Drifting Off To Sleep

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MoMoGesiologist

MoMoGesiologist

What is dead may never die
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The more I do this job, I realize what an honor and privilege it is to take care of patients. As anesthesia, we are the last ones our patients see and hear before drifting off to sleep. Rarely, sometimes unexpectedly, they may have complications and never wake up. In light of knowing you may be the last person a patient sees/hears, what do you guys say to your patients as you induce to comfort them? What techniques do you use (aside from midaz) to make them feel less scared?

Hoping to learn from the masters so I can take better care of my patients!
 
Maybe I’m in the minority, but it peeves me when everybody (ie surgeon, OR nurses etc) yaps to the patient prior to induction. And I’m not a fan of the whole “pick out a nice beach on your favorite island blah blah blah.” I like to keep the talking to the minimum. I simply whisper in the patient’s ear “We’ll take really good care of you” prior to pushing propofol. What I don’t rush are the patient’s goodbyes with family and friends, because you never know if that will be the last time...
 
Lately I've started asking patients, especially the more nervous ones, what music they like or what music relaxes them the most, and I play it from Pandora on my phone via my Bluetooth speaker. They tend to close their eyes and seem very relaxed as we're placing monitors, inducing, etc.
 
Endee said:
Lately I've started asking patients, especially the more nervous ones, what music they like or what music relaxes them the most, and I play it from Pandora on my phone via my Bluetooth speaker. They tend to close their eyes and seem very relaxed as we're placing monitors, inducing, etc.
Click to expand...

The last thing they hear before falling asleep is a Pandora AD :hilarious:. Inception at its finest.
 
Here's a few of mine (some I may have stolen from others here over the years - credit where credit is due):

"Move over to this bed. If you feel the floor, you've gone too far"

"Wait till we're ready for you to move over, we don't want you falling off, it's too much paperwork"

"Feel both sides of the bed and get yourself centered. If you're not centered, try Hare Krishna."

"The BP cuff is going to squeeze every few minutes. It'll be really tight the first time, but won't squeeze you so tight once it gets to know you - like most women"

"This medicine might sting in the IV, but only little bitches complain about it"

"Just let me know when you're asleep so we can get started"
 
SaltyDog said:
Here's a few of mine (some I may have stolen from others here over the years - credit where credit is due):

"Move over to this bed. If you feel the floor, you've gone too far"

"Wait till we're ready for you to move over, we don't want you falling off, it's too much paperwork"

"Feel both sides of the bed and get yourself centered. If you're not centered, try Hare Krishna."

"The BP cuff is going to squeeze every few minutes. It'll be really tight the first time, but won't squeeze you so tight once it gets to know you - like most women"

"This medicine might sting in the IV, but only little bitches complain about it"

"Just let me know when you're asleep so we can get started"
Click to expand...

"Cuff might get a little tight while it gets to know you, but don't worry, it'll buy you dinner afterwards."
 
This is me when the patient tries to talk with the mask on:

giphy.gif
 
Right as I’m pushing the prop, I’ll usually look up at the circulator and say, “remind me, is it the left or right kidney that we’re taking out...?”
 
I started asking people to do simple math.
Count back from 100 by 7's.
What's the square root of 9?
What is Pi to 5 digits?

Not only does it usually elicit a bit of a chuckle, it seems to occupy their mind and keep it off any propofol burning.

Also, you know it was a great anesthetic when they pick up right where they left off as they are waking up.
 
DocVapor said:
I started asking people to do simple math.
Count back from 100 by 7's.
What's the square root of 9?
What is Pi to 5 digits?

Not only does it usually elicit a bit of a chuckle, it seems to occupy their mind and keep it off any propofol burning.

Also, you know it was a great anesthetic when they pick up right where they left off as they are waking up.
Click to expand...
What’s with the count back by 100 by 7s. I’ve heard this so many times. Even when I was going under when I was 10yo, that’s the last thing I remember.
 
I've been the last person to talk with someone before they eventually died - whether it's an emergent intubation or it's inducing before a peri-mortem surgery.

These experiences have haunted me. I want to be sure we do the right thing for everyone.

We have to be upbeat, confident, hopeful, and realistic - all at once.
 
kidthor said:
I've been the last person to talk with someone before they eventually died - whether it's an emergent intubation or it's inducing before a peri-mortem surgery.

