Why anesthesia for children is so different

[@RockinTheBassGuitar]

My daughter had to have an exploratory surgery while in NICU. She was barely 5 lbs (2.268 kg) and 2 months old at the time of surgery. She was still two weeks shy of her due date when she went under anesthesia. Her anesthesiologist was a literal lifesaver. Her iv failed in such a way that all the meds were being injected into her muscle for a little while, he had to compensate and not OD her while still keeping her under for the surgery.

[@benbookworm]

Something that's stuck with me since another video of yours: operating rooms are cold for the surgeon's comfort, but pediatric operating rooms are warm for patient safety. Restocking ORs overnight, I sometimes have to snack a long sleeve scrub top to stay warm, and we can't let that happen to little ones without much thermal mass!

[@bonnyd.5334]

Thank you for all that you do. I love your educational videos. My cat had to have elective, major surgery. She's 16.5 years old and in good health. My cat's vet told me that the protocol that she uses to induce (and reverse) general anesthesia in cats is nearly identical to how you induce (and reverse) general anesthesia in neonates. She has to memorize the same charts you have memorized on weight based dosing of drugs used in anesthesia. She has the same emergency meds drawn as you do for a neonate. She takes respiratory risk very seriously (and cancelled elective procedures due to respiratory stress caused by the Canadian Wildfires.) Again, my vet used a protocol developed by pediatric anesthesiologists for infants including a Fentanyl patch. My cat sailed through her surgery... and wasn't sick from the anesthesia. My cat's vet is known to be an excellent veterinary anesthesiologist, and it showed in how good my cat looked. 14 hours after general anesthesia was reversed, my cat wanted to run the Kitty 500 at night. (Felines are tough customers, but they have lots of problems with medication intolerances.)

[@charlie-gb9bj]

this job warms my soul, its like being a guardian angel for babies and children

[@BuickDoc]

My proudest moment in pediatric anesthesia was when doing Pediatric Hearts, I started a radial a-line on a 700 g (1.5 lb) premie. On the first stick... I was patting myself on the back for a week.

[@mezomoza7]

How could you deal with repeated failure? Don’t you feel hesitant, self-doubting and discouraged?

[@caitlynnmae2475]

As a mama of a premie who’s had surgeries, THANK YOU for being so competent at your job. ❤❤❤ Health care professionals for little ones are angels.

[@LandonStrauss-hc1sc]

You people are so important to the world. ❤

[@HmmmmmLemmeThinkNo]

Holy shit??? I'm not in the field even a little, and i'm so impressed????

[@BuickDoc]

@@mezomoza7 The nice thing about being an Anesthesiologist is success or failure is judged on whether you can deliver the patient to the ICU Physician alive. What happens after that is "not my fault".

[@tomosmells]

Just wanna say thank you to all healthcare workers like yourself. I would have been gone at 19 if it wasnt for medical staff who did everything they could. Now im 24 and I owe it to all the hard workers in healthcare, much love and God bless.

[@GreggBB]

Really interesting differences. And those times to respond when something is going wrong---those are quite the high pucker factor! Thanks for amazing videos and information

[@chrystalbruckner9002]

My daughter has had 3 surgery’s with the same ENT and each time was very different in regards to anesthesia. By the third surgery she was 9 and knew what she wanted to do.

[@caitlynnmae2475]

I am so glad I’m seeing this AFTER my 6 month old had surgery… I would have been so much more worried . Thank you for doing your job so well.

[@krystaljay7697]

As a mom of a heart kid.. these videos are so cool and fascinating! So thank you!

[@surgeon1016]

Not sure if it’s different here in Australia than it is in America but our children’s hospitals actually give us numbing cream at the site of our iv or cannula they did this for all eleven surgical procedures I had at the children’s hospital in order to help desensitise us to the pain of needles and I can tell you it’s the best thing because as an adult I don’t feel a needle being inserted anymore in fact I’ve never been frightened by them because of it

[@skinsciencebymira]

My child was in the ER this year and they use something called the J-Tip to apply lidocaine via pressured gas into the skin and subcutaneous tissue. And he HATED it 😂 It’s super loud and can cause a bruise, it just scared him lol. He actually tolerates IM injections and insertions of IVs really well though so in his mind, it was an annoying unnecessary step prior to something that really isn’t a big deal so let’s get it over with.

