shoes. I always opted for the mask when being put under as a kid.

[@curtiswritt8474]

Sorry to bother you again but I really wanted you to know how much I appreciate your videos, I recently had my 43rd brain surgery for Hydrocephalus and have been treated for infection. I was told this morning that the infection is getting a lot worse BUT WATCHING YOUR VIDEOS BRIGHTEN MY DAY NO MATTER HOW I'M FEELING! Thank you for EVERYTHING that you do sir!

[@priikii]

hope you get better ❤️‍🩹

[@revenevan11]

2:18 Wow, when you cranked the age setting on the ventilator down to 0... it kinda hit me in the heart for a second. So basically, this case isn't neonatal but *is*

[@charlsironborn2798]

You Doc are simply the best! You are make me falling in love of Anestesiology! Thank you from Italy!

[@mf2206]

I'm not a doctor or nurse, but I enjoy your videos very much! They are so informative and really make me appreciate the complexities of the medical field. Good luck with everything that you do!

[@taceyraulerson1394]

As a former pediatric patient who underwent many surgeries and got extremely cold, thank you for turning up the temp in the OR.

[@Lexusfordd]

I wish you taught nursing I swear I would pass every class! You’re so informative and easy to understand.

[@garyjsimm]

Hey Max. Had my endo 2 weeks. Was given fentanyl and versed. Was dreaming I was choking, I WAS! Emerged with a yankauer in my mouth. My anesthesiologist did a great job. Put me back down and all went well. He was very experienced and very cool under pressure

[@NDMD]

This is incredible! As an MS-2 from Georgia interested in pediatric anesthesiology, this even further peaks my curiosity. As a professional videographer and KZbinr too, please reach out if you would ever need help making more OR setup videos or simulation content for your program and I would be very interested in meeting with you and the team at Mt. Sinai!

[@caseyrose6365]

Applying anesthesia this cycle but LOVED my peds rotation (because of the population... obviously not the uber clinic time). Sounds like the best of both worlds!

[@katrinawebb6285]

Great video, best of luck with your future - I really hope you do go into paediatric anaesthesiology. As parent having an anaesthesiologist you feel completely comfortable with looking after your child during surgery/procedures is such a blessing. (I found out today my child will be having an MRI done under GA soon)

[@sopyleecrypt6899]

My son had a lot of surgeries and MRI imaging when he was 8-9. He was cared for by specialist paediatric anaesthesia doctors for his surgeries, and they were great. They looked after him so well, and it was reassuring to know they were specialists in working with children. He is 10 now and has a follow-up MRI tomorrow. He’s never needed an anaesthetic for an MRI, except immediately post-surgery, we’ve been lucky he can tolerate it well. I hope your son’s MRI went ok and he’s well 👍

[@rachelsproule1809]

As a child life student who wants to work in the OR I love this! Thanks for the behind the scenes look!

[@MaxFeinsteinMD]

very grateful for our child life colleagues!

[@rachelsproule1809]

@@MaxFeinsteinMD would you ever do a video with one?

[@MaxFeinsteinMD]

Yeah for sure!

[@rachelsproule1809]

@@MaxFeinsteinMD thank you!

[@rm-dc6tx]

Excellent videos. You take much of the technical stigma of Anesthesiology and explain it in layman's terms so we can all understand what happens.

[@JohnnyCNote]

I had tonsil/adenoids surgery when I was 4. I'd been on the gurney for a while when they said they’d tell me a story. I made it clear that I wasn’t interested in hearing any stories, but it was clearly nothing I could avoid. The nurse showed me a gauze mask and said, "sea captains use these when they go in the water ". While I was struggling, I lost consciousness and I was forced to submit to their nefarious intent. Next thing I knew I was back in my room. I’m 65 now, but I still have vivid memories of the event…

[@thezaftigwendy]

One of my very good friends is a pediatric anesthesiologist here in San Antonio. She's often told me that we don't have enough pedi anesthetists here.

[@kgrfirdjy]

Often, I have had surgery in warmed operating rooms as an adult with dysautonomia. They are awesome when they can feasibly used (spinal neurosurgery, orthopedics, endoscopy // urological procedures) as I have much less post-op shivering.