These experiences have haunted me. I want to be sure we do the right thing for everyone.

We have to be upbeat, confident, hopeful, and realistic - all at once.
Click to expand...
So what do you tell the sick patients before they go to sleep, maybe for the last time?
 
kidthor said:
I've been the last person to talk with someone before they eventually died - whether it's an emergent intubation or it's inducing before a peri-mortem surgery.

These experiences have haunted me. I want to be sure we do the right thing for everyone.

We have to be upbeat, confident, hopeful, and realistic - all at once.
Click to expand...

Premonition, insight, experience, "Sixth Sense", I don't know exactly, but with the two alive patients I intubated immediately prior to death were the most memorable, detailed, compassionate conversations I've ever had as a physician.


It is haunting when you put yourself in the patient's socks. Even more haunting when you realize you're the only one who remembers that moment (assuming you're alone with the patient with no family parent).


"Like tears in the rain."
 
"Remember....don't go towards the light"

"You can look through the pearly gates...just don't walk through"

"Don't worry, your new implants will look great"

"Let me know when you're asleep"
 
Still awake?...oh don't wait for me...go on off to sleep and we'll see you when you're done.....
 
eikenhein said:
Anyone herer warn their patients about the discomfort before pushing the propofol?
Click to expand...
"the anaesthetic sometimes feels a little cold in the arm, that's normal, it just means it's about to work. Focus on your breathing, in and out, that's the way, we'll take good care of you." Done. I feel like a bit of a nob and a broken record, but they seem to like it.

Best one I've ever seen is the morbidly obese scrub team leader running into the room out of breath and screeching "STOP! STOP! IT'S NOT SAFE!!!! DR X YOU KNOW IT ISN'T SAFE!!! THE NOTES ARE IN THE ROOM!!! THIS IS HOW PATIENTS DIE!!! STOP STOP, IT'S NOT SAFEEEEEEE!!!!!! STOOOOOOOOOPPPPPPPPPP!!!!!!!!!!!" And then seeing the abject terror in the eyes of the patient as they've already been bolused with propofol. Turns out the scrub tech decided to report the entire theatre to her superior because the last patient's notes were apparently still in the room during time-out... Rather than mentioning her concerns during time-out...
 
woopedazz said:
"the anaesthetic sometimes feels a little cold in the arm, that's normal, it just means it's about to work. Focus on your breathing, in and out, that's the way, we'll take good care of you." Done. I feel like a bit of a nob and a broken record, but they seem to like it.

Best one I've ever seen is the morbidly obese scrub team leader running into the room out of breath and screeching "STOP! STOP! IT'S NOT SAFE!!!! DR X YOU KNOW IT ISN'T SAFE!!! THE NOTES ARE IN THE ROOM!!! THIS IS HOW PATIENTS DIE!!! STOP STOP, IT'S NOT SAFEEEEEEE!!!!!! STOOOOOOOOOPPPPPPPPPP!!!!!!!!!!!" And then seeing the abject terror in the eyes of the patient as they've already been bolused with propofol. Turns out the scrub tech decided to report the entire theatre to her superior because the last patient's notes were apparently still in the room during time-out... Rather than mentioning her concerns during time-out...
Click to expand...

That's so f'ed up. I hope the patient did not remember any of that
 
0kazak1 said:
I’ve would’ve been pissed, and not many things do that.
Click to expand...
With some of these clowns I wonder if escalation isn't the best way to get through to them. Maybe overhead page security to OR 25 for a disruptive caucasian male, approximately 5'6", wearing scrubs? Think it's a code white at my place. Maybe green. I always get that mixed up with the eloped patient and active shooter colors.

File an HR complaint for a disruptive co-worker? These weapons can't just be reserved for bitter spiteful nurses to use against doctors.
 
One of our old circulators had a couple good ones.

When we were about to roll back to the OR from Pre-Op, he would always look at the pt's significant other and ask
"Anything else on 'em you'd like fixed while we have them in the back?"

His other one (bear in mind he was prob 5'9" and pushing 300lbs
"We checked your insurance, and unfortunately all our attractive nurses are out-of-network - so, you get me."
 
I've been the last person to talk with someone before they eventually died - whether it's an emergent intubation or it's inducing before a peri-mortem surgery.

