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
taking you on a guided tour of what i
think is one of the most fascinating
operating rooms which is
liver transplant surgery
without further ado let's step on in
as you can tell there's a lot to see in
this operating room and so i'm going to
break it down for you piece by piece
and since i'm an anesthesiology resident
i'm of course going to have a big focus
on everything related to anesthesia
starting with this iv pole you can see
that we have a lot of drips set up here
and these are actually all vasopressors
which include vasopressin norepinephrine
epinephrine and a line to run all these
in
all of these brace oppressors come
together into one set of stop here
which goes into one single iv which will
go through a central line panning over
to the anesthesia machine you can see
that on top we have a cerebral oximeter
which isn't used in all cases but is
used mostly for fulminant hepatic
failure patients when we're concerned
about increased intracranial pressure or
cerebral edema or herniation or any time
we're worried about cerebral perfusion
pressure next to the cerebral oximeter
is a bispectral index monitor which we
use routinely in lots of cases not just
in liver transplants and then beneath
that you can see a standard monitor that
would be found in pretty much any
operating room or ventilator controls
you'll notice that there are several
emergency medications strategically
placed on the cart here
and this is a normal breathing circuit
that would be found in pretty much any
type of operating room
we have a suction canister
suction
absorbent
and then all of our airway equipment
including a direct laryngoscopy blade an
endotracheal tube
monitors and this is what a bispectral
index monitor looks like
right next to the anesthesia machine is
a defibrillator
liver transplant surgeries can get
extremely involved and in some cases
patients can become hemodynamically
unstable or even go into cardiac arrest
necessitating defibrillation
so the defibrillator is always close by
painting right next to the anesthesia
machine you can see our anesthesia cart
which has a lot of medications drawn up
and ready to go for the case that's
about to happen in this room
medications shown here include atropine
glycopyrulate phenylephrine ephedrine
epinephrine norepinephrine
insulin nitroglycerin
bicarbonate calcium chloride
lidocaine
fentanyl propofol midazolam rock uranium
and succinylcholine
opening up the cart you can see that we
have a lot more medications that we keep
nearby
and you can actually click this link up
here for a guided tour of this
medication cart by dr erica feigelman
who's one of our liver transplant
anesthesia attendings at mount sinai and
also one of our assistant program
directors next to the anesthesia cart
you'll see this trans-esophageal
echocardiography setup
tee is used very commonly in liver
transplant anesthesia it's worth
pointing out that our liver transplant
anesthesia fellows get certified in the
use of tee this is what the scope looks
like which is inserted down
a patient's esophagus once they're under
general anesthesia so
that the anesthesiologist can get a very
good view of the patient's heart and
liver the other iv pole has a pressure
bag set up with transducers for invasive
lines like arterial lines and also
additional iv bags for other infusions
one of the things i'll point out about
this bed is that the anesthesiologist
actually has the remote to control the
bed positioning which affects not only
the ergonomics of the surgeon but can
also have really important hemodynamic
implications for patients and if
positioned incorrectly patients can also
end up with nerve damage just next to
the anesthesia card is a large supply of
albumin which is commonly used for
volume resuscitation during liver
transplant surgery along with blood
products if the patient is willing to
accept blood products
and then going to the rest of the
operating room you can see that there's
surgical equipment including
electrocautery equipment
needles
sutures gloves
these tables will eventually be used to
put sterile operating equipment on
and on the other side of the operating
room you'll see a blood gas analyzer
which is used very frequently during
liver transplant surgery to analyze many
different components of the patient's
blood which can help guide decision
making in the operating room during
surgery on this mayo stand you'll see
several kits that are used to place
central lines doing procedures like
placing central lines is something that
attracts a lot of people to
anesthesiology and is a big component of
doing liver transplant anesthesiology
behind the anesthesia machine is a
hookup for all of the gases that come
from the central supply in the hospital
these all get hooked up to the
anesthesia machine and we have backup
tanks for them as well
what's not shown in the operating room
but will be brought in right before
surgery is this device called a belmont
rapid transfusor which as the name
implies can do large volume fluid
resuscitation in a very short period of
time these types of devices can be seen
in other types of surgeries that
necessitate large amounts of volume
resuscitation for example trauma surgery
another device commonly used during
surgeries where a lot of blood loss is
anticipated is an auto transfusion
system like the soren extra this device
allows us to recapture blood that has
been lost during surgery filter it and
then transfuse it back to the patient so
that we can minimize the amount of blood
product that needs to be given from
donors well that wraps up this tour of
the liver transplant operating room and
i think this is one of the most
fascinating types of surgeries to
participate in as an anesthesiologist
because there's so much that goes on and
it can be a pretty intense surgery mount
sinai is actually one of the busiest
liver transplant centers in the united
states and the department of
anesthesiology has a fellowship where
anesthesiologists who have finished
their residency can come and get
sub-specialty training in liver
transplant anesthesia
special thanks to dr erica feigelman for
her help making this video and thank you
for watching i'll see you next time