I had an upper gastrointestinal endoscopy. I asked the anesthesiologist what was “on the menu today?” She answered Versed & Propofol. I answered “Oh…like Michael Jackson”. She replied, “Yes…but I’m giving you the correct amount”. 😂. I appreciated her humor and detailed approach. 😉

Max is no longer the Resident but the full blown Anesthesiologist. Congrats to you.

In January my anesthesiologist was awesome! On her 1st visit I told her I was very anxious - she fixed that with a bit of fentanl. We discussed my brachial nerve block. She gave me just a bit more fentanl, let me watch the nerve block administration on the ultrasound screen. She escorted me to surgery, helped me move onto the table and then wished me sweet dreams. The best anesthesia experience I've had.

this stuff fascinates me...I'm a retired firefighter/paramedic, and when I was going through ET training in the OR, I had the coolest anesthesiologist training me to do ET's... one of the patient 's I was intubating was another doctor he worked with. We had to ask his permission for me to intubate him...He had no problem with me doing it, because his colleague would be right there....boy, was I nervous.

Good video. In my first 3 surgeries (knee, prostate, hernia), Came out of anesthesia sicker than a dog and combative. I've shared that with my anesthesiologists in my later surgeries (knee and shoulder) and was told by them that they had "medicines" they could use that could prevent that. Fantastic! I came out of both of those surgeries feeling like I had the best sleep of my life, with no ill effects afterwards. The field of anesthesiology is complex, and fantastic and a good anesthesiologist can make it happen!

I trusted my anesthesiologist with his decisions because he’s the consummate professional.

I just had two procedures; Endoscopy and Colonoscopy five days ago. The anesthesiologist was very informative, attentive, and she made it a very relaxing experience; both her and the other three nurses. The last thing I remember was one nurse placing something in my mouth to keep it open and me staring at the monitors, when she said she was administering the drugs. When I woke up I was back in my room, all of the medical attachments removed and feeling fine as though nothing had happened, but tired and drowsy.

After 12 major surgeries from cancer, AK-47, car accidents I appreciate this video so I know what goes on each time.

“It’s just a KZfaq video” - that you even need to say it 🤦🏻‍♂️ This is a fantastic channel.

I'm in my late 70's. A couple of years ago I was brought into an operating theater where I was scheduled to have some sort of procedure on my stomach. In the theatre at the time was the very aimiable Surgeon and a very pleasant lady Anethsatist. We had an enjoyable conversation and they made me feel quite relaxed, (I was feeling very nervous just prior). During the conversation, the lady was pushing buttons etc. on a box next to me (about the size of a microwave oven). I asked her if that was her box of tricks to knock me out. She said it was, then said "In just a moment, you'll feel like you've had a lot to drink and may feel a little drunk." Within seconds I felt quite drunk. I was about to say, "Blimey you're not kidding". But I never got those words out! The next thing I was aware of was waking up in a room with a nice Nurse sitting next to my bed! That was my one and only experience in an Operating Theatre! Have you any idea, what would have made me feel drunk so quickly?

Funny story, I remember before a major surgery I was extremely nervous to the point of shaking uncontrollably as I was being wheeled into the OR. Was talking to the anesthesiologist and she says "ok we're giving you the midazolam now", next thing I know I'm super relaxed and screaming in the oxygen mask "lets do it!!"

Both times I had general anesthesia, I had no clue it was kicking in. I was talking to the doctors, then I was talking to the doctors, without any idea the procedures were already done.

Thank you for mentioning the importance of telling patients that they may loose consciousness after receiving the midazolam. I received midazolam while my stretcher was being pushed down the hallway to the anaesthetia room. I was told it was a med to just help me relax, so I did not expect it to put me asleep. My last memory pre op (before PLIF surgery) was slumping over to one side of the stretcher and slurring my speech. Not the quiet, relaxing induction i was expecting. But all went well, with great results for my back. Enjoy your videos.

It amazes me that you remember all of this. I find that when it comes time to talk to the anesthesiologist I’m typically rushed and I never get to ask what the anesthesia plan (I’ve only had outpatient procedures).

Your voice is very calming. Kind of an anesthetic in its own right.