These experiences have haunted me. I want to be sure we do the right thing for everyone.

We have to be upbeat, confident, hopeful, and realistic - all at once.
Click to expand...
I hate putting people to sleep in the ICU world. I had a young patient that I had to intubate for respiratory failure with bleomycin induced toxicity. She told me she was scared before I did the RSI. I tried to reassure her but she ultimately never woke up and she was palliated two weeks later.
 
pgg said:
With some of these clowns I wonder if escalation isn't the best way to get through to them. Maybe overhead page security to OR 25 for a disruptive caucasian male, approximately 5'6", wearing scrubs? Think it's a code white at my place. Maybe green. I always get that mixed up with the eloped patient and active shooter colors.

File an HR complaint for a disruptive co-worker? These weapons can't just be reserved for bitter spiteful nurses to use against doctors.
Click to expand...
They got reamed. Honestly, haven't had an issue with them since.

leviathan said:
I hate putting people to sleep in the ICU world. I had a young patient that I had to intubate for respiratory failure with bleomycin induced toxicity. She told me she was scared before I did the RSI. I tried to reassure her but she ultimately never woke up and she was palliated two weeks later.
Click to expand...
That sucks. Adding oxygen to that dumpster fire of a toxicity must've been tough. I'm sure your reassurance went further than you realise to ease her troubled mind, and that's all you can really offer at that point.
 
Last edited:
kidthor said:
I've been the last person to talk with someone before they eventually died - whether it's an emergent intubation or it's inducing before a peri-mortem surgery.

These experiences have haunted me. I want to be sure we do the right thing for everyone.

We have to be upbeat, confident, hopeful, and realistic - all at once.
Click to expand...
I have a mental file cabinet full of peoples’ last words on this Earth.

My favorite was the guy who said “Alright everyone, I’m ready for my hysterectomy.”
 
For my elective day I couldn't really care what their final words they hear are. They're going to wake up, even those with horrific cancers etc. They'll have propofol dreams and loads of narcs or a block. They'll be fine.

The ones that really do haunt me are the ones you know won't make it.
 
Newtwo said:
For my elective day I couldn't really care what their final words they hear are. They're going to wake up, even those with horrific cancers etc. They'll have propofol dreams and loads of narcs or a block. They'll be fine.

The ones that really do haunt me are the ones you know won't make it.
Click to expand...
I thought that before but recently had a pt with unexpected surgical complication that made me think I can’t know 100% how someone’s course will go. Made me re-evaluate how I treat patients, even the ones I think will be in and out quickly. It was a very humbling experience.
 
leviathan said:
I hate putting people to sleep in the ICU world. I had a young patient that I had to intubate for respiratory failure with bleomycin induced toxicity. She told me she was scared before I did the RSI. I tried to reassure her but she ultimately never woke up and she was palliated two weeks later.
Click to expand...

Ruptured AAAs overnight are the worst. I still remember the two that died post-op in the ICU. Both were confused, except all they could definitively say was that they were cold before we started.
 
After emergence when male pt is stable and on their bed,
“congratulations, sir. You now have a beautiful baby boy.”

If 60+ year old lady in preop appears nervous I like to ask, “is there any chance you could be pregnant?” That usually gets them to laugh.
 
woopedazz said:
"the anaesthetic sometimes feels a little cold in the arm, that's normal, it just means it's about to work. Focus on your breathing, in and out, that's the way, we'll take good care of you." Done. I feel like a bit of a nob and a broken record, but they seem to like it.

Best one I've ever seen is the morbidly obese scrub team leader running into the room out of breath and screeching "STOP! STOP! IT'S NOT SAFE!!!! DR X YOU KNOW IT ISN'T SAFE!!! THE NOTES ARE IN THE ROOM!!! THIS IS HOW PATIENTS DIE!!! STOP STOP, IT'S NOT SAFEEEEEEE!!!!!! STOOOOOOOOOPPPPPPPPPP!!!!!!!!!!!" And then seeing the abject terror in the eyes of the patient as they've already been bolused with propofol. Turns out the scrub tech decided to report the entire theatre to her superior because the last patient's notes were apparently still in the room during time-out... Rather than mentioning her concerns during time-out...
Click to expand...
God damn, I hope they had already got a nice dose of midaz before that.
 
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