[@surgeon1016]

@@skinsciencebymira in hour children’s hospitals I think once you hit around 8 or 9 they actually allow you to decide what you want to do like if you want a mask or if you’d prefer the needles honestly I agree needles are way easier you get it over it quickly

[@hbtried7818]

I had a tonsillectomy at age 5, and for some reason I have a very specific memory of being given an oral medication pre-surgery. I think it stuck in my brain mainly because of how much I HATED the taste. Watching your videos I’ve always wondered what that must have been, since obviously you’ve mostly talked about inhaled and iv medications. Now I (probably) know!

[@ladyeowyn42]

My son had his tonsillectomy at 3 and didn’t like the medicine either. He also woke up in a delirium, thrashing around a ripping stuff out. It was just me, his dad, and a single recovery room nurse. It felt out of control.

[@kgrfirdjy]

i got liquid chloral hydrate for oral sedation as a 2 year old in the mid 1980's. It was extremely bitter, a rough induction for ct scans /// mri, and made me combative when I awoke. Luckily, it is no longer available in the united states & there are easier meds to mix in juice like liquid lorazepam.

[@briannaball5164]

I had eye surgery when I was like 2, also remember hating the oral meds beforehand. I literally shoved my hello kitty pillowcase I’d brought with me, over my head bc heck that crap😩

[@songofruth]

I would love to see a video on how differently anesthesia might need to be handled for elderly people - not people who are just 65, I'm talking over 80 and higher.

[@aryscharovsky9419]

Depends on how sick they are, but we basically adjust the dosing and give arounf 50% of what a healthy afult would need in terms of anesthesia

[@dklein2008]

Love the Dr G video of Anesthesia making the resident cancel the surgery 🤣

[@kevindavis8175]

“He’s about to get dramatic.”

[@PsRohrbaugh]

Mike saved thousands of pediatric life's and if you feel drawn to that he's the surgeon to talk to.

[@JimAllen-Persona]

How do you distinguish between pediatric (which can really cover 0-17) and anesthesia on neo-natal (say 0-1) and toddler (say 1-4). Are they all under the same “pediatric” umbrella? Is it a sub-sub speciality? Happy holidays to you and your wife and a peaceful new year.

[@jacobnieves7728]

Hi there! I’m not an anesthesiologist, just a med student so please don’t take this as fact haha. But my hospital generally allows non-fellowship trained general anesthesiologists to provide anesthesia for anyone age 3+ (and if the kid is around 3-5 they pretty much have to be perfectly healthy undergoing an elective case). Otherwise the case is done by pediatric anesthesiologists. This is in the US as well.

[@kristinchong629]

🎉🎉🎉. The internet frontier for the people. Thank you doctor for going the extra extra extra to make bigger concepts for people. I really hope for everything for u and everyone cause its a lot of work and not too much recoginization to make the next generation of science tech for gen z. Like KZbin get on this. 2024 we are here. 🎉🎉🎉

[@kittypewpew]

I work in a tertiary peds hospital in the EU, we put emla cream and put an iv before induction from ASA 1 to 4, the only time we mask induce is if we fail iv like 3+ attempts. Interesting difference in culture! I see less than 10 mask inductions a year.

[@Spicytots5]

Always a fantastic video from you Dr. Feinstein!

[@rayoflight62]

It now years that I follow you, since the start of your residency. Your videos have always been very interesting to watch . Thank you Dr. Feinstein, Merry Christmas! Greetings, Anthony

[@darriontunstall3708]

Wow, children anesthesia is really cool! Would want to do kids and adults Anastasia! Anesthesiologist is so cool and amazing! It takes a special person to be an 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

[@PsRohrbaugh]

I drop names extremely rarely but I think this is a great fit. You and Mike would be a good pair.

[@Fluteperson01]

It seems pedi anesthesiology is similar to veterinary medicine in weight based calculations are everything and always memorized we also have emergency drugs pulled up as well!

[@siannevautour8659]

When we put endotracheal tubes in cats they get laryngospasms where as dogs don't 😊 a little Vet Med info for you 😊

[@jorihiukka6483]

I like how you insert little carwwe path notes of yourself right at the end of your vids.

