Your Healthcare - March 2024

Name: Your Healthcare - March 2024
Uploaded: 2024-04-04T19:33:48.3266667Z
Duration: 57 min 54 s

April 04, 2024

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00:51Welcome to your healthcare.
00:53I'm doctor Amit Lahav,
00:55and in this show we discussed
00:58different types of medical aspects
01:01and different type of professions in
01:04the field of medicine. Anesthesia.
01:06What types of forms of anesthesia?
01:09Different procedures, surgeries.
01:11Even going to the dentist,
01:13you receive some form of an anesthetist.
01:17What do you know about the anesthesia
01:19that you need to prepare for?
01:21How do you get the best
01:22out of the anesthesia?
01:23What are different forms of anesthesia?
01:26Today we are privileged to have
01:29with us Doctor Brian Kerner,
01:31Director of Regional Anesthesia,
01:33Bridgeport Hospital, Assistant Professor,
01:35Yale School of Medicine,
01:37Department of Anesthesiology,
01:38who will enlighten us with all his
01:41knowledge regarding the field of anesthesia.
01:44What do you need to know?
01:45How do you prepare for these procedures
01:48with the anesthesia you may require?
01:50Stay tuned.
01:51Don't fall asleep,
01:52because we've got a lot coming
01:54for the field of anesthesia.
01:55I'm Doctor Amit Lahav.
01:57You're watching your healthcare.
01:58We'll be right back.
02:25Welcome back to Your Healthcare.
02:28I'm Doctor Amit Lahab.
02:30And today we'll discuss
02:31the topic of anesthesia.
02:33If we can go to the presentation,
02:34please. So anesthesia,
02:37it's a big topic but a lot to know about.
02:40And again, we are privileged today to
02:42have with us doctor Brian Koerner,
02:45who will speak to us about
02:47anesthesia and the different forms
02:48of anesthesia and anesthetic agents.
02:53So anesthesia, as just a definition,
02:56is a state of controlled temporary loss of
02:59sensation or awareness that is induced for
03:01medical purposes like procedure, surgery.
03:03Like I said, even at the dentist,
03:06it may include some or all
03:09form of anesthesia, analgesia,
03:11paralysis, amnesia,
03:12and perhaps a form of unconsciousness.
03:17Anesthesia works by blocking signals
03:19in the nervous system up to your
03:22brain through your spinal cord.
03:24The nervous system is made-up of the brain,
03:26spinal cord, and the nerves
03:28that go to your extremities.
03:30Messages from the body travel through
03:32the nerves and spinal cord to the brain.
03:35Anesthesia blocks pain messages from
03:37getting to the brain and thereby you can
03:41have these type of procedures in surgery.
03:44Anesthesia is a way to control
03:46pain during surgery or procedure by
03:49using medicine called anesthetics.
03:51It can help control your breathing,
03:54blood pressure, blood flow,
03:55heart rate and rhythm.
03:57And these things can be controlled by your
04:01anesthesiologist or what we call CRNA.
04:05Well, what are some of
04:06the types of anesthesia?
04:07We'll get into more detail
04:08as we go into the show,
04:10but just to break it down a little bit,
04:12there's local anesthesia,
04:14regional anesthesia,
04:15and then general anesthesia.
04:19For the local anesthesia,
04:20it numbs a small part of the body
04:22from minor procedures like things
04:24for the hand or sometimes toes.
04:26For instance, you may be awake
04:28during the procedure, or you may also
04:30get a sedative and be more asleep.
04:33Regional anesthesia blocks pain
04:34to a larger part of your body,
04:37like your legs or your whole arm,
04:39for instance.
04:40Epidural spinal anesthesia,
04:42and we'll make the differentiation
04:44on this with Doctor Kerner later on,
04:46is a shot of anesthetic near the
04:48spinal cord and the nerve roots.
04:50It blocks pain from an entire region
04:52of the body such as the belly, hips or both,
04:56lower extremities such as your legs.
04:58And finally this general anesthesia.
05:00This is the one that most people
05:02are aware of where you have sort of
05:04the tube down helps you breathe,
05:06you're on a ventilator and you're
05:08completely out for whatever the
05:10procedure may be or the surgery
05:12that you're undertaking.
05:13So local anesthesia here showing
05:15is even things like at the dentist,
05:17you get a little bit injection for
05:19a nerve root to decrease the pain
05:21in your mouth.
05:22If you have like hand procedures,
05:24sometimes things like carpal
05:25tunnel or toe procedures,
05:27this is a local anesthesia.
05:29And now this very small area
05:30that needs to be worked on,
05:34moving on to regional anesthesia,
05:36again it's a bigger area.
05:38There's also things called nerve blocks.
05:40We'll speak with Doctor
05:41Kerner about this as well.
05:43And nerve blocks help decrease pain
05:45in a certain larger area of the
05:48body such as your knee or your arm,
05:50for instance.
05:51And Speaking of nerve blocks,
05:54different type of nerve blocks,
05:56some that go into your neck to arm the
05:58whole shoulder and upper extremity
06:00for things like shoulder procedures
06:03or elbow procedures in your leg to
06:05numb things like your lower extremity
06:07from your knee down for instance.
06:09So these blocks help with pain and they
06:12have become really a forefront of pain
06:16management for even big procedures
06:18such as total joint replacements.
06:21Then we look at things like
06:23epidural spinal anesthesia,
06:25we'll make the differentiation on this.
06:27And really the indication here is where the
06:29needle really goes and it's in your back,
06:31in your spine and it helps numb
06:34a larger portion of your body,
06:36really kind of from your lower
06:38extremities even up to your belly.
06:40Things like pregnancy or delivering a baby,
06:43as well as procedures even again like
06:45jaw replacements that can numb the hip,
06:47the knee,
06:48any procedures in the lower extremity.
06:50And then finally,
06:52general anesthesia in general means
06:54that you are out, completely out,
06:56You're not even breathing on your own.
06:58There's a tube that goes down
07:00your throat and there's actually
07:01different versions of this as well.
07:03But general anesthesia can be
07:06even done for facial procedures
07:08where the tube is done not go down
07:11your your throat from your mouth,
07:13it actually goes from your nose.
07:15But again,
07:16general anesthesia essentially
07:17numbs everything.
07:18You are out for the procedure.
07:22So what are what determines really the
07:25type of anesthesia that you will use?
07:27Well, your past and current health,
07:30your family history, other surgeries
07:32you may have had health problems,
07:34heart disease, diabetes can indicate
07:37the type of anesthesia example.
07:40You may need general anesthesia
07:41to ensure your comfort and safety
07:44during certain types of bigger,
07:45larger procedures.
07:46The results of tests such as blood tests,
07:50EKG and so forth can also indicate the type
07:55procedure that you may or may not need.
07:58Well, how should you prepare for anesthesia?
07:59We'll discuss this really at
08:01at length with Doctor Kerner.
08:03You know you got to avoid certain
08:05food and drinks a certain amount
08:06of hours before the procedure.
08:08Smoking is always a risk,
08:09not just for wound healing,
08:11but also sometimes for the type
08:13of anesthesia you may receive.
08:15You need to stop taking different
08:17type of herbal supplements.
08:18Different medications also have
08:20to be stopped before surgery.
08:25Certain blood pressure,
08:26not all but certain blood pressures.
08:27Also, these type of medications
08:29need to be stopped before the type
08:32of anesthesia you may receive.