[@AJohnson0325]

Another thing I’ll add is that the IV tubing and size of IV fluid bags is different for kids. In young infants under 2 you can use a burette set. It has a cylinder at the top that you can measure an amount of IV fluids and prevents giving too much fluids. In kids older than two you use a microdrip iv tubing which has a flowrate slower than what’s normally used for adults. Using a 250 mL or 500 mL bag is a smart idea because then there’s no way the patient could get fluid overloaded with a whole liter of fluid. Those microdrip sets seem to love to make air bubbles and you have to get all of them out.

[@bordensirk]

I would trust you 100% you seem confident and what you’re doing

[@darriontunstall3708]

Great video man! I learned a lot! You’re my favorite Anesthesiologist!

[@kostasva843]

Can you make a video about anesthesia subspecialties and their special skills and characteristics required (for example in which one is an anesthesiologist required to know good TTE heart ultrasound or good regional blocks etc).

[@MaxFeinsteinMD]

This is a great idea. Soon I'm going to work on a video where I do an overview of the subspecialties!

[@Skatejock21]

One job I couldn't imagine an anesthesiologist needing to do is what happened to my aunt. This woman went through so many surgeries for her arthritis that eventually took her life after 33 years with it. She had 1 surgery with her hips, wasn't the first one but due to her neck being fused, the doctor could not put her to sleep due to the airways. It was a very complex surgery from what I was told and needed to be meticulously planned. She had hip replacements awake, I believe it was her 3rd or 4th. The position the anesthesiologist must have felt that he was in, I couldn't comprehend because he had to manage her pain very well. She had an epidural as well prior to help and I wouldn't even know what else.

[@petaks01]

Thanks for the excellent tour. Only one question popped up after this, how do you handle the drawn drugs if not used during the procedure?

[@MaxFeinsteinMD]

Technically any drug that’s drawn up and not used should be discarded.

[@petaks01]

@@MaxFeinsteinMD That was of course what I had in mind too but my English isn't the best. As liquids I guess they have to be disposed and incinerated? in a special way. Not like you squirt all of them out in a bucket and ship the resulting cocktail to be destroyed :p

[@davidadams9391]

👍 well explained! My favorite anesthesiologist! Thanks Dr Max! God bless!

[@MaxFeinsteinMD]

Thanks for watching and following along as always David!

[@KristiBranstetter]

You would make an excellent pediatric anesthesiologist! Go for it!

[@aden1337]

good luck with your career! hope you get your place in pediatrics

[@snackymcadams]

I too am very drawn to pediatric anesthesiology. I had (many) terrible experiences as a child in pre-op. I don''t think at the time, almost 40 years ago, manufacturers spent too much attention to making child sizes equipment. All my traumatic memories are from being forced to breath into a big black mask that covered my whole face to my eyes, the gas smelling of artificial cherries, and going into complete panic but the anesthesiologist just put more pressure down on the mask while my whole body wriggled trying to escape. Obviously, I ended up going under, but that is a horrible last memory and feeling prior to going into a several hours surgery. I want to change that and give children a safe experience in what is already a very scary time. I just want to cry just thinking about it.

[@AnesthesiaGuru]

Pediatric anesthesiology is an excellent specialty to practice

[@saramurphy5754]

I would love to see a video about malignant hyperthermia! It’s something that most people do not know about but most find interesting. Is there a way for anesthesiologists or doctors to know if a patient has MH if they’re a trauma patient needing immediate surgery and the family can not inform the doctor? As a person with MH, one of my biggest concerns or fears is my doctor or anesthesiologist not knowing that I have MH.

[@MA-zg2pz]

You can wear a medical ID bracelet/necklace (metal). Lots of people do for this very situation.

[@Andrew-eq8jm]

Hey Dr Max, Why no set up of a T~piece? And a good way to remember tube size in Paediatrics is (age divided by 4, plus 4) Thanks for doing these education videos by the way, always good to go over basic setups, keep up the threat work.

[@MaxFeinsteinMD]

Hi Andrew, very astute observation about the lack of T-piece! This particular setup was for a hospitalized patient who already had an IV placed that I was going to hook up to. Thanks for the nice feedback!