I've been put under a number of times for procedures and surgeries and Valium that was used in the past was awesome. I'm surprised that it's not longer the mainstay drug that it was 20-30 years ago. Doctors made a giant mistake and did not pre-medicate me with a sedative prior to taking me back into the OR for an eye surgery when I was a small child, probably because I was so quiet. I was spooked when someone uncovered an instrument tray, and I jumped off the gurney and ran for the door. People went running after me and had to forcibly restrain me to the gurney while the drugs they put in through an inhalation mask took effect. So now I tell the anesthesiologist that they absolutely need to medicate me before I can see the OR. It helps everyone involved enjoy a peaceful, productive procedure.

So interesting! I’ve had over 20 surgeries and I don’t think I’ve ever been told exactly what I was given.

I was put under anaesthetic for a hernia op. When the Doc came to see me afterwards I asked him who was going to the Caribbean on holiday and he looked somewhat shocked. Apparently that discussion went on during the mesh being screwed into my abdominal wall. Heaven knows how that occurred because I never felt a thing.

Great video man, I learned a lot about the Anastasia cocktail, my eye muscle surgery is Thursday, it’s a eye muscle surgery to strengthen my right eye muscle it’s crossed because of my cerebral palsy, I’m a little nervous. 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, it takes a special person and skills to be a anesthesiologist or CRNA and you’re one of them! You rock man!!

Don’t forget this excitement during those long hours of residency! Congratulations

Truly enjoy the videos doc. Thanks for taking the time to make them.

Great video! You raised some very interesting questions at the end. As a patient, I want to know as much as I can to help relieve, "the fear of the unknown", and I am just naturally very inquisitive. I can totally understand how that may stress another person out, though. To your point, anesthesiologists should be sensitive to individual patient needs, and ask what those are. I have nothing but the utmost respect for the job you do! I have always had amazing anesthesiologists!

Great video as always Dr Feinstein. Your channel has become one of my favorites. you do a great job explaining everything. I've had 13 surgeries and I always told my Dr I wanted to know exactly what he was doing step by step and why he was doing it. For a few reasons. 1 it made me more comfortable 2 it just interesting stuff. I can tell from your videos that I would have been very comfortable with you doing my case. That's important for me to be comfortable with the Dr. You seem like a great Dr who cares about people

Thank you so much for acknowledging the paradoxical reaction. I get severely aggressive and black out for a long period of time. I feel so terrible coming out of it because I have done or said awful things.

Always enjoy your videos. I know what questions I need to ask my anesthesiologist about their plan for me.( they are surprised). I have had 7 ortho surgeries, my experiences ranged from so-so, to terrifying to excellent. I now ask and discuss my plan. Thank you, Dr. Max for empowering me.

Midazolam is amazing. All I remember is waiting for the elevator to go to surgery and the next thing I know I wake up in recovery. I asked the surgeon if I was conscious when I was wheeled in for surgery and he said I was fully alert and making jokes with everyone!

I like what you said about not wanting to surprise patients, My last procedure the last thing I remember is the staff telling the nurse "I just gave him something to help him relax". It would have been nice if I had been told before hand.

Thank you for making this interesting and informative video. I'm like reading the reports that the hospital give you after surgery, in them they give all the details, including what stuff they give you to make you "comfortable". It prolly wouldn't interest some folks, but I appreciate it.

I found your videos just over 2 years ago as someone who has some pretty big health anxiety (ahead of surgery, in this case) but also is interested in learning about all kinds of things and I have to say it makes me so happy to hear you say "Max Feinstein, anesthesiologist" and not resident! Congrats!

Ah the "milk of amnesia" I was a vet tech and we used quite a lot of that. I had general anesthesia at a small, very small hospital. My anesthesiologist said he was giving me something prior to surgery but then reached into his pocket and said "I forgot it". I expected him to get it or call a nurse but he said "don't worry about it, you don't really need it anyway". After waking up I had 4 day migraine and have suffered with both migraine and cluster headaches since. I don't know if it's related just food for thought. Changed my life though, pain is unbearable. Thanks for the video and my theory on the use of the word " cocktail " is probably a throwback from the days when cocktails were a lot more prevalent and everyone knew how the made you feeland were considered safe and acceptable putting a patient at ease.