[@Leander_]

Hi Max, awesome video, thanks! How long does your training for pediatric anesthesiology take?

[@MaxFeinsteinMD]

It’s one additional year of fellowship training after completing a four year anesthesiology residency!

[@rodhoover9158]

Really Enjoy your work Max. Thank you.

[@rcom9880]

The antecubital fossa bandaid is a nice touch

[@Graham_Rule]

Many years ago when I was in a local children's hospital, during a tonsilectomy, I looked up and saw various masked faces looking down at me. One of them said, "I see that Mr ____ has lost his spectacles", and soon I was asleep again. I don't remember the name but I'm fairly sure of the profession of Mr ____.

[@soranuareane]

Would you be willing to do a video on Suboxone and what complications that might cause to a patient needing either routine or emergent surgery?

[@craigt4467]

Thank you so much I learned so much Great video My best wishes always from Las Vegas Craig Bravo 👏🏽

[@gracier2718]

I’ve had this question for forever, if you’re brought into a hospital unconscious and need surgery, do they still use all the typical drugs to put you to sleep or not since you’re already out?

[@MaxFeinsteinMD]

It depends on the situation, the patient’s vital signs and the surgery, but generally it would be lower doses of the same drugs as when someone came in awake.

[@gracier2718]

@@MaxFeinsteinMD Interesting. So if you give lighter anesthesia, can you tell by the vital signs if the person is waking up or feeling pain? Also, would there ever be a time when you wouldn't give anesthesia to an unconscious patient during major-ish surgery?

[@MaxFeinsteinMD]

Correct the vital signs would be the main guiding factor. There’s also a “depth of anesthesia” monitor applies to the brain that is somewhat controversial but widely used, which can also help guide dosing. The only type of surgery with absolutely no anesthesia would be an organ donor who has already been declared dead. Anesthesiologists are still often involved to help administer medications that maintain organ perfusion and oxygenation of the lungs.

[@gracier2718]

@@MaxFeinsteinMD so interesting! So I've heard that organ donors (although declared dead) can still feel pain. Is this true? I've never wanted to become a donor because of what I've heard.

[@LandonStrauss-hc1sc]

These people can't possibly get paid enough.

[@sarahvlach2767]

Dr Feinstein thank you for your videos. I started a biochemistry major 20 years ago but didn't have the support or deep drive/study habits to keep going so I quit. Now I'm looking to pursue my medical dream. I'm looking to potentially become a CRNA or CT tech. Your videos make sense and are helping me decide if I want to go on a CRNA track. Do you have advice on how to pay those day to day bills while in medical school? This is probably my biggest barrier as a 39 year old with a family! CRNAs require more schooling than CT techs and it's recommended to not work while in school. Best of luck on your career endeavors and your wife's endeavors.

[@jacobtorris3428]

1) CRNA school is not medical school 2) CRNA is a farrr bigger commitment than CT tech school. CT tech school is an associates degree that you can enroll in with a high school diploma. CRNA school requires you to become an RN with a bachelors degree, gain ICU experience, and then complete a doctorate level education in nurse anesthesia.

[@MizLaur]

My 1yo nephew had to have surgery on an undescended…erm, testicle. He refused to have his top or bottoms (clothes, people…) removed and was given special permission to wear his outside clothes into his surgical suite. I always wondered what anesthetic he might have received.

[@cassandrasingle922]

Very interesting video. I have Turner's syndrome. I am an adult but I am 4 feet 8 inches and about 45kg. I know with some medicines like some antibiotics they give me a children's dose.

[@Fluteperson01]

Hi! Veterinary technician here thinking about getting my VTS in Anesthesia! It would be so interesting to talk about veterinary medicine anesthesiology with you!

[@pegaseg70]

He has a video on it already, but I would love to see more of veterinarian anesthesia

[@Fluteperson01]

@@pegaseg70 I think I’ve seen it but I feel it’s very surface level intro to it, I would do some big differences and then highlight some really cool things we do with ortho anesthesia, right now I am a ICU veterinary Technician, my patients are normally super sick on multiple drips maybe even on a ventilator.

[@XBEAST2023]

Keep up the good work 👌🏻

[@r0ky_M]

4:42 Q./ those Emergency meds drawn up in needles, if not used , do they go back into storage or are they disposed of and new needles/meds drawn up for every patient?