[@BLK2000]

would hope my son gets someone like u for his op :)

[@bettysmith4527]

Can you explain why pediatric patients get pressure controlled instead of volume controlled ventilation? I have tried looking it up, but cannot seem to find the answer. I am glad you share my love for pediatrics, they are the best patients to care for!! Good luck with your fellowship pursuit!

[@meek6809]

The volume-controlled mode cannot reliably give less than 200mL of gas which is needed for pediatric patients. This is because their lungs are much smaller, they breathe faster, and the inspiratory duration is half of the expiratory duration. Because of these variables, it is tough to precisely deliver small amounts of volume for pediatric patients. Hope it gives some light to your question. Basically, the pediatric patient would get too much air leading to (baro)trauma.

[@AnesthesiaGuru]

In my clinical experience, pressure-controlled ventilation can provide a better tidal volume at lower pressures compared to volume-controlled ventilation. To my knowledge, this is the most common reason why pressure control is used!

[@RockinTheBassGuitar]

Getting the correct sizes is essential. My husband's coworker just lost his 3 yr old grandson because he blead out from damage caused by too large of a tube being used to intubated. The child's poor mother had to hold her son while he blead out internally in her arms. There are horrifying consequences to getting things wrong.

[@keithnichols7926]

When my tonsils and adenoids were removed in the late 1930s, the anesthetic was a wad of ether-soaked fabric on a tea-strainer that was slapped on my face by the nurse who assisted the doctor. The doc made off with my uvula, too.

[@cpoppyfin6751]

The meow was very appropriate. 3.0 and 3.5 are the most common sizes for feline anesthesia.

[@rodhoover9158]

Ty Max! Well done!

[@PrettyPink7]

You’re the bomb Dr. Feinstein! ☺️

[@ianshelton6662]

Can you show how you would set up a procedure room for dental IV sedation?

[@benburns5995]

Thanks Max for this informative video. What is the age limit where a patient would be considered Pediatric? Seems like in this case the patient was a very young baby.

[@MaxFeinsteinMD]

Technically 18 is the cutoff between pediatrics and adult. That said, it's not unusual for anesthesiologists who aren't boarded in pediatric anesthesiology to take care of patients younger than 18 (pediatric anesthesiology is part of general anesthesiology training).

[@HegelUnderstander]

Watching this video before delving back into pulmonary physiology.

[@jules1983]

Great video as usual!

[@rodhoover9158]

Thank you Max. Well done!

[@nursestacyrn8136]

I’m going for my CRNA after I complete my APRN which is about two years from now. Trying to get as much info regarding anesthesia before I apply. Thanks for the videos ! ☺️

[@ashleyaniyankunju5971]

hi sir ......................im ashley im an aesthesia technologist....... actly from my student period i was scary about paediatric cases...but after this video got the confidence to assisst...thnk you sir.......... by the way i also scary about neuro cases... is there any video in your channel😁😆😆😆

[@curtiswritt8474]

I always love your videos doc!

[@PuenteAJ]

Love your videos, very interesting

[@shayleegoss1460]

Not sure how I ended up here, but from all the information I've learned I just might end up pursuing a career in Anesthesiology. I find it really interesting.

[@EastTNPhotography]

I don’t get why they can’t take the air out of iv’a for everyone. Doesn’t seem like it takes that much longer to prime it. I always get fussy about it and make sure they know I do not want bubbles

[@manjulakarunaratne8265]

very interesting and informative ,thank you sooo much

[@musman9853]

Great vid as always!

[@MaxFeinsteinMD]

Thanks Mohammad!

[@eun-hikim5313]

Thanks for sharing! Loved it!

[@salomelau]

I'm currently studying some foundation courses for respiratory therapy online and I'm a bit interested in AA! I don't have firsthand experience with the equipment until the beginning of September so thank you for showing the comparisons between adult and pediatric sizes! I am curious to know what happens to the unused emergency drugs if there was no emergency during the case. Would you have to throw it all away or can it be used for another patient?

