Im a second year nurse anesthesia student and I have loved being able to listen to how you explain videos in a concise and thorough manner. Please keep up with the videos and congratulations on graduating residency!
As someone who’s undergone nearly a dozen surgeries (yeah, I’m a mess) this was incredibly fascinating! My first one was in 1981 (cavernous hemangioma removal), when I was 7 ish - I got violently ill afterwards!! It was incredibly upsetting and scared me for a looong time. Just hearing about the titration levels of opioids made a world of sense to me! Loving your channel, and congratulations on completing your residency!!
I’m an Anesthesia Tech and these videos help me so much. Being able to understand things and anticipate physician’s needs is so valuable. Congrats on residency graduation doc!
I was a surgical tech 35 years ago and our surgeons told us that if a body responded to pain, the patient wasn't "deep" enough. Things have advanced quite a lot since then.
Yes, I saw that study! I wanted to present the studies that looked specifically at outcomes related to drug dosing and pain scores, so I didn’t include it in this video. But I think it’s great you did that work!
I thought you were going to put the sensor on and do a variety of painful things to show it working. What a missed opportunity 😂 Also congrats on graduating, love your videos
@@MaxFeinsteinMDDoctors used to experiment on themselves all the time. Ethically dubious, maybe, but imagine the views Barry Marshall could have got when he tried to give himself an ulcer if only CZcams had existed in 1984!
I am a circulator and often have to act as the DJ. Our operating rooms have really nice speaker systems. We are thinking about adding subwoofers to the OR tables. You nailed the surgeon/music types!
I had a pilonidal cyst removed twenty years ago. The anesthesiologist immobilized me when I was on my stomach. I could not move, yell or do anything to tell her that I was not fully under. I could feel the scalpel cut into me and the scraping of bone as the surgeon was trying to release the cyst. I felt everything. The awful part of it was listening to the surgeons bad jokes about his recent vacation to Hawaii. On top of that I had to pay the anesthesiologist out of my own pocket because the original doctor was a no show and the one I got wasn’t in my insurance plan. I wish they had that back then. Thanks for the video. Also, congratulations 🎉
Congratulations on becoming an anesthesiologist! Love your videos. The more surgery I have, the more interested I become in anesthesia. Very fascinating field.😊
Great video!! Congrats on on graduating!! You inspire me so much! 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! I have always wanted to be a anesthesiologist since it was a kid
I have awoken multiple times under general anesthesia and can say that you definitely feel pain. That has been a reason I have studied pain management as a nurse. A better way of checking pain levels when someone is unable to talk would be a godsend.
A corporation paying for a study of its product's effectiveness does invalidate the results actually. In engineering that's a big no-no and safety studies must always be impartial and independent. This device is pretty simple and it probably does help, but proper tests must be done first before it's widely adopted.
Thank you so much for making these videos! I find them extremely fascinating! Could you please make some videos on nerve blocks? I’ve had 6 surgeries on my left hand and one more in coming August and I got the nerve blocks with each and it’s a interesting procedure
It's basically a polygraph machine. They are pretty useless at detecting lies, but it sounds like they may have another purpose. (Causing yourself pain during a polygraph examine is a common trick to throw it off, so it makes sense that it would be useful for detecting pain.)
For the one surgery I have had in my life (jaw surgery in 2007) I can remember the anesthesiologist asked me something like did I feel the effect of the injection or getting sleepy. I said no, a few seconds later she asked me the same question and my answer was the same no! I fell no change at all. After that I woke up in recovery and I felt nothing between then and recovery that I can remember. I did need meds when the nurse came around to ask me how I felt in recovery. I said 5 out of 10.
Congrats on graduation. 🎉You sound more authoritative than in your previous videos. Seriously! It seems like your voice is at a slightly lower pitch and your delivery is a bit slower. Conscious or subconscious? 🤔
Congratulations on you graduating residency! Really interesting machine. I hope you find it does help you in a reliable way. Sounds like it could make things easier for you if so. Will you stay where you are now that you are an attending Dr, or would you like to venture out?