08:33So it's important to prepare for the right
08:37anesthesia for your procedure or surgery.
08:40Some potential side effects of anesthesia,
08:43things like back pain or muscle pain,
08:45chills, difficulty urinating, fatigue,
08:47something headache or itching,
08:50nausea and vomiting are just some few side
08:53effects that can occur with anesthesia
08:55and obviously these are minimal.
08:57We try to minimize all these type of
09:00side effects and give you the best
09:03opportunity to have the best anesthesia
09:05you can with minimal side effects and
09:07the best benefits of that anesthesia.
09:10So who is at risk for
09:12anesthesia complication?
09:13Well, the older you are,
09:14the more medical conditions you may have.
09:16So advanced age, diabetes or
09:18kidney disease always plays a role.
09:20There's a lot of fluid shifts and
09:22different medications that go through
09:23your kidneys that can affect your kidneys.
09:25And as well, the liver family history,
09:28something called malignant hyperthermia
09:30and we can discuss this a little bit later.
09:34Heart disease,
09:34high blood pressure or history of strokes,
09:36for instance, can indicate really
09:39a higher risk for anesthesia,
09:41lung disease,
09:42difficulty breathing,
09:43COPD or obstructive lung disease,
09:47emphysema, obesity,
09:48there's more weight on your chest or lungs.
09:52Higher body mass index or what we
09:54call a BMI can also raise some risks
09:57for certain type of anesthesia if
09:59you're on any type of neuroleptic
10:02or neurological medications.
10:03Seizures, sleep apnea,
10:04and again smoking creeps up into this,
10:07as well as some of the risks that
10:11anesthesiologist has to assess
10:13before giving you anesthesia.
10:15Now,
10:15we spoke briefly on malignant hyperthermia.
10:18This tends to be rare,
10:20but it's terrible if it happens and has
10:22to be really approached very quickly.
10:24It's a severe reaction to certain
10:27drugs used for anesthesia.
10:28Again, this tends to be pretty rare,
10:30but the anesthesiologist is always ready.
10:33It's a severe reaction which typically
10:36includes dangerously high body temperature,
10:38rigid muscle or spasm,
10:41fast heart rate and other symptoms.
10:43And this needs to be properly
10:45treated very quickly.
10:46And that's why sometimes there's
10:48carts around the operating room just
10:50for these type of rare occasions.
10:53But the anesthesiologist is the one
10:55that monitors you throughout the
10:57procedure and make sure that you
10:58are safe and comfortable to whatever
11:00procedure or surgery you may have.
11:02And this really comes down to
11:04monitoring you during anesthesia.
11:05You know what are the anesthesiologists
11:07looks at not just blood pressure,
11:09breathing, but everything else.
11:11You they literally monitor you
11:13throughout the entire time.
11:15Somebody's always looking after you
11:17all the time to make sure again you
11:19are safe throughout the procedure.
11:21So that brings us up to anesthesia.
11:24And what I like to do is we're going
11:26to take a very short break and we're
11:27going to come back and introduce
11:29Doctor Brian Kerner again Director of
11:32Regional Anesthesia and Bridgeport
11:35Hospitals as well as Clinical
11:37Assistant Professor at the School
11:39of Medicine at Yale. Stay tuned,
11:41we'll be right back and we'll
11:43enlighten you more about anesthesia.
12:16Welcome back to your Healthcare.
12:18I'm Doctor Amit Lahab.
12:20And again, we're privileged today to have
12:22with us one of my colleagues and friends
12:25from Bridgeport Hospital system in Yale,
12:27New Haven Health Doctor Brian Kerner.
12:31Doctor Kerner, thank you very
12:33much for being with us here.
12:34You know, as director of regional anesthesia,
12:37Bridgeport Hospital affiliated with Yale
12:39School of Medicine assistant professor,
12:41really it's a privilege to have you here.
12:44And I think it's a really important topic of,
12:46you know, individuals out there really,
12:48you know, getting some sort of anesthesia,
12:50but you know,
12:51not really knowing what you're getting,
12:52how to prepare for it,
12:53some of the history of anesthesia.
12:55So let's begin.
12:56Actually,
12:56a little bit of your background.
12:58Sure. Well, I'll start by saying
12:59it's a pleasure to be here.
13:01Thank you so much for having me.
13:02I'm excited to be here and sort of teach
13:04the audience a bit about what anesthesia is.
13:07I think there's a lot of
13:09misconceptions out there and,
13:10you know, beliefs about what we do.
13:12So it'll be great to clear
13:13a few of those things up.
13:14So thank you for having me, my background.
13:17I grew up in the Northeast.
13:19I have a family at home.
13:21I have two young girls,
13:24soon to have a third.
13:25I did my medical training down
13:27in South Florida, the Southeast.
13:28Then I spent a year and a half in
13:31Seattle doing specialized training,
13:33what's known as regional anesthesia.
13:35That's really my passion.
13:36And then we came back to the Northeast,
13:38where I settled into a position
13:40with Yale School of Medicine and
13:42now mainly at Bridgeport Hospital,
13:44Milford Hospital on Park Ave.
13:46Medical Center.
13:47So you actually have experience throughout
13:49I should say the whole continent going
13:52from the northeast to the South to
13:54the northwest back to the northeast,
13:57which actually makes it a a kind of a
13:59more complete experience of even what's
14:01done throughout the continental USA.
14:03Absolutely. There are different
14:05cultures you know in medicine and it
14:07has been great to experience that.
14:08So I feel privileged to have an opportunity
14:10to have done that and use those skills
14:12that I've learned along the way,
14:14you know for patients every day.
14:15And again some of your interest is
14:17actually in the in regional anesthesia
14:19and blocks and I've had the privilege
14:21of working with you also in the
14:23operating room on different blocks
14:24for joint replacements which is proven
14:27actually very efficient very well.
14:29And that's how you sort of even move
14:32these patients through from staying in
14:34the hospital to same day type of surgery
14:36even for very big type of procedures.
14:38So the regional part of anesthesia
14:40has become really very important,
14:43you know part of of really
14:44any surgeon's practice.
14:46Absolutely, I it's something I'm
14:47that I'm very passionate about.
14:49Now, regional anesthesia of course having
14:51doing some extra training in that and
14:54practice it every day like you said
14:55with joint procedures like yourself.
14:57But there are two reasons why we
14:59would do a regional anesthetic.
15:01One would be for pain control afterwards,
15:03so you'd receive a full general anesthetic
15:05and then this is for pain relief for
15:07a period of time after the surgery.
15:09But another reason we do regional
15:12anesthesia and we will touch more
15:14on this along the way is we can
15:15avoid a general anesthetic entirely.
15:18So there are patients who really are,
15:19it's contraindicator really not safe to
15:22be doing a full general anesthetic on.
15:25So we can just do a regional anesthetic,
15:27either a spinal,
15:28an epidural or a peripheral neuroblock and
15:30we can avoid general anesthesia all together,
15:33which can be much safer and people
15:35typically feel a lot better afterwards.
15:37So let's actually go into your,
15:39your first slide of really
15:42what is anesthesia,
15:43if we can go right the back. Yes.
15:45So let's talk a little bit about
15:47just starting with the basics.
15:48What is anesthesia?
15:49Great. Well, like I said,
15:51we started talking.
15:52I think there's a lot of misconceptions
15:54about there about what we do.
