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| Dr. Joel Aronowitz |
Dr. Joel Aronowitz: “Hi. I want to do a little explanation of anesthesia. Stephanie, where are you? No, no, don't leave.”
Stephanie: “No, no, I'm not.”
Dr. Joel Aronowitz: “No, I was going to say Debra.”
Stephanie: “She just left.”
Dr. Joel Aronowitz: “Stephanie is one of our nurse-in-ests at this, and don't tell anybody one of my favorites. I want to explain anesthesia. So we have anesthesiologists who are MDs. We have RN practitioners who are called certified registered nurse-in-ests, CRNA. And then we have sometimes an RN who monitors a patient during conscious sedation. But typically in an operating room setting like we're going to go into here in a second, we have either an MD or a CRNA who is trained specially and has experience at giving anesthesia. So let's go back and maybe you can explain the process to us. Let's sign it down with us. Your dress and your little anesthesia video here for everybody. So Stephanie, this is your workplace. Can you explain this, how you approach anesthesia?”
Stephanie: “Sure. You know, it starts with the patient interview in the pre-op area, and depending on the type of surgery, depending on different patient comorbidities, we determine an anesthetic plan. And anesthesia can be general, it can be sedation, it can be regional. But most of the time we're doing general anesthesia.”
Dr. Joel Aronowitz: “So what's the difference between general anesthesia and IV sedation?”
Stephanie: “So general anesthesia typically renders a patient unconscious where we take over their breathing for them either through an endotracheal tube or an LMA, and sedation... An LMA is a tube that just sits at the back of the throat so it doesn't go down the trachea. Right. And sedation is typically done by, most of the time, through IV sedation, and the patient is breathing on their own, through nasal cannula, and we're able to monitor their entire CO2. Through general anesthesia, we use the anesthesia machines there, and typically, unless you're doing a total IV anesthetic, we'll use inhalational anesthesia, mostly through sivoflurane and sometimes desflurane. There's also isoflurane, which we don't see in surgery centers. So the way that you give anesthetic agents is either through the vein, like propofol, where a little device like this pumps in the anesthetic agent at a particular rate, or this machine right here, which vaporizes a liquid anesthetic, in this case sivoflurane, and then that enters the circuit, controlled by these knobs. A certain amount enters the breathing circuit. This is connected to the breathing circuit that goes to the patient, and the anesthetist or anesthesiologist can deliver a particular amount of anesthetic through the gas that the patient is inhaling, and then the rest of all of this is basically to monitor the patient's body size, which the anesthetist has to do at all times.”
Dr. Joel Aronowitz: “And that's why surgeons, even though we give anesthetists our time, and anesthesiologists our worst time, we love you so much because that's what allows us to do everything that we do in a safe environment for our patients. Your anesthetist or anesthesiologist is very important, probably as important or even more important than your choice of surgeon. So that's a little bit about anesthesia. If you have any questions, please leave a comment below, and we'll do our best to answer them. If we don't know the answer, we'll just make up the answer. We'll find out for you.”
Stephanie: “So are there any anesthesiologists or anesthetists jokes sticking out?”
Dr. Joel Aronowitz: “I know a lot of jokes. I don't know the appropriate ones. Stay tuned. We'll do a doctor joke YouTube here in the near future. Anyway, glad you could join us, and we'll see you back in Aronowitzland sometime soon.”
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