I know that there is a huge push to remove opiods from any type of pain management and that makes good sense. I had part of my colon removed on an inpatient procedure, I had no need for opiods after. They used a ton of great over the counter products, in a very structured way. However, I had surgery on my thumb, and it was probably only twilight sedation. The pain has never gone away!!!!
First off I would like to say I quite enjoy your videos and find them very educational and informative. Today I had excision of a rather large lipoma, 17 x 6 cm, from my upper mid back. My surgeon felt it was too large to do under a local so I was in a surgical center and had the usual cocktail of fentanyl, propofol, decadron, etc., and that sort of thing, so obviously I was fast asleep. However, the OR nurse commented that I was moving my legs enough (I was positioned on my right side so I did not have to be paralyzed and ventilated etc. had I been prone), that she had to hold my legs to keep me still. This makes me wonder if I was feeling pain. Just a rhetorical question but timely given the topic of this video. It is now roughly 10 hours post surgery and my pain is well controlled on Norco 5/325 in spite of having a 4 inch incision. I would not even call it pain, more like muscle soreness. I appreciate the anesthesiologists who do their utmost to keep the patients comfortable.❤
Well if the patient is having surgery under local anesthesia if the patient isn't screaming from horrible pain that would be a good indication that things are working. If the patient who's under local anesthesia is chatting with you about their vacation plans & how life is going that's another good indication that things are going smoothly. If the patient is talking with you that's also a good sign that they're alive.
I feel like risks with opioids in hospitals are overblown. Nausea? Anti enetics. Respiratory depression? Low dose naloxone. Compare to giving too much ketamine, cardiac arrest likely.
More double blind studies needed. An unbiased third party should investigate if these claims are true. If they are, it seems like it could greatly reduce the need for additional opioids being blindly administered during surgery/
Congratulations on completing your residency. Do you still have to take boards or did your finish those? What's your next move? Q: If you administer a paralytic, how does it impact the movement score? How does the device account for it?
** QUESTION ** Hey there Dr. Max! Have you ever come across any studies around patients with narcolepsy and general anesthesia? I have narcolepsy and I recently went under general anesthesia for surgery. Anesthesia worked well, however recovery was not typical. While other patients were up and ready for release after about 15 minutes. I was completely “wasted” for 5 HOURS after surgery. When I was finally able to stand and walk, I had to hold onto the walls to stop myself from falling over. What is interesting to me is that in contradiction of our outward symptoms, people with narcolepsy rarely get into deep sleep rhythm. My sleep study had me at 8 minutes of deep sleep over 105 minutes total. I should also note that in preparation, I took NO stimulants for one week prior to surgery. Any insights you can share ? I should also note, that I have red hair as well and typically require additional freezing during dental procedures. Thank you!
It is often the case that if the manufacturer of a device/drug/etc doesn't do the initial studies, no other (unaffiliated) researcher is necessarily going to conduct those studies. It doesn't mean the results are biased, and it doesn't mean it's unethical. It just needs to be declared and considered when interpreting results, along with any other potential sources of bias.
Wondering about using this device in a conscious sedation setting. I’ve had 10+ ESI (lumbar, TFESI, caudal, SI Joint). We are on a path for SI Joint ablation. The last procedure was a bilateral SI block to prove efficacy and get insurance authorization. The block was the only procedure (all done by same interventionist) where I have a memory of being in pain. Typically the fentanyl/versed cocktail puts me into a state where I’m not making memories or “feeling” pain. I spoke with the doctor and he said that I showed no signs of pain or made any sounds. He said that he would look at dosing to see if they had done anything different from previous injections. I’m already scheduled for the left side SI ablation and for the first time am a bit apprehensive about the possibility of pain. I’m not new to pain or surgery (two-level lumbar fusion Dec 2022). Thank you for your service.