15:56And for those who haven't seen it
15:57in the life of an anesthesiologist,
15:59it's actually pretty wild to see
16:01the patient go through this process
16:03of being in the pre op area fully
16:05asleep or unconscious and then wake
16:06up as if nothing had happened.
16:08So it's good to talk about.
16:11I'd like to sort of tell the story of how
16:13a patient comes into the operating room,
16:15their experience.
16:16So for the audience,
16:17typically you've spoken to your surgeon
16:19maybe a few times before coming in.
16:21You know preparation has been made,
16:23but typically you haven't spoken
16:25to your anesthesiologist before.
16:26So you sort of learn what the plan will
16:28be and we'll talk about most common
16:30surgeries where you do receive that
16:32general anesthetic that you talked about,
16:34where you're fully asleep or unconscious
16:36and then we put that breathing device in.
16:39So typically, you get to the operating
16:41room around 6:30-ish in the morning,
16:44pretty early for scheduled
16:45surgery time of 730.
16:46You'll arrive,
16:47you'll change into a hospital gown,
16:50You'll speak to nursing staff.
16:52You'll typically get an intravenous
16:53line and then you'll speak to the
16:55anesthesiologist at some point.
16:57And that's when we'll talk about
16:58what our plan is and, you know,
17:00agree on that.
17:01For this procedure,
17:02we need a general anesthetic
17:04where typically I will say you're
17:06asleep for the entire procedure.
17:08We'll get into the, you know,
17:09specifics of of that.
17:11It's not technically sleep,
17:13and we'll describe how we
17:14put a breathing device in.
17:16You may walk up with a sore throat,
17:17talk about a few risks,
17:20then we'll make sure the operating
17:22room is ready at that 7:30 or
17:24operating room start comes around,
17:26we'll start rolling the patient back.
17:27Now when we think about general anesthesia,
17:30I want you to think about a few
17:32different goals that we have
17:33anytime we do an anesthetic,
17:35amnesia or inability to form new memories,
17:39analgesia or pain control,
17:41hopefully of minimal to
17:42no pain unconsciousness.
17:44So essentially you're unaware of
17:46anything that's happening during
17:48the procedure and muscle relaxation.
17:50So essentially you're not moving while
17:51the surgeons are trying to operate.
17:53So we'll think about those four things,
17:55amnesia, analgesia,
17:57unconsciousness and muscle relaxation.
18:00So typically we go back to,
18:02you know,
18:02a story of a patient going through
18:04the operating room.
18:05We start rolling you back and
18:07I may administer a medication
18:09called the benzodiazepine,
18:10at which point you become
18:12a little bit more relaxed,
18:14you know,
18:15the nerves go away less anxious and
18:18that gives some of the amnesia portion
18:20of things we call anterograde amnesia.
18:22So you don't really remember
18:23much after that with a low dose.
18:25You may remember things,
18:26but it may become a little bit fuzzy.
18:28We get you into the operating room,
18:30we move you over to the operating room bed,
18:32we put our monitors on.
18:33That typically includes a blood
18:35pressure cuff pulse oximeter to
18:37measure your blood oxygen levels.
18:39An EKG would measure your heart throughout
18:41and we'll typically do a pause at that
18:43point and make sure we have the correct
18:45patient doing the correct procedure.
18:47Absolutely make sure
18:48everything's remained safe.
18:49Now we'll put an oxygen mask on to fill your
18:52lungs up with oxygen and then we're ready.
18:55We're at that point.
18:56I'll administer a fairly
18:57large dose of medication,
18:59typically propofol along
19:00with a pain medication.
19:02And it's like I said,
19:04it's pretty wild to see if you
19:06haven't seen it within 10 seconds to
19:0830 seconds you're completely out,
19:09so unconscious your body goes limp
19:12and like you said you lose the
19:14ability to breathe for yourself.
19:16Now this works.
19:17Propofol typically works with bonding
19:19to different receptors in the brain.
19:21GABA A receptors we we call
19:24them so an inhibitory,
19:26so everything sort of
19:27relaxes and is negative.
19:28So these these brain waves that you have,
19:30the electrical activity,
19:31they slow down or they become more organized.
19:35Now once you're unconscious,
19:36we make sure we can help breathe for you.
19:38I'll give you a few breaths
19:39with the device we have,
19:41similar to what we have here.
19:43And once we do that,
19:44we give another medication.
19:45It's a muscle relaxant,
19:46A paralytic that allows us to
19:49essentially get that breathing
19:51device in easier and allows you to
19:53do your pre surgery as you need to.
19:55So we've talked about a few different things.
19:56Amnesia,
19:56the benzodiazepine allows you to not
19:59start making memories after that.
20:01Unconsciousness and pain control
20:03the propofol and other medications
20:04we've given during that point.
20:06So these
20:06medications help also with pain.
20:08So you don't feel anything from the
20:10procedure or the surgery. Absolutely.
20:12And you don't remember anything absolutely.
20:14Now the unconsciousness is one thing,
20:17but we also want you don't want
20:18you to react to the painful stimuli
20:20that you have during the procedure.
20:21So typically what a surgeon
20:24does is stimulating and painful.
20:26So we don't, we don't want to
20:27see a raise in blood pressure
20:28or raise in heart rate etcetera.
20:30Those are sort of the tools we use to
20:32make sure that you're fully anesthetized.
20:34So at this point we've spoken
20:36about those goals of anesthesia.
20:39But I want to dive a little bit
20:41more into the unconsciousness
20:42portion of things and and how it's
20:44different from a normal sleep cycle.
20:46You know, typically when a patient comes in,
20:48I will tell them and they'll ask me,
20:50will I be asleep for the entire procedure.
20:52And while I say yes, you will,
20:54it's quite different from normal sleep.
20:57So the way that the brain functions
21:00essentially is electrical activity.
21:02And these medications that we give it
21:05inhibits the ability of electrical,
21:07electrical activity to communicate
21:09one part of the brain to the other.
21:12That's the language that the brain speaks.
21:13It's electrical activity.
21:14Now once the brain can't speak
21:16one part to the other,
21:18that's when we're not aware anymore.
21:20And that's exactly what these medications do.
21:22Now let's talk about normal sleep.
21:25Everyone's heard of this R.E.M.
21:26cycle, non R.E.M. cycle.
21:28That's that's typical terms
21:29that most have have heard of.
21:31R.E.M., R.E.M. is rapid eye movement.
21:33So during this period there's an extreme
21:35amount of brain activity happening.
21:37If we look at an EEG electroencephalogram
21:39and we look at the brain waves
21:41of a patient under, you know,
21:43under sleep,
21:44it looks very similar to an awake
21:46patient actually.
21:47So you're still forming memories,
21:48you're still essentially
21:49processing everything that has
21:50happened throughout the day.
21:52You're still hearing things,
21:53you're still sensing things.
21:54None of that happens during an anesthetic.
21:56You're essentially unconscious and
21:58it's it's more similar to a a coma like
22:02state similar to to death versus sleep.
22:05Now if I were to say to a patient all
22:07of that when they came in for a surgery,
22:10you know you're in a cult reversible
22:13medication induced unconsciousness coma,
22:14half the patients would walk right
22:16out the door of that moment.
22:18So while it's simpler to say you're
22:19sleeping and it's one way to look at it,
22:21it's quite different from sleep.
22:24So it it's it's do you can you
22:26dream and then remember anything
22:28from that or the essentially these
22:31medications like you go down,
22:32you have anesthesia and the
22:33last thing you remember is going
22:34into the operating room and
22:35when you come out it's all done.
