what's up everybody my name is max feinstein and i'm an anesthesia resident at the mount
sinai hospital in new york city. in this video i'm going to be dispelling the age-old myth that
all that anesthesiologists do after inducing anesthesia is sit and read the newspaper. if
you find this video interesting or helpful i'd really appreciate it if you liked it and
subscribe to the channel. let's... take a look at this new logo that I've got,
and then we'll dive in. let the logo roll. nice!
part of the reason that i don't read the newspaper after inducing anesthesia is because i literally
haven't held a physical newspaper in my hands for like 10 years since my grandfather, may he
rest in peace, bought a newspaper subscription for me for my birthday. and to be honest i don't
even know where i would find a newspaper if i needed to for the sake of making this video.
the other part of the reason that i don't start reading the newspaper after inducing anesthesia
is because there's actually a lot that needs to be done. and so in this video i'm going to be
sharing with you a mnemonic that i made to help me remember all the things that need to be done
after most inductions of anesthesia. if there's nothing else that i'm remembered for in my career,
i hope that it's this mnemonic. before we get too far, i want to mention that today's video
is sponsored by the alphabet. before i had the alphabet, my brain was filled with difficult
mnemonics like "i get smashed" or "u go away, u are away, u are gone" or "snow-drop" or
"catch-22". what do these even mean? the alphabet makes it simple to take something that you already
learned when you were a small child and apply it to your everyday practice of anesthesia.
now that i've got the alphabet, i've got a reliable checklist in my head that i
can get through despite frequent interruptions immediately post-induction in the operating room.
hey anesthesia can i get the table up?
oh yeah, sure
hey anesthesia can i get the table down a little?
um, yeah sure
hey anesthesia can i get the table a little more up?
hey surgery, why don't you just do what I do? pull up a chair,
have a seat, and make it easy. no reason to complicate things, you know?
without further ado, let me walk you through all of the
components of my alphabet mnemonic for post-induction to do's, starting with A,
B, C, D, E, and F. and in this video i'll show you each of those components.
the A in this mnemonic stands for "antimicrobials", and antimicrobials
are very commonly used during surgery. for example you might use one like...
i actually don't know how to pronounce this it's either ceFAZolin or cefaZOLin, i'm not sure,
but it's used very commonly for surgery, and also for making fun of orthopedic surgeons, which is
for another video. but the most important thing to remember about antimicrobials is that in order
to be effective, they have to be administered to the patient before the incision is made,
so that's the reason why it's the first part of this mnemonic, because immediately after i induce
anesthesia i want to get the antimicrobials going right away so that that won't hold up
surgery. it's worth pointing out that although anaphylaxis is relatively uncommon during surgery,
that antimicrobials - along with paralytic agents - are some of the leading causes of anaphylaxis,
so as soon as you start administering antimicrobials in the OR, you should be attuned
to any changes in vital signs that could indicate that there's an anaphylactic reaction happening.
next up on the list is B for "Bair hugger", which is actually the name brand of this warming device
that kind of looks like R2D2 but is used in an operating room to deliver heated air to a special
blanket that goes over a patient's body or their arms depending on what the surgical site is. so
obviously operating rooms tend to be quite cold, but one other factor that contributes to patients
becoming cold during surgery is that a lot of the anesthetics that we use are vasodilators, meaning
that blood vessels are going to get bigger, and particularly the blood vessels in the arms
and the legs, and that causes a redistribution of blood. so warm blood leaves the core of the
body and goes to the arms and legs, which reduces core body temperature. that can be catastrophic
in terms of enzyme function or organ function, so it's really important that we make sure that
patients are nice and warm during surgery. next in the mnemonic is C which stands for "change the
ventilator settings" and i incorporated this in the mnemonic because i think it's really important
to just go through your ventilator both before and after induction and make sure that the settings
are appropriate for the patient, and particularly if i found that after i placed an endotracheal
tube they have very high end tidal co2 - which would be reflected right here - then i may want
to increase my respiratory rate to breathe off some of that co2 back down to a normal level.
next up on the list is D for "drain the stomach" which you would do either
with an orogastric tube or a nasogastric tube that would look something like this.
this isn't going to be applicable for all types of surgeries, but particularly for
abdominal surgery where the surgeon may want to have the stomach emptied in order to help
their visualization, or if you have done a rapid sequence induction and intubation
for a patient who's potentially an aspiration risk you may want to place an orogastric tube
or a nasogastric tube to make sure that the stomach contents have been removed.
the E stands for "emesis prevention" - or preventing vomiting. and there are a lot of
different medications that i can administer to try to prophylactically prevent post-operative
nausea and vomiting, but there's one in particular that's most effective when given
right at the beginning of surgery, which is why i included it in my post-induction mnemonic.
that medication is a steroid called dexamethasone.
last but certainly not least is F for "Fahrenheit" which is a reminder to put some
sort of thermometer on the patient's body so that you can keep track of their temperature throughout
the duration of surgery. and i do apologize to my colleagues who are not in the united states
for whom this fahrenheit just won't apply. so maybe F could be "figure out the temperature"?
i don't know, I'm sorry, i'll let you know if i come up with something better, but
it's really important that we keep track of a patient's temperature during surgery because
as i mentioned at the beginning of this video, some of the agents that we use
can rarely precipitate anaphylaxis. and there are other reasons that a patient's
temperature may increase or decrease so it's really important that we're aware
of any changes so that we can intervene and make sure the patient's temperature is normal
and there aren't any other underlying problems causing a temperature change.
well that wraps up this mnemonic, i hope you found it helpful, and do keep in mind that
there can be a lot of other tasks that come up immediately after induction of anesthesia,
but what i found is that all the components that are included in
this mnemonic are pretty common across pretty much all the anesthetics that I do,
so i hope you found it helpful. thanks very much for watching and i'll see you next time