Hi. This is so interesting! I’m curious as to how you tell if patient needs insulin during surgery. I had vascular surgery a few yrs back and had to have insulin twice during the 4.5 hr surgery. Is there a special monitor on the patient or do you have to prick patients finger to test it. Thanks in advance. 😊❤️🇨🇦
Hi Max! I have a question... I have Raynaud's phenomenon and i need to get surgery, but doctors always try to measure my oxygen saturation with an oxymeter and as i have really bad blood perfusion they never get good measurements... are there other options to measure blood oxygenation in surgery?
My first go-to option besides the fingers is the earlobe. And if that doesn’t work, the nostril. And if that doesn’t work, the nasal septum always works!
I’ve been under 3 times for knee scopes and my question is whenever I have woken up from anhessthia my pain is always really bad and also I’m always nauseous I told them for my third and I got double the Zofran and that worked but I woke up in way more pain than ever before from my latest surgery, is it normal to wake up in pain and just be crying from it and also when I ever get the pain medication in my iv it didn’t kick in for about 20-30 minutes is that all normal just curious because I might be getting my 4th surgery but hopefully more time and pt will avoid a 4th!!!!!!!!!!
Congratulations on graduating from residency!!! Your videos are some of the best anesthesiologist videos on CZcams and really informative.
Im a second year nurse anesthesia student and I have loved being able to listen to how you explain videos in a concise and thorough manner. Please keep up with the videos and congratulations on graduating residency!
Finally, a way to tell how much pain our anesthesiologists are in.
😂
Imagine drugging up a patient and then realize the system is hooked to your body.
As someone who’s undergone nearly a dozen surgeries (yeah, I’m a mess) this was incredibly fascinating! My first one was in 1981 (cavernous hemangioma removal), when I was 7 ish - I got violently ill afterwards!! It was incredibly upsetting and scared me for a looong time. Just hearing about the titration levels of opioids made a world of sense to me! Loving your channel, and congratulations on completing your residency!!
I’m an Anesthesia Tech and these videos help me so much. Being able to understand things and anticipate physician’s needs is so valuable. Congrats on residency graduation doc!
I was a surgical tech 35 years ago and our surgeons told us that if a body responded to pain, the patient wasn't "deep" enough. Things have advanced quite a lot since then.
Another old surgical tech and this is fascinating! I love your videos!
Congrats Max on graduation! We used the NOL index at our center for a research study as well!
Yes, I saw that study! I wanted to present the studies that looked specifically at outcomes related to drug dosing and pain scores, so I didn’t include it in this video. But I think it’s great you did that work!
I thought you were going to put the sensor on and do a variety of painful things to show it working. What a missed opportunity 😂
Also congrats on graduating, love your videos
I actually really wanted to do this, but I thought there might be some ethical concerns that would be best avoided lol
@@MaxFeinsteinMDyou could have at least pinched yourself. Just sitting there the numbers jumped from. 20-45.
@@MaxFeinsteinMDDoctors used to experiment on themselves all the time. Ethically dubious, maybe, but imagine the views Barry Marshall could have got when he tried to give himself an ulcer if only CZcams had existed in 1984!
@@MaxFeinsteinMD fair enough! but i would have been satisfied by something minor that you can easily stop yourself, like pinching yourself lol.
Congratulations on graduating residency! I’m not a doctor or med student, but I enjoy learning about this stuff anyway. Keep up the great work!
Congratulations on finishing your residency! I'm 8 months into my Junior year in anaesthesiology residency.
Congratulations for graduating residency and thanks for always providing such informative videos I’ve learned so much from watching your videos
I am a circulator and often have to act as the DJ. Our operating rooms have really nice speaker systems. We are thinking about adding subwoofers to the OR tables. You nailed the surgeon/music types!