22:37That's a good question.
22:39Typically you don't dream under anesthesia.
22:40So the the like I said the language
22:42that the brain speak is this
22:44electrical activity and once you
22:46block those electrical activity
22:47in the gates that allow them,
22:50the brain isn't communicating
22:50with the other part of the brain.
22:52So you're not forming these thoughts.
22:54So there's literally a a block of time
22:56that you just you can't account for.
22:58You were there all of a sudden you
23:00wake up in recovery room and it just
23:01something happened in the middle.
23:02You obviously had a procedure or surgery
23:05or something like that and then you just,
23:07you don't have that time period
23:08sort of in your brain.
23:10It's, it's a gap, right.
23:11It's pretty amazing to have somebody
23:13you know undergo A surgical procedure,
23:15an invasive procedure and then wake
23:17up hopefully paying for your minimal
23:19pain as if nothing had ever happened.
23:21And you were mentioning also one
23:23of the medications that I'll
23:24use really widely is propofol.
23:26Propofol is like a Milky white kind
23:28of substance that you give through
23:30your intravenous or your IV and that
23:32actually kind of knocks you out.
23:33You said, you know, 10 to 30 seconds.
23:35I don't think I've seen any of the
23:37patients make it to even 10 seconds.
23:39You're completely out.
23:40Something is a little bit burned when it
23:43goes in and it's very quick as it goes in,
23:46but it makes you kind of very comfortable.
23:49Some people, you know,
23:50relate that also you know the Michael
23:52Jackson story where he went to
23:54sleep using this type of medication,
23:56which is really he was getting anesthesia.
23:58There's no dreams, nothing else.
24:00And it's it suppresses your breathing
24:02and you can if it's not controlled by
24:04someone with professional like yourself,
24:06it it's really dangerous.
24:07But it works extremely well for things
24:11like even colonoscopies, endoscopies,
24:13I mean gentle anesthesia, you utilize it.
24:16Is it short acting, long acting,
24:18like how long do you get from,
24:20you know, one shot of this stuff?
24:22It's relatively short acting.
24:24Typically if we give one of
24:26those large bolus medications,
24:28you know both doses of medications
24:30typically within 5 to 10 minutes,
24:32you're starting to really wake up.
24:34Now it depends how long
24:35we've run that medication.
24:37Once you're under anesthesia,
24:38we keep you in this unconscious
24:40state either with prop fall or other
24:43medications through your IV or anesthesia,
24:45anesthesia, gases and the typically
24:47the longer you run those,
24:49so the longer the surgical procedure,
24:51the longer that stays in your system.
24:53So you know with experience,
24:55with you know taking all
24:57factors into account,
24:58we stop those medications at the
24:59appropriate time and you're ready to
25:01wake up at the end of the procedure.
25:02There's always communication
25:03with the surgeon, you know,
25:05in the procedure and so forth.
25:06And you brought something here
25:08also because you say you kind of,
25:09you bagged the patient, right.
25:10You kind of pushed some oxygen in
25:12before you you put the tube in.
25:14Could we go through some of the stuff
25:15to use for a general anesthesia here?
25:17Sure. Let's see,
25:20this here is called an AMBU bag.
25:21It's it's essentially a device where when
25:24you squeeze this green portion here,
25:26it allows us to breathe the patient.
25:27So we we put a mask on and if
25:30long as we're squeezing that bag,
25:32we're what we called ventilating the patient.
25:34So moving air in and out and oxygen
25:36is and carbon dioxide of the main
25:39medications that we want to move. Again,
25:41this is, it's a bag that you can
25:43squeeze it in, in this air that's
25:44going to come from one side.
25:45So you help the patient sort of
25:47breathe when you do that exactly,
25:48you also have a face mask right there.
25:50Too many patients will remember the
25:52last thing is the face mask going on and
25:55then typically counting back from 10.
25:57Now this device here is probably
25:59the most critical device we
26:01have in an anesthesiologist.
26:03If everything around this were to fail,
26:05electricity goes out for whatever
26:06reason our ventilator and we don't
26:08use this for the entire procedures.
26:10Patients are placed on ventilators with
26:12with which assist with ventilation.
26:14But if everything fails this
26:16device will save a patient's life.
26:18So it's it's critical having
26:20any anesthetizing location,
26:21it's it's absolutely critical.
26:23So that that's then you manually
26:25help the patient breathe until the
26:27anesthesia comes out and they're and
26:29get in control of their own breathing.
26:31Absolutely, yes.
26:31Now a few of the other things which
26:34we brought today we have the our
26:37endotracheal tube, this is a large one.
26:39So we could see on the television
26:42typically it's a little bit
26:44smaller than this and this,
26:46once you're under anesthesia,
26:48once you're unconscious,
26:49once you have some analgesia,
26:52so pain control and you're relaxed.
26:54We would place this essentially
26:56down into the trachea and we use
26:58another device here which we have,
27:00it's called a laryngoscope.
27:02It went essentially has a light on the end.
27:05It's so we can see into the
27:06patient's mouth as we're doing that.
27:08And you got to look kind of
27:09down the throat exactly because
27:10if the tube essentially you
27:12know there's two pipes there,
27:13one is your esophagus,
27:14one is your your trachea.
27:16One obviously goes to the stomach,
27:17the other goes to the lungs.
27:18So you want to make sure this tube
27:19goes in the right place to the lungs,
27:21otherwise you're pumping
27:22air into the stomach.
27:23Absolutely. That's critical.
27:24It's something that you know you do
27:27thousands of time through training
27:29and become pretty comfortable with.
27:30So, right, That has to be in
27:32the correct place and the and
27:34the device you're holding there,
27:35it's called a laryngeal mascara way.
27:37It's it's a much less invasive
27:39way of helping a patient breathe
27:41during the procedure.
27:43So this essentially just sits
27:44in the back of your mouth,
27:46holds the tongue off the back of
27:47your throat and allows us to use
27:49our ventilator without putting that
27:51stimulating endotracheal tube down
27:53South. Essentially the the tube
27:55goes down further into your your,
27:57your breathing tube essentially your
27:59trachea where this kind of sits more
28:01just in the back part of your mouth.
28:03So patients who have let's say
28:06significant sleep apnea or sort
28:08of very let's say obese here with
28:10short stocking necks for instance,
28:13that you're you're afraid that
28:14the tongue is going to go back and
28:16it's going to hurt their breathing.
28:18This is when you potentially use
28:20something like this to kind of go back
28:22in the back of the throat to move that
28:23tongue forward and help them breathe
28:25better. Exactly.
28:26That's sort of a a secondary indication.
28:30One would be we use that
28:31just to be less stimulating.
28:33But two, if we ever had
28:36trouble ventilating that,
28:37that can be a rescue device.
28:39So it allows us to better
28:40ventilate the patient. Exactly.
28:42And then I always hear you also
28:43when you know when you put some
28:45oxygen and and use this face mask,
28:47as you sort of put it on your face,
28:48you say it may smell like a little like
28:51plastic and that's OK that's normal, sure.
28:53But you have oxygen flowing through.
28:55Absolutely. And and the oxygen
28:57that you're kind of giving through,
28:58obviously it's not forced oxygen,
29:00it's just a little bit higher level of
29:02oxygen to kind of expand your lungs,
29:04making sure that you're getting that
29:05oxygen through your body and your,
29:07your red blood cells, right.
