Notes on Inducing General Anesthesia

Introduction

• Speaker: Max Feinstein, Anesthesiologist in NYC
• Purpose: Demonstrate the process of inducing general anesthesia for a hernia repair surgery.

Initial Patient Interaction

• Introduction to the patient (Mr. Patient)
• Check monitors:
  • Blood pressure cuff
  • EKG stickers
  • Pulse oximeter on the same arm as IV
• Begin to reassure the patient, acknowledging normal nervousness

Pre-Anesthesia Preparations

• Relaxing medication administered through IV
  • Takes about 10-15 seconds to take effect
• Oxygen provided for preoxygenation
  • Importance of deep breaths for effective oxygenation

Importance of Situational Awareness

• Acknowledgment of the importance of communication in the operating room
• Awareness of available equipment (defibrillator, bag-valve-mask)

Safety Protocols (MS MAIDS mnemonic)

1. M - Machine:
   • Set up ventilator settings and enter patient age/weight
2. S - Suction:
   • Verify working suction to remove any obstructions post-anesthesia
3. M - Monitors:
   • Confirm all monitors are attached and functioning
   • Check baseline readings and address irregularities
4. A - Airway:
   • Ensure airway equipment is functional (e.g., laryngoscope)
5. I - IV:
   • Verify that the IV is working properly
6. D - Drugs:
   • Double-check availability of necessary medications for induction

Patient Interaction

• Administer relaxing medication (midazolam)
• Monitor patient's heart rate and anxiety levels

Preoxygenation Process

• Administer 100% oxygen to replace nitrogen in the lungs
• Monitor patient's oxygen saturation levels

Induction of Anesthesia

• Administer opioids (fentanyl) to manage pain response
• Administer propofol for induction
  • Warn patient about possible warmth sensation
• Administer rocuronium (paralytic agent) after induction

Intubation Process

• Use laryngoscope to visualize vocal cords for intubation
• Insert endotracheal tube and inflate cuff
• Connect tube to ventilator for gas delivery

Post-Intubation Care

• Monitor vital signs and ensure adequate ventilation
• Use tape to secure endotracheal tube
• Start inhaled anesthetic (sevoflurane) for maintenance

Conclusion

• Importance of attention to detail and protocol adherence in anesthesiology
• Acknowledgment of the experience and learning process
• Encouragement to check out more content on the speaker’s channel

Additional Notes

• Communication with medical team during the procedure is critical
• Awareness of potential complications and patient comfort is essential
• Simulator used for teaching purposes, actual procedures may vary.