I had a pilonidal cyst removed twenty years ago. The anesthesiologist immobilized me when I was on my stomach. I could not move, yell or do anything to tell her that I was not fully under. I could feel the scalpel cut into me and the scraping of bone as the surgeon was trying to release the cyst. I felt everything. The awful part of it was listening to the surgeons bad jokes about his recent vacation to Hawaii. On top of that I had to pay the anesthesiologist out of my own pocket because the original doctor was a no show and the one I got wasn’t in my insurance plan. I wish they had that back then. Thanks for the video. Also, congratulations 🎉
Congratulations on becoming an anesthesiologist! Love your videos. The more surgery I have, the more interested I become in anesthesia. Very fascinating field.😊
Congratulations Dr Feinstein on completing your residency. Advice for the last 2 surgeries Ive had helped immensely. (Bubble gum flavor in o2 mask)
Congratulations on graduation! Thank you for educating and empowering us as patients.
CONGRATULATIONS FOR GRADUATING!!!!! I’m so proud of you max 🥳🎉
Great video!! Congrats on on graduating!! You inspire me so much! 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! I have always wanted to be a anesthesiologist since it was a kid
I love your patience in explaining info. on your videos. If I needed surgery again I wish I could have you for my anesthesiologist.
Congrats. And love ur videos. It reminds me of the bis we used to monitor awareness in the ‘90’s which came main stay and then discontinued
Congratulations Max!
I have awoken multiple times under general anesthesia and can say that you definitely feel pain. That has been a reason I have studied pain management as a nurse. A better way of checking pain levels when someone is unable to talk would be a godsend.
I've heard so many stories of this it's terrifying
Congratulations on graduating!!
Congratulations on graduation
Congratulations on your graduation Max! 🎉
Congratulations! Hope to follow your steps in the future as my journey kinda started with your videos, wish you all luck
Hey max, just wanted to say again that you're videos are amazing and thank you for letting me experience the OR at sinai!
A corporation paying for a study of its product's effectiveness does invalidate the results actually. In engineering that's a big no-no and safety studies must always be impartial and independent. This device is pretty simple and it probably does help, but proper tests must be done first before it's widely adopted.
Congratulations! Enjoy your videos and hope you have many successful years in practice and continue to educate us as well.
Congrats on graduation! 🎉
Thank you so much for making these videos! I find them extremely fascinating! Could you please make some videos on nerve blocks? I’ve had 6 surgeries on my left hand and one more in coming August and I got the nerve blocks with each and it’s a interesting procedure
Congratulations on your graduation!!
I’m having surgery soon. Your videos are very reassuring. Thank you 🙏🏼
Congratulations on graduating!
Congratulations on graduation!
Congratulations! 🎉
congrats on finishing residency!
Congrats graduating!!!
LETS GO MAX, SHEEEESH 🎉🎉🎉👏👏
CONGRATS! So happy for you! You sure have come a DARN long way! Where are you working now? Or are you going to do a fellowship?
Congrats on graduating! love your videos
Congrats on graduating!! Love Love the channel!
Congrats Max!
hope they let you make videos at your new place Dr. Feinstein
I’m actually going to continue making videos at Mount Sinai!
Grats on the raise!
Ahhh a whole Anesthesiologist now!!!! Feeling like a proud subscriber 💉💕
Congratulations on completing your residency!
Congratulations on completing your Residency, Dr. Feinstein!! Any word yet on your Fellowship - and will you continue to make videos? (Please!!)
Congrats Doc!
I used to read about this stuff in Alex striker books when I was a kid
Congratulations
Congrats! Enjoy your videos hope you keep them up.
Congratulations on finishing residency! Love your videos.
It's basically a polygraph machine. They are pretty useless at detecting lies, but it sounds like they may have another purpose. (Causing yourself pain during a polygraph examine is a common trick to throw it off, so it makes sense that it would be useful for detecting pain.)
Congratulations!!!
Congrats!!
For the one surgery I have had in my life (jaw surgery in 2007) I can remember the anesthesiologist asked me something like did I feel the effect of the injection or getting sleepy. I said no, a few seconds later she asked me the same question and my answer was the same no! I fell no change at all. After that I woke up in recovery and I felt nothing between then and recovery that I can remember. I did need meds when the nurse came around to ask me how I felt in recovery. I said 5 out of 10.