29:08So typically when we're breathing fresh,
29:12you know air here,
29:13the oxygen percentage is about 21%.
29:15Now when you get to that unconscious state,
29:19there's typically a period of which we
29:21call apnea or you're no longer breathing.
29:23Now in order to extend that safe time
29:25that you can be APNIC or not breathing,
29:28if we can get the amount of oxygen
29:31in your lungs to 100% versus 21%,
29:33that extends that up to 10 minutes
29:36or so in a normal healthy patient.
29:38So just in case we did run
29:40into any kind of trouble,
29:41it extends that period of time.
29:42That's why it's so important that
29:44we hold that oxygen mask over your
29:46face as you're going to sleep.
29:48So just out of curiosity,
29:49if let's say you're a swimmer
29:50and you want to, you know,
29:52go in the pools from the
29:53whole length of the pool,
29:53if you actually take 100% oxygen beforehand,
29:56you can literally hold your breath
29:58a lot longer because you're getting
29:59more supply of oxygen to your lungs
30:01than your breathing fresh air.
30:03It's a great question and a great comment.
30:06Yes. Typically your oxygen levels
30:08will stay higher for longer,
30:10but typically it's actually the
30:12carbon dioxide which causes people
30:14to pass out eventually. Once,
30:16once you're not breathing or ventilating,
30:18you're moving two different gases,
30:20oxygen and carbon dioxide.
30:21So once that carbon dioxide level goes up,
30:24that's when you pass out and
30:25that's when you were on to trouble.
30:27Understood, understood.
30:28And if we can go actually to the next
30:31slide on the levels of anesthesia,
30:34let's kind of talk about some
30:35of that as well. Sure. So
30:39we talked about general anesthesia,
30:40right and we briefly touched on regional
30:43anesthesia which we will touch on later.
30:45But regional anesthesia essentially
30:48blocks the pain sensation and may not
30:50allow you may you may not be able to
30:52move or full full muscle relaxation.
30:54Now because of that we may may not
30:56need a full general anesthetic.
30:58We may not need you to be in completely
31:01unconscious or use IV medications to
31:03accomplish those other things like analgesia.
31:06So we can do procedures under less
31:09full body anesthesia than if we
31:12hadn't done that regional anesthesia.
31:14So, so that's a big benefit there.
31:16Now there are procedures where
31:18we actually want you relatively
31:19awake during the procedure.
31:21I know that sounds you know,
31:22scary for some,
31:23but it's actually a safer way
31:25of doing some procedures.
31:26First, we can talk about a cataract,
31:28I mean that's a pretty much as minimally
31:31invasive surgery as we get that
31:32either we give very little sedation,
31:34minimal sedation where you can
31:36talk to us or no sedation,
31:38some patients are fine with that.
31:40It's just not necessary for
31:41that type of procedure.
31:42So we don't give more than needed.
31:44Now there are other procedures
31:46which are more invasive and a
31:49few examples would be a carotid.
31:51So sometimes the the blood vessels
31:53in the neck have some blockages
31:56which need to be cleaned out and you
31:58go to a vascular surgeon for that.
32:00Now in order to monitor that that
32:01patient isn't having a stroke or
32:03decreased blood flow to their
32:04brain during that period,
32:05we actually want them relatively awake.
32:07So they can sometimes they'll be
32:08squeezing a ball or something like that,
32:10or we say something and we hear the
32:12squeak and we know that their brain
32:14on that side of the body isn't having
32:16ischemia or diffuse blood flow.
32:18So in that's the case,
32:19we don't want a full general anesthetic.
32:21We want something like a moderate
32:22sedation where you're more relaxed,
32:24you're calm,
32:24but you're able to kind of follow commands.
32:27And then like I certain eye surgeries
32:30or face surgeries,
32:31they want you to be able to smile
32:33or lift your eyebrows.
32:34They want to make sure they're not
32:36affecting any of the nerve crucial
32:37nerves in your face or they want
32:39to make sure it looks like it's
32:41supposed to look so.
32:42So those are sort of examples why we
32:44wouldn't need a full general anesthetic.
32:45We typically call that Mac monitor,
32:48anesthesia care.
32:49So it's a wide range of sedation
32:52where were there were involved,
32:54but it's not that full general anesthetic.
32:56So again, we want to make a
32:57little bit of the distinction
32:58also that you know you're awake,
33:00but it doesn't mean you remember
33:01also everything that's going on.
33:03So you're awake,
33:04you're not feeling the procedure,
33:06you're able to kind of just not be asleep,
33:10but you also may not remember
33:11part of the procedure as well.
33:12And that's really where your expertise
33:15come into like kind of making sure
33:16that you get more of one versus the
33:18other depending on whatever procedure
33:20or surgery you have, right. The exactly.
33:22And those can be some of the more
33:24challenging cases actually for an
33:26anesthesiologist sometimes if we are
33:28able to fully control your breathing
33:30with a breathing tube and a ventilator,
33:32it's a little simpler than I having
33:35to also worry about or be concerned
33:37about an unprotected airway.
33:39So essentially a patient during
33:40sedation is breathing on their own.
33:42We're we're we're not,
33:43we don't have any support in their mouth.
33:46So it's challenging,
33:47but it's an exciting part of our
33:50profession and it's just a wide
33:51variety of things that we do.
33:53And that's also in different
33:55procedures, surgeries.
33:55You some see the patient kind of go a
33:58little bit deeper into sleep and you
34:00actually kind of bring them back out again,
34:02they may not remember anything,
34:04but you just want them to breathe a
34:05little bit more on their own rather
34:07than sort of kind of stop breathing.
34:09So you adjust these medications as
34:11appropriately and every patient's different.
34:13You know, again,
34:14you're monitoring blood pressure,
34:15you're monitoring pulse oxometry,
34:17you know, how much oxygen to have blood.
34:19I mean you, you have all these monitors,
34:21you look like a NASA and an expectation,
34:23but everything is there for a reason.
34:26Absolutely. You know,
34:27it's it's the monitoring which has
34:29really made anaesthesia a safe practice.
34:32Let's talk about you know,
34:3350 years ago and we didn't have
34:36nearly the amount of monitoring that
34:38we have now and anesthesia really
34:39is a was a much unsafe for practice.
34:42Anesthesia is extremely safe these days.
34:44I mean we do you know millions of anesthetics
34:47and patients typically do very well.
34:49So actually if you bring really
34:51the the history of anesthesia,
34:53why don't we talk a little bit kind
34:55of the the history of anesthesia.
34:57I think that's really interesting of
34:59kind of how things have changed over,
35:01you know, decades of providing anesthesia,
35:04right. So actually it's not even decades,
35:06centuries and millennia people
35:08providing anesthesia for patients.
35:10So you know we have records back to
35:13the 4000 BC where people are using
35:16things like opium and and alcohol and
35:19different herbal supplements to to
35:22help patients who need medical work.
35:25Now I will say during that period it
35:27was pretty barbaric and and painful
35:30and you know they don't nearly,
35:31they didn't nearly have the technology or
35:33medical advancements that we have today.
35:35But the fact is patient need people
35:37needed help from physicians and sometimes
35:40those were painful and but but there
35:42was sort of the practice of anesthesia
35:44for for millennia at this point.
35:46Now it isn't probably till the mid
35:491800s where we can think of the birth
35:52of modern anesthesia and we could
35:55think of that essentially ether,
35:57the ether diethyl ether is a
36:00medication and essentially was used
36:02in the 1800s as a recreational drug.