[@AJohnson0325]

It’s weight based so you’d have to get rid of it and get the proper dose for the next pediatric patient. You don’t want to be doing dose calculations in the middle of an emergency.

[@jenniferaustin8362]

I love your videos!!!

[@fernandopenah]

So cool, although by the looks of it, seems like the OR goes through a lot of bio-hazard waste. Wonder how it all gets disposed.

[@mariusghemis4255]

Why do you introduce air in the vial? And how long is your paediatrics rotation?

[@MaxFeinsteinMD]

The air in the vial helps force the medication into the syringe - less work for me to pull back. I do three months of pediatrics throughout residency, plus random pediatrics cases interspersed through the rest of residency.

[@sherrydawson6253]

Wow your so organized and meticulous! Wore u scared with your 1st pediatric case especially if it was a baby? Love your videos! Thanks

[@jenniferalpiner7974]

Max I had woken up after anesthesia screaming from eye pain. Took 3 hrs for pain to go away by me holding my eye open to stop further abrasion but used rewetting drops. It was traumatizing to wake up like that!! Do you have fid about this? Or would love to chat about what happened to me

[@sandybrown1086]

I ALSO want to pursue Pediatric Anesthesia first I got to enter residency in my country best regards for you Sir!

[@JulieR73]

Please do a tour of a scoliosis surgery OR

[@AdmiralofU2]

When do children require paediatric anaesthesiologists (as opposed to "general" anaesthesiologists)?

[@MaxFeinsteinMD]

I don’t think there are strict cutoffs at hospitals, but typically it’s based on the type of surgery and the comfort level / experience of the anesthesiologist.

[@MultiLuckychris]

Come to El Paso Childrens hospital!!🌠

[@Bobbobbob678]

Hey doc. Do you have any advise of getting over a needle/blood test phobia and passing out every time I get it? I never look, I where numbing cream and I say the alphabet but it still doesn’t work

[@parkersre-creation]

Do cognitive behavioural therapy, specifically exposure therapy. I had a severe needle phobia as a kid and now I give myself weekly injections no problem.

[@Bobbobbob678]

@@parkersre-creation ok perfect. Thanks👍

[@gbfeinstein]

I am the good doctor's mother, and I can tell you that he was terribly afraid of needles when he was younger. I used to have to sing to him to distract him while the needle went in!

[@michaelkazanov6608]

Dr Feinstein quick question for you sir how often does an anesthesia resident participate in pediatric or neonate surgeries

[@luigi5890]

At what time during an operation do you administer the Dexamethasone or Ondansetron? Does it make a difference with the patient when these drugs are administered? and do you administer these drugs at every operation.

[@MaxFeinsteinMD]

Dexamethasone at the beginning, ondansetron at the end. It does make a difference. They are given unless contraindicated.

[@luigi5890]

@@MaxFeinsteinMD Thanks

[@luigi5890]

One last question. When you meet your Anesthesiologist, how do you communicate in terms he/she will understand, that you get violently sick from the after effects of the anesthesia? Maybe there is a communications problem in some cases.

[@francishubertovasquez2139]

You're competent professional, you have look alike actor in the Philippines, named Albe Casiño.

[@DrQuestion]

I like your videos so much and your cap too.

[@eveningstar1]

Thank you!

[@coffeecat9337]

Sorry if this is super creepy but I had cardiac surgery on July 7 at mount Sinai and I’m pretty sure I saw you or someone who looks just like u in the cardiac holding area 😂 my anesthesiologist ended up being Dr Larese and he is super amazing! He even visited me the day after 🥺

[@MaxFeinsteinMD]

haha not creepy at all. I've been known to be seen around the holding area at Mt. Sinai! Dr. Larese is an excellent physician and a very kind person, I greatly enjoy working with him and glad you had a chance to meet him.

[@coffeecat9337]

@@MaxFeinsteinMD thank you! If you can, please tell Dr Larese, his Ross procedure patient from 7/7/21 is doing a lot better even though I don’t remember a single thing 😂😂😂

[@coffeecat9337]

Also Dr Feinstein, I am a social work student but I learned a lot from your videos! It’s super entertaining! And you do a great job simplifying everything!