I love the video, It would be really cool to see another day in the life video.

Midazolam has honestly changed my entire life view of GA. From the age of 8, I’ve just fallen apart in the anaesthesia room to the point my veins have all but reduced to nothing; when I was younger, I’ve fought off anaesthetists. After hearing how anxious and upset I get, one anaesthetist at the start of a series of planned surgeries put a plan in place for me to have IV midazolam on the ward and another dose in the anaesthesia room. I’ve been able to have proper conversations, not stress about my heart rate being up and even when we had to use a tiny vein in my hand and infuse the propofol extremely slowly, the burning etc didn’t phase me. I’m having my hip replaced in a fortnight and have already stressed how much I want this to be repeated to be as calm as possible.

Thanks for explaining this. I'm Canadian, and part of a great hospital system called UHN, or the University Health Network, in Toronto. Colonoscopies required. Recently the team changed the cocktail from Propofol (a very dirty high and nasty recovery) to Fentanyl, and honestly I was kind of shocked when I heard 'the F word' given its street reputation. Happy to say that it was a MUCH better experience than Propofol. Not quite 'fresh as a daisy', but waking up as if from a delicious sleep.

Hey Max, perfect timing! I'm getting set for my Anesthesiology residency starting April 1st here in the Philippines. Thanks a ton!! 🥹

How they invented half of these things and the ability it has to completely block the pain and memory of it all is absolutely mind blowing

I'm glad I didn't get anterograde amnesia the last surgery I had. The anesthesiologist was not much older than me and we were chatting while things were getting ready to start and we got on the topic of video games and we talked about Fallout for a few minutes. After that I knew I was in good hands and I cannot praise medical workers like him that try to make you feel comfortable enough!

I love to watch your videos. The stuff is so interesting. It's fascinating to me. Thanks for educating us

I always have talked to the Anesthesiologist before any surgery. I like to see all the people involved in the Operating Room & therefore I am most Calm by that alone. In my past I have purposely wanted to see everything but of course I will go under just before Intubation for General Anesthesia... 😎👍

What a reassuring person.

What an interesting and educational video. Thanks doctor.

Awesome information. Thank God for these awesome medicines

I am someone who has a paradoxical reaction where it makes me anxious! I also don’t get the amnesia. I had my first endoscopy in fifth grade and I remember the nurse giving me that med in a syringe to put in my mouth and she said that she bets I won’t even remember that conversation. Well im 32 years old (will be 33 in july) and still remember so clearly I DO remember! I most often get MAC sedation for the types of procedures I get (I’ve only had general once) and I know my cocktail and I have it on a sheet of paper I always bring a couple copies with to the surgery center. The anesthesiologists and CRNAS love my sheet. It doesn’t have the doses for most the meds but it has the names and such of what has worked well.

Great to see you Max!

Hello Max, I love your vids and want to let you know that you are amazing at what you do. I want to be a anesthesiologist when I grow up too!☺️

Really good information. I'm guessing if I tried to tell an anesthesiologist what I'd like to be given, they's just laugh at me and give me what they felt was best.

I perceive your accumulating experience and maturation. Looks good.

I like what you said about not surprising people with IV meds. When able, I always ask what the medication is and how much is being given. Typically I'll recognize the medication, and the reason for it will be contextually obvious (ie I'm complaining of pain and they want to administer, the reason is self evident), and recognize the dose as therapeutic. Anything I don't recognize, I want to implement I'm getting it, and if the explanation doesn't make sense, either I want education or I don't want the medication, although that's never happened. It unfortunate, but I sometimes feel providers don't want to discuss it, possibly to avoid a long conversation with a confused or medically naive patient, but it's not just good practice, it's really the only way to practice ethically and safely.

I was given Versed (Midazolam) prior to anesthesia from propofol. I had no memory loss up until my eyes shut. After that, zero idea.. But I do remember getting to inject (push the plunger) of the propofol after it was already twisted into the IV or whatever.. I also remember being concerned at watching the site grow from how thick it was and asking if I need to slow down - but nope, push push push.. My concern was I would damage or blow a vessel. I definitely didn't get the plunger all the way down before I woke up in the recovery room. Lots of people feel strongly that the anesthesiologist let me do that.. but I really don't see any issue with it. It was pre-measured by the doctor, set up and ready to go by staff, and all I did was push the plunger. Definitely pretty cool.