36:05So there were what were known
36:06as ether parties.
36:07People would get together and
36:09use ether and have a, you know,
36:11have a good time.
36:12But what doctors were noticing
36:15was that patients,
36:16people were hurting themselves
36:17and not noticing it.
36:19So they weren't experiencing any pain
36:20and then they wouldn't notice that they
36:22had an injury until the following day.
36:24So that's really when physicians starts
36:27thinking maybe we can use this for a
36:30surgical procedures where they're only
36:32using alcohol or you know, you know,
36:34hold a piece of wood really tight.
36:37You know,
36:38maybe we can use this to
36:39our advantage and one,
36:40make people more comfortable, but two,
36:42do cervical procedures that had
36:44never been performed before before.
36:46Now ether is not used anymore,
36:49but derivatives of ether are used every day.
36:53We use medications like suvofluorine,
36:55desfluorine, ISO,
36:56fluorine,
36:56and they're all derivatives of ether,
36:59diethyl ether,
37:00and those are medications that
37:01keep people asleep.
37:03So that's really more for the gentle
37:05anesthesia type of treatment,
37:06right? Absolutely.
37:07Now around this time period.
37:10Additionally, cocaine was being
37:13used for medical procedures.
37:15So essentially what happened was it
37:17landed on the tongue of a physician and
37:20they realized their tongue went numb.
37:21So the thought was how can we use this
37:24to numb different parts of the body?
37:26Now we typically don't use cocaine anymore.
37:29Sometimes it is used for high
37:32procedures and things like that.
37:33But for obvious reasons we use medications
37:35that are very similar to cocaine.
37:37So we use lidocaine, bupivacaine,
37:39ropivacaine, Med pivacaine.
37:41These are all local anesthetics which
37:43function in a very similar way to that.
37:46Propofol works in the brain,
37:47but they only work on certain ports of
37:49either your central nervous system,
37:51your spinal cord or your
37:52peripheral nervous system.
37:53Let's say the nerves will
37:55go down to your leg.
37:56The way that those function is
37:58they work on these proteins,
37:59so they bind to proteins on nerves and they
38:02form an electrical electrical blockade.
38:04So no longer can that electrical
38:07system pass through rendering
38:09you not able to feel sensation,
38:11pain or move that part of your body.
38:14So like we've talked about that's
38:16extremely useful for us, for example,
38:18joint procedures like yourself,
38:19a total neuarthroplasty.
38:21We're using a combination of
38:23regional aesthetic techniques.
38:25We're using typically a spinal anesthetic.
38:28We're inject numbing medicine
38:30into the spinal canal,
38:32into the CSF or fluid that surrounds
38:34your nerves and that forms that
38:36blockade allowing you to you do
38:38your surgery potentially without
38:39a full genital anesthetic.
38:41Patients feel a lot better afterwards.
38:43They don't have as much pain afterwards.
38:45They're typically able to do
38:46rehab a lot quicker,
38:47which is important for for
38:49you and the recovery process.
38:51So we do that part of regional anesthesia.
38:53We also do peripheral nerve blocks
38:55typically for a knee procedure we'll
38:57do the one or two nerve blocks for
38:59your knee helps with pain afterwards.
39:02That lasts typically anywhere from
39:04about 24 hours, maybe up to a few days.
39:08Now important to know specifically from
39:10those two the variation between the
39:13spinal anesthetic and the peripheral
39:15neuroblock for a knee operation.
39:17Now for a spinal anesthetic,
39:18typically you are completely numb.
39:20It's if your legs are not there
39:21and it can be a sort of a jarring
39:23sensation for patients when they
39:24wake up from in the recovery room.
39:26And we do warn that for patients
39:28afterwards they will be numb,
39:29they won't be able to feel it does come back.
39:31That comes back after about 3-4
39:33hours depending on medication.
39:35Now for peripheral nerve blocks,
39:37you may not have full pain relief.
39:40And the reason for that is we don't
39:41want to block those motor nerves
39:43that go to that part of your body.
39:45So you want a patient walking as
39:47soon as possible possible after your
39:50knee arthroplasty, hip arthroplasty.
39:52If we block those, no motor nerves,
39:54they're not able to walk properly,
39:56they're not able to move,
39:57regain motion of that joint.
39:59So we try to block that sensation which may
40:02not get full pain control, but it helps. Or
40:05anything helps that, you know,
40:06you have to take less narcotics or
40:08narcotics that have pros and cons to it.
40:10Obviously they can make you all so dizzy,
40:13constipated, you know,
40:14having more difficulty kind
40:16of with nausea and vomiting.
40:19So anything that's regional,
40:20which you really been implement,
40:22you know implementing this for quite
40:24a long time and really instrumental
40:25in helping drive this even through the
40:28Bridgeport hospital system to to kind
40:30of get patients use less narcotics,
40:31they are more awake,
40:33more comfortable and able to mobilize
40:35very quickly after big procedures
40:37like like knee replacements and
40:39hip replacements for instance.
40:40So what I actually want to do is I
40:42want to take a short break and I
40:44want to dive a little bit into the
40:45anesthesia team and then we'll go even
40:47specifics on the type of anesthesia again,
40:49talk about spinal epidurals for instance,
40:52and some of the sort of side effects, risks,
40:55benefits of these type of procedures.
40:58You're watching your health care.
40:59I'm Doctor Amit Lahav here
41:01with doctor Brian Kerner.
41:02We'll be right back.
41:43Welcome back to your healthcare.
41:46I'm doctor Amit Lahab here
41:48with Doctor Brian Kerner.
41:50Anesthesia and we talked a lot about
41:53the the history of anesthesia gel,
41:55anesthesia, some of the different
41:57medications that are used for the
41:59state of anesthesia, analgesia,
42:00pain relief and so forth.
42:03And Doctor Koerner,
42:03again thank you very much for being
42:06with us really and lighting us a
42:07lot about the field of anesthesia.
42:09Let's just briefly talk about
42:11the anesthesia team,
42:12because it's not just you,
42:13it's sort of a team approach and we'll
42:15go to some specifics in anesthesia
42:17and some of the risks involved
42:18with different type of procedures.
42:20Absolutely. It's a great topic to talk
42:22about because one of the most common
42:25questions that I get asked when I speak
42:27to a patient before surgery is will you
42:29be there the entire time And it depends.
42:31So there are different practice
42:33types within the United States.
42:35Some of them are physician only.
42:37So if you have a physician
42:39only anesthesia practice,
42:40it means you will have a
42:41physician with you in that room.
42:42The entire case,
42:43the majority of places within the country
42:45are not that they're A-Team model,
42:47which is very good as well.
42:49I work very,
42:50that's the model that I practice in.
42:52It means that we work with the physician and
42:56a CRNA or a a certified registered nurse,
42:59anesthetist or anesthesiology assistant.
43:02Now those other fields have gained
43:05extra training in anesthesia.
43:07So they're experts in the field
43:09of anesthesia just going by that
43:11a different path whether through
43:12nursing or or or otherwise.
43:14So typically I will be it's
43:18called medical supervision.
43:19So I will essentially be in charge
43:22of the anesthetics of up to four
43:24patients at a time and there's
43:25someone else in that room,
43:27a highly qualified individual
43:28making sure to monitor the patient.