[@JustMe-12345]

Ive recently seen a tiny 26 week preterm baby getting intubated and omg soooooo tiny. And the masks for babies are also really small. (I spent 2 weeks on neonatology rotation. Aka newborns)

[@philipjaffe8788]

I've done peds for 11 years and used the Miller 00 maybe twice lol.

[@theraptorsnest5891]

Hey Doc....just curious.....did you have labs drawn or was it student practice day? 😉

[@MaxFeinsteinMD]

Haha good eye, I had labs drawn, no practice this time

[@starfishgurl1984]

I was wondering the same thing, lol, thanks for asking the question, as a blood donor I’m constantly drawn to people’s arms out of curiosity and instantly noticed the bandaid as a result, haha.

[@privacyvalued4134]

"Who doesn't love Llamas?" Well according to the Genie in the Disney movie Aladdin (and science), camelids like llamas apparently spit. A lot. Camelids also work up a lot of thick, foaming saliva when they "go into heat." Most kids aren't gonna care. Bright colors and cheerful people are what they'll be more interested in than scientifically accurate attire.

[@MaxFeinsteinMD]

Touché

[@Tommie22x]

Max! your finished your residency?! congratulations!!!!

[@vsquared2020]

Why use succ vs rocc paralytic if it could cause MH? The picu drs i work with rarely use succ when intubating.

[@autgoff]

I had the same question. I work in ED and roc is the norm for us, we almost never use succ

[@s.h.5720]

until what age do you need pediatric anesthesiology

[@MaxFeinsteinMD]

There’s not a strict cutoff. It typically depends on provider comfort, patient complexity, and institutional policies. Not a satisfying answer, but it just varies so widely that it’s not possible to generalize.

[@thebenandfridayshow]

Hi max are you training to be a pediatric anesthesiologist?

[@jaromirlatal177]

Yes, mentioned at 8:36

[@Twinsen764]

Got any Mario scrub caps?

[@Capt-Intrepid]

Very interesting.

[@ssl3546]

How much of what you say about children also applies to "little people" (i.e., people with dwarfism)?

[@caydenprescott]

Do you think I will start walking again I had a spinal fusion in October 2022 and released near Christmas time of 2022 and I have been paralyzed from the waist down since

[@LandonStrauss-hc1sc]

I sure hope you do!❤ All the best.

[@AdmiralofU2]

How does one become a [paediatric] anaesthesiologist (as opposed to a "general" anaesthesiologist)?

[@MaxFeinsteinMD]

In the US, the requirement is to do a year-long fellowship and take a written board exam after having already become a general anesthesiologist.

[@southaussiegarbo2054]

I had a staff member in hospital preop say that crushed up pandol tablets in water was how liquid panadol was made.... yeah no its not lol I also was given either midazolam or clonidine preop mixed into cordial....they tho didnt make cordial strong enough so it tasted like i bit a lemon lol 😂😂

[@mackenzieb2218]

Can you confirm/deny redheads need more Anesthesia than normal?

[@camaro720hp]

He already did a video on that.

[@LandonStrauss-hc1sc]

They do.

[@PsRohrbaugh]

I am personal friends with a famous pediatric surgeon and would be willing to connect you if it'd help.

[@PsRohrbaugh]

Reach out to Mike Marcheldon. Tell him I sent you.

[@marianfrances4959]

That shit killed my 9 year old.

[@LandonStrauss-hc1sc]

I'm sorry for your lose.

[@markrobinowitz8473]

Putting kids to sleep. Every parent is jealous.

[@gourabsarker9552]

Sir do you earn 500k dollars a year as an anesthesiologist? Plz reply. Thanks a lot.

[@linnsoltwedel]

You can. Google it.

[@robertwilliam9558]

Anesthesiologists can make over $750K.

[@JimAllen-Persona]

Why do you care what he personally makes? It’s easily looked up on the web to see the average in NYC is just over $400k. Lord knows how much of that goes to malpractice insurance.

[@sarahvlach2767]

That's a very rude question.

[@robertwilliam9558]

@@JimAllen-Persona The number you provided isn't accurate. You can see on the website I provided.