Hi Dr. Max, love your videos. Please make a video on morphine and its current use in anesthesia / pain management

Great information. So far the only procedure I have had that required anything was a colonoscopy. Usually I am up and ready to leave pretty quickly and feeling well rested. However, once they had a hard time waking me up. This was about 15 years ago though, so perhaps the anasthesia was different back then.

Thanks Doc, You explained alot.

I had midazolam before my basic surgery for anxiety it was wonderful defiantly helped with the anxiety. I have no visual memory's but can remember talking for a few minutes after including sliding onto the operating table I only made it halfway and was told by someone I didn't quite make it and to scoot over just a little bit more.

I had a hernia operation and the anaesthetist was showing off to his friend from another hospital. He promised me my best sleep ever. He succeeded.

Nice informative video. In the near future, I probably will be getting a cranial cervical thoracic fusion and this gives me an idea of how the anesthesia process will be like

So this is probably why I can remember that "fuzzy feeling" before going under, and sometimes I can't. Sometimes I don't get the fuzzy feeling at all, and start to panic that I won't fall asleep before the doctor begins! (I hate that, LOL!) So interesting, thank you!!

Great info doc- I think your point about the doctor NOT “ warning “ you that a certain medication is about to be given is an important one. After 14 spinal surgeries, rarely has that been done and not doing it just makes me more anxious….DOCTORS TALK TO YOUR PATIENTS!!

I specifically requested no Versed for one of my surgeries (I am comfortable in the OR and was not nervous). It was a very cool experience to remember what the OR environment was like. A few weeks later I needed a revision surgery (a bone fractured) and asked for the same thing. The anesthesiologist understood but said "it was a very strange request". A few minutes later the resident was about to put something into my IV when I said "wait... what is that?!" it turned out that it was, indeed, the Versed. I explained to him that I didn't want it. He had not injected it yet and took it out. I thought I was safe at this point, but as I was being wheeled into the OR I felt something go into my IV. I remember entering the OR and filming a quick video (which I have)... but sure enough... nothing after that 2 minutes or so and looked at my paperwork and they indeed, gave me that injection at the exact time the video is timestamped. I was so bothered by this... clearly I felt comfortable without it and maybe it is "different" but I think they just didn't want to follow the "waste" protocol or whatever, idk but there was no reason I should have been given it. Haha.

Great review! Thanks!

Excellent information!

I taught forensic drug analysis for many years. I always asked what i was getting so i could relate the effects i felt to my students.

Amazing presentation Dr

Thanks for this, I am about to have a growth removed from my kidney. Will be meeting the anesthetic team next week to work out a regime to accommodate complex needs as I also have heart failure

Going under for an esophageal dilation, about half of the propofol went in before the IV went sub-Q. What a great time had by me!....

Great video! Interestingly enough, I remember reading a study showing that midazolam can cause small amounts of retrograde amnesia!

In Nov. & Dec. just 16 days apart I had 2 surgeries and had general anesthesia both times. I had Versed, Propofol & Fentanyl plus a bunch of other meds. The first surgery was 20 mins In & Out, the second was 2 hrs., long. I always remember the second I go under, when I wake up. The Ortho came in to talk to me soon afterwards and the nurse said you probably won't remember that he was here, but, I did. I've had 15 surgeries and he's the first I ever remember seeing. I think I come out of sedation pretty quickly.

Excellent program just a question what kind of a sedation would you use for let's say conscious sedation for an ankle this location. I use fentanyl 25 mg with versed 2mg, to start, Some say ketofol but i think that combination may cause some errors

Great video. This video took out all the fears a I had about anesthesia. I have never have been unconscious. I don't even know what it feels like....being unconscious. You explained this very nicely and concisely what's it like being under. Thank you for sharing your thoughts and experience. Great job.

To me when getting anesthesia i ABSOLUTELY want to know when its being Administered... i had an Anesthesiologist not tell me before and it wasn't a pleasant experience. I tell every doctor multiple times i want to be kept in the loop. Thats my opinion at least.