43:31But really there's always someone
43:32with the patient no matter what. Oh,
43:34absolutely. Like I said, one of the
43:36standards of care for anesthesia you
43:38so you have a qualified individual
43:40there for the entire procedure.
43:42So it's it's safety is always priority
43:44and that's why somebody S always
43:46watching the patient, no question.
43:47The anesthesia perspective,
43:48absolutely. I mean I I work very
43:50closely with my team colleagues
43:52and I would trust myself or my
43:54family member with one as well.
43:55They're they're fantastic. You like
43:57the commander in chief and you have
43:59really excellent people working with you.
44:00Absolutely. It's a team absolutely
44:02that's even in the surgical field,
44:04you know you have physician assistant
44:06and nurse practitioners working with the
44:08surgeon to help facilitate the surgery
44:09and and you know can't do it alone,
44:11There's a team model,
44:12right. I I think it's important
44:14to distinguish that we are
44:15available at every point though.
44:17So one of the core standards is
44:19that if something were to happen,
44:21we're immediately available,
44:22sometimes within seconds we can
44:24be in that room. So absolutely
44:25and let's speak briefly also about about
44:27the safety of anesthesia and we'll
44:29kind of go maybe into some of the,
44:30you know, risks and benefits of
44:32different type of anesthesia.
44:32Absolutely great, great topic.
44:34What something we touched on a bit before
44:39is how anesthesia is so safe at this time.
44:42But 50 years ago it was
44:44quite a different ball game.
44:46Essentially at that point we were
44:48looking at a different monitor,
44:50so not the same monitors that we have now.
44:53And you'd have to check each of
44:54those every 5 minutes or so.
44:56So you you would look at the patient's chest,
44:59look like they were breathing,
45:00look at their skin,
45:01make sure they're not blue.
45:03You would now only take a blood pressure
45:05and that was your your anesthesia
45:06monitoring and every 5 minutes or
45:08so you would check those things.
45:09That's going back 50 years or so.
45:11It wasn't until about the 1970s,
45:13nineteen 80s where this.
45:15This push and safety started to
45:17come about and we had the invention
45:19of new monitors.
45:20One of them,
45:21absolutely crucial is the pulse oximeter.
45:24That's a device that we put on
45:26your finger prior to an anesthetic
45:28and it measures that level of
45:30oxygen in within your blood.
45:31Crucial now it's a standard of care
45:33that we monitor that continuously
45:35throughout the entire procedure.
45:37So instead of having to look at
45:38a patient's skin to make sure
45:40that they're not losing oxygen,
45:41I could,
45:41you know,
45:42I hear on the monitor at all times
45:45that that patient is oxygenating.
45:48We use blood pressure,
45:49cough every 5 minutes at a maximum,
45:51sometimes less than that,
45:53sometimes continuously.
45:55We also use what's called end title CO2.
45:59So we talked a bit about before
46:01the different gases that we
46:02exchange on a normal basis.
46:04One is oxygen and one is carbon dioxide.
46:07The best way you can see that we are
46:10adequately breathing for a patient
46:12is by measuring their carbon dioxide.
46:14We have new monitors now essentially there.
46:17It's pretty amazing how we're we
46:19can look at an EEG continuously
46:22during a surgery to see how deep
46:24or how anesthetized a patient is.
46:27Because studies show that if you are
46:29too deep or you have too much anesthesia,
46:32you may not do well afterwards either.
46:34So it may predispose to things like
46:36delirium and things like that.
46:38So now we have monitors like
46:39that that we can use.
46:40So it's the invention,
46:41the inclusion of these new modern
46:43monitoring systems which allowed anesthesia
46:45to be incredibly safe at this time.
46:48And you know also for the sake of
46:50time let's actually go through like
46:53an epidural versus spinal or you know
46:56regional 1/2 your body essentially that
46:58you're you're giving anesthesia to.
47:00So what's the difference between
47:02epidural and spinal for instance, sure.
47:05So it is medication going to a
47:08different location essentially.
47:09Now we can do a bolus or a
47:12single shot of medication.
47:14We can do a catheter,
47:15that catheter can go in either location,
47:17but it's really the location
47:19of that medication which has
47:20its have a different effect.
47:21Typically a spinal anesthetic
47:23is much a stronger effect.
47:25So it happens almost instantly,
47:26within a few seconds or in a few minutes,
47:29you're completely numb and
47:31it's very reliable.
47:32Epidural tends to take a little bit longer.
47:34The reason for that it's,
47:35it's outside that spinal fluid.
47:38So you have a layer of tissue
47:40called the dura matter.
47:41The epidural is outside that gera matter.
47:43The spinal is inside that dura so or
47:46the sub arachnoid space we call it.
47:48It's where all that fluid is.
47:49Now both can achieve the same effect,
47:53but typically spinal's a little bit
47:55more reliable and a lot stronger.
47:57Now we go ahead it it is in your lower back,
48:00this is really kind of where the,
48:01the needle goes in order to
48:03do an epidural or a spinal,
48:04correct. Now it can be low back as
48:06we can see from the model here or
48:09we can put epidurals higher up.
48:11Now the reason we can do an epidural
48:13higher up and not a spinal is
48:16because it's much safer to enter
48:18that spinal column at a lower level.
48:20Essentially your your spinal cord
48:22ends at a a, the high lumbar spine,
48:25so the mid back, lower mid back.
48:27And I sometimes explain this and I
48:30had a patient recently tell me and I
48:32I say that it's a bundle of nerves,
48:35your spinal cord and a point it ends
48:37and you just have strands of cords,
48:39split strands of nerves floating in liquid.
48:42And that's why it's safe to enter
48:44in that point,
48:45because instead of taking a chance
48:46of going into one of the nerves,
48:48they essentially get pushed away.
48:51We call that the Cordia Aquino
48:52or the horse's tail.
48:55And if you bought a kit here also
48:58just maybe show quickly what do
49:00you have there in the kit for
49:02sure. For us,
49:03we have a standard epidural kit here.
49:06I'm not sure if the camera can focus
49:08in and everything is pretty small here,
49:10but we have a catheter here
49:12technically in a pregnant patient,
49:15patient who is laboring and
49:16we want to have some form of
49:18analgesia or pain control,
49:20which many prefer to have.
49:22We would insert this catheter
49:24into the epidural space.
49:26We do that via certain needles
49:29which we have here in the kit.
49:31We use that with different syringes and
49:33we have a spinal needle here as well.
49:36That spinal needle essentially
49:38is what we take and we enter
49:40into the spinal column through
49:42the the spaces in your back.
49:44So again, these needles
49:45actually are also very thin,
49:47very small because you don't need a big
49:49hole to actually give these medications.
49:51You just need a small entrance
49:52and just to get and you don't even
49:55have to give much of anything.
49:56You give a few CCS and you're
49:58or a few millimeter milliliters
50:00actually and that's all you need.
50:02And then you're numb for the waist down,
50:04right. Our our goal is to use the
50:06smallest needle as possible and
50:07typically the IV that you receive in
50:10the intravenous line that you receive in
50:12the pre op area that's typically bigger,
50:14almost always bigger than the needle
50:15that we would use in your back.
50:16So we want to use a small needle.
50:18The reason for that is you can
50:20have less complications,
50:20so you can have less chances
50:23of getting a headache,
50:23maybe less chances of bleeding,
50:25things like that.
50:26So yes we use the smallest needle possible.
50:28So how do you prepare for anaesthesia?