[@MSflyer2005]

I have heard you mention corneal abrasions in a few videos. Is this a common injury seen in anesthesiology?

[@AnesthesiaGuru]

Corneal abrasion is a rare complication because of all the precautions taken by anesthesiologists

[@DoryDordory-nt5oq]

How old is pediatric patients? Teens include pediatric or adult?

[@LaurenN2N]

At what age does pediatric end though? Eg. a 12 year old is not an adult but you cannot do everything in the same way like you would with a baby either I guess?

[@iamnotgoldenhar8645]

I love you explain all to all of us. I would like to do a calob with you, coming from someone who has had at least 20 surgeries. Think about it

[@fadilagomes9901]

Interesting video

[@5555LN]

I am an adult but have to use smaller intubation tube. Is that something you see.

[@MaxFeinsteinMD]

Yes, either for people who are smaller or who have known airway narrowing, or if the surgical field is in the airway and the surgeon needs a smaller tube for better visualization.

[@5555LN]

@@MaxFeinsteinMD thank you! I do have some narrowing.

[@iamnotgoldenhar8645]

I get the smaller one. Lol. I had 3 ivs at one point. I have bad luck. Lol..but I'm still here

[@aidenoconnor5291]

What is the role of the anesthesia tech?

[@francishubertovasquez2139]

That very advanced telephatic knowledge of the Extra Terrestials or Annunaki or Angelic types which can depress or activate sensoreum by precisely tweaking the organs involved, and that Telephatic capability could be one of the battle fronts of Angels, Intelligent Beings, Aliens, Annunakis in the endtime final battle like demi- gods(god- like but not real God ) Angels, Titans or Luciferian SaTANists.

[@DigitalAndInnovation]

What brand electrodes are those?

[@MaxFeinsteinMD]

Philips medical

[@DigitalAndInnovation]

@@MaxFeinsteinMD Thank you!!

[@gracier2718]

What age does pediatric medicine stop?

[@MaxFeinsteinMD]

Technically at age 18

[@markholm7050]

Oxygen is the green tank. What is in the yellow tank?

[@MaxFeinsteinMD]

Air

[@markholm7050]

@@MaxFeinsteinMD Thanks.

[@robertceliberti7175]

It's so different from when I had surgery as a child. The machine was different. The masks are clear, unlike the black mask I remember.

[@lorazam_]

why u don’t have an anesthesia technologist to help u in your preparation

[@garyjsimm]

Why wouldn’t you have epi drawn up as well to treat the anaphylaxis?

[@AnesthesiaGuru]

Epi is usually available in a pre-drawn epi syringe

[@michellescarfSpacex]

Whenever he says baby or Pediatric .. I go Dawwww whittle whittle babies 🍼

[@yimeizi2648]

Why adult ekg don’t have cats on them

[@Spartacus.D]

Do you think its possible for a deaf person to become a Anesthesiologist?

[@maximusmaxipad482]

I think I like watching you because we have the same first name and your last name is f***ing cool! Its Frankenstein and Enstine or just Frankenstein spelled different

[@frankdonagher7279]

you are great

[@nurshark10]

I wish you could be my anesthesiologist. I’m having surgery in October.

[@candywilson3884]

What surgery are you having?

[@KadeSuchan]

Interesting, I always knew air emboli were bad, but didn't know about the heart defect part. As an adult with an asymptomatic PFO, is this something that could affect me?

[@joeapple8449]

Does a Pediatric Anesthesiologist make more money?

[@MaxFeinsteinMD]

Slightly more on average, but when you consider the opportunity cost of a year of attending salary, then over the long haul there’s generally not an increase compared to doing general Anesthesiology (ie. no fellowship)

[@DrQuestion]

More money means much more risks

[@FezCaliph]

Is your full name Maxwell?

[@MaxFeinsteinMD]

Nope

[@Divewith.G.M_Official_Channel]

Just like if you're becoming the surgeon you have to be qualified to be able to do pediatrics you know what I mean

[@janasvobodova3987]

👍

[@junelcunanan9113]

I have ADHD

[@cubsfan5734]

I rather be knocked out with. Propofol. Then gas