Anesthesia Induction Demonstration by Dr. Max Feinstein

Introduction

• Speaker: Max Feinstein, Anesthesiologist in NYC
• Purpose of Video: To show the process of inducing general anesthesia for a hernia repair surgery.
• Acknowledgments: Thanks to Mount Sinai Hospital's Department of Anesthesiology and Dr. Mike Le.

Initial Patient Interaction

• Patient Check: Conducted a pre-anesthesia check with the patient.
• Monitors: Ensured patient had blood pressure cuff, EKG stickers, and pulse oximeter attached.
• Patient Comfort: Acknowledged patient's nervousness and provided reassurance.
• Relaxing Medication: Administered calming medication through IV (midazolam).

Pre-Procedure Steps

Situational Awareness

• Recognized available equipment in the operating room.
• Identified emergency resuscitative equipment (defibrillator, bag valve mask).

Ms Maids Mnemonic for Anesthesia Preparation

1. M - Machine
   • Set ventilator settings according to patient's age and weight.
2. S - Suction
   • Checked for working suction to clear the airway if necessary.
3. M - Monitors
   • Ensured monitors were functioning and readings were normal before induction.
   • Noted patient's heart rate and oxygen saturation.
4. A - Airway
   • Checked availability and functionality of airway equipment (e.g., laryngoscope, endotracheal tube).
5. I - IV
   • Confirmed IV patency and readiness for medication administration.
6. D - Drugs
   • Verified that all necessary medications for anesthesia induction were ready.

Induction of Anesthesia

• Preoxygenation: Administered 100% oxygen to fill patient's lungs, increasing safety margin.
• Medication Administration:
  • Administered fentanyl and propofol for induction.
  • Monitored for effects (e.g., heart rate changes, respiratory rate).
• Rocuronium: Administered as a paralytic agent after propofol.

Intubation Process

• Bag-Mask Ventilation: Ensured proper ventilation with 100% oxygen until intubation.
• Laryngoscopy: Used laryngoscope to visualize vocal cords for intubation.
• Intubation: Inserted endotracheal tube and inflated cuff to secure airway.
• Connection to Ventilator: Connected endotracheal tube to ventilator for gas delivery.

Monitoring During Procedure

• Continuously monitored vital signs and CO2 output during ventilation.
• Adjusted ventilator settings and ensured patient stability.

Conclusion

• Explained the importance of communication and situational awareness in anesthesia.
• Briefly mentioned further learning opportunities in anesthesiology.
• Encouraged viewers to check out related content on cardiac anesthesiology.