50:30You know what, what should we tell patients,
50:33you know, to prepare for general versus
50:35spinal versus just having a procedure done?
50:38Sure. I I think the most important thing
50:40is that you have a good relationship
50:42with the primary care doctor.
50:43That primary contractor who knows
50:45you over a long period of time
50:48could essentially manage your your,
50:50your medical problems and then if needed
50:52sends you to different specialists.
50:54So make sure that everything is
50:56what we would call optimized.
50:58So we want a patient in the best condition
51:01possible going into that procedure.
51:03Things such as losing weight,
51:04things such as stopping smoking,
51:07getting diabetes under control,
51:09things like that,
51:10they can really make a difference
51:13for a patient undergoing surgery.
51:16And in diabetes, there are certain,
51:18no, you know, this is something new
51:19that actually came up, some of these,
51:21some of these diabetic medications
51:23actually have to be stopped before
51:25the procedure and some have to be
51:27stopped even a week before the
51:29procedure for certain reasons.
51:30You know why,
51:32right. So I think you're referencing
51:33Ozempic and that's probably in every,
51:35you know, not only health magazine
51:37but also lifestyle magazine
51:38within the country at this point.
51:40So, you know, it's being spoken about it.
51:42It's being used more and more frequently now.
51:44And the reason for that is while
51:46this medication was used for a long
51:48time for diabetes, like you said,
51:49there's also a new indication
51:51and maybe new indications coming.
51:54It's now being used as a weight
51:55loss medication for people who
51:57don't have diabetes.
51:58There was a trial recently,
52:00almost 20,000 patients and people were
52:03using Ozempic for three years and they
52:05were having a 10% weight loss during
52:08that period and they were having a
52:1020% decrease in cardiovascular event.
52:12So we're going to see more and
52:14more patients on this medication.
52:16Now the way it works is in
52:19multiple different ways,
52:20but one it increases the insulin in
52:22your body so it breaks things down,
52:23hence weight loss.
52:24You think less about food,
52:26but important for anesthesia is it
52:28induces what's known as a gastroparesis,
52:31the slong of the digestive tract.
52:34What that what that means is
52:36typically you're told to not eat
52:38or drink anything for a period
52:39of time before an anesthetic.
52:41The reason for that is we want all
52:43that food that you've been eating
52:45to pass through to a safe point.
52:47One of the most serious complications
52:50that can happen during anesthetic,
52:52it's called aspiration.
52:53Essentially what that is,
52:55is contacts from your stunning
52:57stomach going up and then going
52:58down the wrong pipe into your lungs.
53:00That can cause pneumonia and really
53:03serious health complications for a patient.
53:05So when patients are taking Ozempic,
53:08they have this medically
53:10induced gastroparesis.
53:11So slowly the digestive tract and
53:13they're more likely to have food
53:15in their stomach when if they
53:17weren't on that medication they
53:18wouldn't that wouldn't be there.
53:20So the recommendations are right now
53:22if you're on a once weekly medication
53:24that you only that you missed the dose
53:27prior so you don't take it within
53:29a week of anesthesia and that's the
53:31decrease that risk of aspiration.
53:33And let's speak in the last few minutes
53:35even though we have some of the, you know,
53:37the risks that we try to to decrease,
53:39you know, things like people say
53:41you don't nausea or vomiting,
53:42headaches, things like that. Sure.
53:45Nausea is one of the things that people
53:47really do not like to experience
53:49after anesthesia and it's somewhat of
53:50a common complication that we have.
53:52You know they they've done studies
53:54where they essentially ask people
53:56would you rather be in pain or
53:58nauseous after surgery and almost
53:59everybody says I'd rather be in pain.
54:02Yeah, the combination of the two is horrible.
54:05So you know we have protocols our
54:07our institution there are what
54:09we know as guidelines,
54:10so recommendations that we give multiple
54:13different anti nausea medications
54:15to try to decrease the chance that
54:18a patient will be nauseous for
54:19anesthesia. And again nausea also is
54:21is you know the the higher level of
54:23anesthesia you get like general anesthesia
54:25carries a little bit more of that
54:26risk than a regional anesthesia like
54:28a spinal or nerve blocks or regional
54:31absolutely great point.
54:32So if we utilize that
54:34that regional anesthesia,
54:35often we don't have to use that same
54:37level of general anesthesia or same
54:39medications and people are less
54:41likely to be nauseous afterwards.
54:43So that's again one of the reasons
54:44that you know we try to kind of sort
54:46of minimize some of the anesthesia.
54:48You're getting it going more towards
54:49blocks or regional anesthesia which
54:51is really even an orthopaedic spin
54:52sort of the trend and it works better.
54:54And this is really where your
54:56expertise come in handy.
54:57This is what you do in order to get
54:59the patient safely through there and
55:01more comfortably through it as well.
55:03You know even things like like like
55:04headache and a lot of people say you
55:06know am I going to be in pain or
55:07how much pain am I going to have?
55:09And this is really where again
55:11your expertise come in handy.
55:12The blocks that you give that that
55:14regional or aerial anesthesia that
55:16you provide the patients makes a big
55:19difference on mobilizing the patient,
55:21make him feel more comfortable
55:23that way and then less use of again
55:26narcotics and other medications that
55:28can cause some some side effects.
55:30Is there anything else would you
55:31say the patient you know how do
55:33you prepare for anesthesia?
55:33We spoke about optimization with your
55:36primary care, your medical comorbidities,
55:37make sure your blood pressure is good,
55:39estrogenation, whatever you can do.
55:41Your diabetes is well controlled
55:42to decrease some of those risks.
55:45Anything else you would add to the
55:47patient to maybe to relax, you know,
55:48you're in good hands, so to speak.
55:50Absolutely.
55:5111, I would say is stop smoking.
55:54Having surgery is a great opportunity
55:55to sort of counsel patients and there
55:57are higher risks for patients who
55:59smoke during the preoperative period.
56:00So if you're able to,
56:01it's a good time to stop.
56:02We know it's hard.
56:03We know everybody's not going to do that,
56:05but it's a great opportunity to try that.
56:07Now as far as relaxing,
56:10take it easy night before,
56:11watch a movie, try to get some sleep.
56:13If you don't,
56:14we'll get you a nice nap we say.
56:17And really anesthesia is an
56:19incredibly safe thing these days.
56:20I mean people do incredibly well.
56:23So
56:23well in the last,
56:25you know couple minutes here again
56:27I want to thank doctor Brian Kerner
56:29really Director of Regional anesthesia,
56:31Bridgeport Hospitals,
56:32Associate Professor at Yale School
56:35of Medicine Department of Anesthesia.
56:37Really it's been a privilege working
56:40alongside with him providing patients
56:42excellent care blocks, pain relief,
56:45safety, decreasing those risks,
56:47optimizing those benefits.
56:48So you can really undergo the procedure
56:51and focus on on really getting better.
56:53We spoke with some of the risks
56:54and benefits of anesthesia,
56:55different types of anesthesia.
56:57And really, how do you prepare for your
57:00anesthetic with the team of leading
57:03the team by the anesthesiologist.
57:06This is your healthcare.
57:08You've been watching the field of anesthesia.
57:11Again, thank you to doctor Brian
57:13Kerner for being here with us.
57:15As I always say,
57:16the more you know about your health,
57:17the better you are,
57:19but making the appropriate
57:20decision for yourself.
57:21I'm Doctor Mila Hav,
57:22and thank you for watching.