Congratulations on graduating residency!
When they took my Gall Blader by open Cut the Dr same as you placed a piece tape on my Head i think it was connected to a machine Great Video Max.
My worst post-op symptom was severe nausea for 2 days afterward!
Congratulations on graduating anesthesiology residency.
🎉🎉🎉 on Graduating!
Congrats on graduation. 🎉You sound more authoritative than in your previous videos. Seriously! It seems like your voice is at a slightly lower pitch and your delivery is a bit slower.
Conscious or subconscious? 🤔
Congratulations on you graduating residency! Really interesting machine. I hope you find it does help you in a reliable way. Sounds like it could make things easier for you if so. Will you stay where you are now that you are an attending Dr, or would you like to venture out?
I know that there is a huge push to remove opiods from any type of pain management and that makes good sense. I had part of my colon removed on an inpatient procedure, I had no need for opiods after. They used a ton of great over the counter products, in a very structured way. However, I had surgery on my thumb, and it was probably only twilight sedation. The pain has never gone away!!!!
I had open heart surgery only using Tylenol
First off I would like to say I quite enjoy your videos and find them very educational and informative. Today I had excision of a rather large lipoma, 17 x 6 cm, from my upper mid back. My surgeon felt it was too large to do under a local so I was in a surgical center and had the usual cocktail of fentanyl, propofol, decadron, etc., and that sort of thing, so obviously I was fast asleep. However, the OR nurse commented that I was moving my legs enough (I was positioned on my right side so I did not have to be paralyzed and ventilated etc. had I been prone), that she had to hold my legs to keep me still. This makes me wonder if I was feeling pain. Just a rhetorical question but timely given the topic of this video. It is now roughly 10 hours post surgery and my pain is well controlled on Norco 5/325 in spite of having a 4 inch incision. I would not even call it pain, more like muscle soreness. I appreciate the anesthesiologists who do their utmost to keep the patients comfortable.❤
Well if the patient is having surgery under local anesthesia if the patient isn't screaming from horrible pain that would be a good indication that things are working. If the patient who's under local anesthesia is chatting with you about their vacation plans & how life is going that's another good indication that things are going smoothly. If the patient is talking with you that's also a good sign that they're alive.
I feel like risks with opioids in hospitals are overblown. Nausea? Anti enetics. Respiratory depression? Low dose naloxone. Compare to giving too much ketamine, cardiac arrest likely.
More double blind studies needed. An unbiased third party should investigate if these claims are true. If they are, it seems like it could greatly reduce the need for additional opioids being blindly administered during surgery/
Congrats on no longer being a resident. It makes your intro a few words shorter lol
The device is FDA authorized - so the unbiased third party review has been completed
Congratulations on being graduated antesialogist
Mmm, interesting at how this works to interpret pain. This is a problem in search of a solution I have been thinking about for years!
Congratulations on your recent graduation from residency! 🥳
Congratulations on completing your residency. Do you still have to take boards or did your finish those? What's your next move?
Q: If you administer a paralytic, how does it impact the movement score? How does the device account for it?
So is it possible that we feel the full pain of surgery but forget about it very quickly?
Midazolam? Is the patient in pain the whole time and just doesn't remember?
Thanks!
Congrats on not having to say Anesthesia Resident!
your cap is looking damn good 😍
** QUESTION **
Hey there Dr. Max! Have you ever come across any studies around patients with narcolepsy and general anesthesia? I have narcolepsy and I recently went under general anesthesia for surgery. Anesthesia worked well, however recovery was not typical. While other patients were up and ready for release after about 15 minutes. I was completely “wasted” for 5 HOURS after surgery. When I was finally able to stand and walk, I had to hold onto the walls to stop myself from falling over. What is interesting to me is that in contradiction of our outward symptoms, people with narcolepsy rarely get into deep sleep rhythm. My sleep study had me at 8 minutes of deep sleep over 105 minutes total. I should also note that in preparation, I took NO stimulants for one week prior to surgery.