Very informative MAX !!!!

I love your channel great explanation 😊

Very interesting and informative!

I had to have jaw surgery when I was 27 because I accidentally cracked the last molar in my mouth. It was a tooth that to be fair we had been monitoring for almost 20 years at that point. The oral surgeon suggested that I only get enough sedation to basically make me super relaxed but I would remain conscious. I absolutely insisted that they actually knock me out because I recognized that I would have a difficult time with the placement of the tooth. I also by that point knew that I could insist on IV insertion location and insisted on it being switched to the back of my hand versus my elbow because I knew that I would be far more relaxed. Two of the best decisions that I ever made for self-advocacy.

Amazing the faith we put in something that we don't really understand how it really works.

Two weeks ago, I underwent bilateral Radio Frequency Ablation on lower spine, L1-L4. My pain management doc is an anesthesiologist and I’ve had this procedure multiple times before. But this time, I got Versed, fentanyl and propofol! I woke up at home in my bed not remembering anything after I got on the procedure table. took two to three days before my brain returned to full function. Turns out he really got busy with a lot of nerves and it took over a week before the RF started working. He has amazing skills because this is the best my lower back has felt in several years.

I had propofol for my most recent colonoscopy and it was highly superior to the versed, morphine, Benadryl mix they’d used in the past. When I came around after the procedure there was no dizziness or nausea at all, just “oh hey! Done!” The state I live in requires an anesthesiologist for propofol, so I gather there was an extra charge, it was worth every penny!

Thank you! UK Theatres Pharmacist here. Please could you tell us about TIVA? Onset & offset? Many thanks.

After a previous terrible experience with a mask induction, the anesthesiologist for my knee replacement listened, believed & was generous with 2 doses of Versed - 1 when he did the nerve block & 1 as we rolled to OR. He then did spinal & Propofol. I will forever love that man

Thanks Max!

Anterograde amnesia from the midazolam hit me HARD when I had surgery. Have to say I'm a little bummed I don't recall any of the OR as I probably found it fascinating; last thing I remember was my surgical team wheeling me into the hallway, asking me if I was feeling the sedative yet, to which I replied, "Yeah, a bit." .... Next thing I knew I was waking up in a hospital bed 4 hours after the operation with the third movement of Shostakovich's Violin Concerto No. 1 stuck in my head. 😂 (Interestingly, I don't recall the recovery room at all either, save for some vague sensations and sounds. Couldn't tell you what it looked like or how long I was there before being transferred to my room.)

I have been very fortunate to have the anesthesiologists in the pain clinic really listen and medicate accordingly. Many times, if my pain is high, they hit me with a couple of doses of fentanyl. It really helps get my pain down and my heart rate and pressure better. Then I'll be listening or humming to the music in the room and bam! Propofol on board and next thing I remember is waking up after.

In Serbia offten as premadication anesthesia procedure a cocktail is given of Midazolam and atropin and/or fentanyl instade of atropin..... in my most recent anesthesia experiens over ten yaers ago, during the upper endoscopy procedure.... I was given just popofol, and in Repeated procedure a few years later a I was "premedicated" wtih some Midazolam or fentanyl.... The only difference that I felt was when just "propofoled" my eyes were burinig seconds before I Iost my conscience. And when I was premedecated burning sensation was not present.....

I have had several gut surgeries and will say without any doubt at all , that Midazolam is the first drug that I remember being placed within the IV in the prep area , Midazolam is the Mercy drug with the surgery as it calms and relaxes and generally placed me in a very still and easy state , yet and maybe because I am a medical Cannabis Patient , I never once got any memory loss after administration , as a matter of fact the memories are very clear (photographic) of entering the OR and looking around (I always want to see the Or room I will be in ) and none of the memories are scarry either . so the BRILLIENT Anesthetist got it super right every time for me . Most interesting to me is how clearly I can remember a good deal of the prep and also always wake up fast after and in good spirits . They just always got it right for me .

My best surgical experience involved “IV Margarita” The anesthesiologist called it that. It was fentanyl and midazolam. Not gonna lie, it was a great combo before being induced for major surgery

Happy purim, Max

When I recently had conscious vascular surgery, I was given Remifentanil, which I understand is even more potent and short acting than fentanyl - it wears off instantly when it stops being infused.