Any insights you can share ?
I should also note, that I have red hair as well and typically require additional freezing during dental procedures.
Thank you!
Congratulations! When do you take Boards? Written/oral/both? Or waiting until after fellowship and take only peds?
Thank you! Written boards in a couple weeks, oral boards next year, peds boards also next year.
So, how’s that PSLF application going? Like me, you probably filled it out in the past 24 hours.
Looks like this device shows that recording CZcams videos kinda hurts.
The person doing the research should have no affiliation with the company!!!
So would the results be bias????
Are there ethics boards???
It is often the case that if the manufacturer of a device/drug/etc doesn't do the initial studies, no other (unaffiliated) researcher is necessarily going to conduct those studies. It doesn't mean the results are biased, and it doesn't mean it's unethical. It just needs to be declared and considered when interpreting results, along with any other potential sources of bias.
Wondering about using this device in a conscious sedation setting. I’ve had 10+ ESI (lumbar, TFESI, caudal, SI Joint). We are on a path for SI Joint ablation. The last procedure was a bilateral SI block to prove efficacy and get insurance authorization. The block was the only procedure (all done by same interventionist) where I have a memory of being in pain. Typically the fentanyl/versed cocktail puts me into a state where I’m not making memories or “feeling” pain. I spoke with the doctor and he said that I showed no signs of pain or made any sounds. He said that he would look at dosing to see if they had done anything different from previous injections. I’m already scheduled for the left side SI ablation and for the first time am a bit apprehensive about the possibility of pain. I’m not new to pain or surgery (two-level lumbar fusion Dec 2022). Thank you for your service.
I have some herbals I want to use but theyre itchy, can I use anasthesie to ease the pain?
Hi. This is so interesting! I’m curious as to how you tell if patient needs insulin during surgery. I had vascular surgery a few yrs back and had to have insulin twice during the 4.5 hr surgery. Is there a special monitor on the patient or do you have to prick patients finger to test it. Thanks in advance. 😊❤️🇨🇦
Hi Max! I have a question... I have Raynaud's phenomenon and i need to get surgery, but doctors always try to measure my oxygen saturation with an oxymeter and as i have really bad blood perfusion they never get good measurements... are there other options to measure blood oxygenation in surgery?
My first go-to option besides the fingers is the earlobe. And if that doesn’t work, the nostril. And if that doesn’t work, the nasal septum always works!
How do you control pain on patients stabilized on suboxone and how do you treat post op pain
How would you deal with someone already on a large amount of opiates before surgery?
Dr. Max, why do anesthesiologists sit behind a drape?
Can this device also perform the functions of a pulse oximeter?
Not at this time
I have fibromyalgia. What would happen if i put this on? Unlimited power maybe?
Hey Doc, did you find a fellowship for after residency?
Love ❤️
The fact that that machine exists at all is kind of frightening.
Can I buy anasthesie for my personal use
I’ve been under 3 times for knee scopes and my question is whenever I have woken up from anhessthia my pain is always really bad and also I’m always nauseous I told them for my third and I got double the Zofran and that worked but I woke up in way more pain than ever before from my latest surgery, is it normal to wake up in pain and just be crying from it and also when I ever get the pain medication in my iv it didn’t kick in for about 20-30 minutes is that all normal just curious because I might be getting my 4th surgery but hopefully more time and pt will avoid a 4th!!!!!!!!!!
My dude got pain management so good that he didn't even notice his cranium had been removed, exposing his cerebrun. Smdh.
Edit: originally wrote cerebellum and ruined my joke. Seppuku is my only option.
hey you have to change your channel banner now that you're no longer a resident
31 gauge needles too thin to inject research oils they bend. I prefer 29 gauge needles.