I recently had inner ear surgery and remember telling the OR staff that I was a bit apprehensive just before the surgery. The first medication the anesthesiologist gave me was midazolam and he told me that I would start to feel it within about a minute. What seemed like only about a couple minutes later I found myself in recovery. The only thing I remember in between was talking to a couple people about the surgery but I couldn’t tell if that was before the procedure or as I was being taken into recovery.

I just had a open heart surgery, 5 wks ago.(Full Root Aortic Replacement) I wish I had an anesthesiologist, or surgeon, who had spoken to me about some of these side effects, or expectations from such heavy sedation like this man. In the end, all is well. Just a traumatic experience made worse by way of lack of knowledge or expectation. (God bless the men and women in this profession.)

You need to come to 🇦🇺 Australia!!! We need such empathetic Drs like you ❤ love your channel 🙌

Your the best.

I’ve been putting off post weight loss skin removal surgery until after I build my house for funding purposes but I’m very curious to see how I’ll react to medications because as a result of having sensory processing disorder I have a very high pain tolerance and often over or under react to certain stimuli depending on how it effects my body so I know I’ll have to talk to my anesthesiologist about that when the time comes because that’s what my anxiety is the most afraid of, so thanks for this explanation, it definitely helped a lot!

Great content! Idea 💡 Could you do proposed anesthesia cocktails/treatment for surgery we see on TV shows like ER, House, etc. ? It would be so cool to see how a real anesthesiologist would handle such complex cases!!!

Hi, Dr. Max…I enjoy learning from your videos. I wanted to share an experience I had and ask if it’s a regular occurrence. I had a partial shoulder replacement about two years ago and they inserted a “pain ball” to help with the pain. Unfortunately, it caused problems with my breathing. From my own research, I found that the nerves affected by this device are precariously close to the nerve(s) that control one’s diaphragm and can cause breathing issues. I had to have my spouse remove it as it was quite distressing having difficulty breathing. The difficulty subsided immediately after removing it. (I called the number they gave me at the hospital first to make sure it was ok to remove it early.) Is this a common occurrence? If I am unfortunate and have to have a similar procedure done on my other shoulder, is there any effective alternative for pain management apart from this “pain ball” device? Thank you for making these videos!

Ive shot a few Hypnoval vials over the years. Great times. Hypnoval is a brand name of Midazolam, glass vials, 7ml(ish, can't really remember what size they were). Liquid Benzos, what a great feeling!!!

Thanks for your video doctor. In Australia an anaesthetist is a medical doctor that has then spent another four years in a speciality and become a fellow in that field. Seems in USA you may use a slightly different term anesthesiologist. Also once a specialist in some states doctors drop their Dr. title and become Mr. …. Interesting.

Post throat cancer treatment has had me having Endoscopy procedures 4-5 times a year for the pass 10 yrs. along with about another half dozen surgeries for other issues I have had more Anastasia than most. That said, I've never had any bad reactions. Some times the anesthesiologist will even indulge me when I ask if they will give me "the Slow Drip" they say oh you what to enjoy it! and I say exactly. I noticed if everything is ready in the OR and staff is standing by waiting for the doctor to finish up with his laptop notes, they'll let me enjoy the ride for about 2 minutes otherwise it's lights out in about 10 seconds :)

I was told I was receiving a " mixed cocktail " when I get a Stellate ganglion blocks. Can you tell me what goes into a Stellate ganglion block?

Could you also talk about how you can taste the medications given intravenously? I remember the nurse telling me I might taste the saline when she place my IV, but I didn’t. Then in the procedure room (upper endoscopy under general), I could totally taste whatever they gave in my IV (probably midazolam or propyphol). It was terrible tasting, whatever it was.

Thanks for the truth max!

These medicines are amazing had it 3 of my 4 times going under for all my knee surgery and I remember nothing after having it put in my iv and I’m grateful for it because I’m an extra nervous patient for surgery lol😂

I find that even if i do remember something from a procedure, it makes it feel like a dream rather than something i actually experienced.