Intubation Before Anesthesia Takes Effect? (YouTube Video)

[URGettingSleepy]

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Hi all.

I'm by no means an expert when it comes to anesthesia, but I was browsing YouTube and came upon a general anesthesia induction video in which the anesthesiologist attempts to intubate a patient, clearly before the patient is asleep. Again, I'm by no means an expert, but am still curious as to whether this is common medical practice.

I've provided a link to the video below, and the part about which I'm curious is about 1:10 into the video.

http://www.youtube.com/watch?v=2RK77jZXhaQ

 

[Planktonmd]

The patient is obviously morbidly obese and the Anesthesiologist was probably trying to intubate her without abolishing her spontaneous breathing because he was concerned that he might have trouble intubating her.
It is not a very elegant way to do it but he was successful.
There are instances when an awake intubation could be indicated and there are ways to minimize patient's discomfort during that procedure.

Hi all.

I'm by no means an expert when it comes to anesthesia, but I was browsing YouTube and came upon a general anesthesia induction video in which the anesthesiologist attempts to intubate a patient, clearly before the patient is asleep. Again, I'm by no means an expert, but am still curious as to whether this is common medical practice.

I've provided a link to the video below, and the part about which I'm curious is about 1:10 into the video.

http://www.youtube.com/watch?v=2RK77jZXhaQ

 

[Spandex]

A DeVilbiss atomizer and 4% lido is your friend.

 

[Trisomy13]

We have an attending who will occasionally do this, and when the patient is adequately topicalized, it's not such a bad technique. It's not as elegant as an awake FOB, but it gets the job done.

 

[Fastrach]

"Getting the job done" can look pretty ugly sometimes. I could change a lightbulb with my feet, too, if I tried hard enough...

 

[Bertelman]

I'm more disappointed in how many times he had to turn around, draw up more drugs, etc. Have that shit ready, man!

 

[pgg]

2 years, 5 posts, no user status, 1 "is this how a colonscopy is supposed to go" post, and 2 YouTube videos with "did the anesthesiologist do this right" type questions ...

You're acting awful lawyerly, my friend.

 

[WholeLottaGame7]

2 years, 5 posts, no user status, 1 "is this how a colonscopy is supposed to go" post, and 2 YouTube videos with "did the anesthesiologist do this right" type questions ...

You're acting awful lawyerly, my friend.

Same thought crossed my mind

 

[i want out]

Hi all.

I'm by no means an expert when it comes to anesthesia, but I was browsing YouTube and came upon a general anesthesia induction video in which the anesthesiologist attempts to intubate a patient, clearly before the patient is asleep. Again, I'm by no means an expert, but am still curious as to whether this is common medical practice.

I've provided a link to the video below, and the part about which I'm curious is about 1:10 into the video.

http://www.youtube.com/watch?v=2RK77jZXhaQ

couple points, subtle as they may be.

pt obese, also noted mouth cancer in the caption.
probably doing an "awake look" to make sure he didn't kill her on induction.

probably a little uncomfortable for her if she remembers it at all, but less uncomfortable than having an obese airway combined with mouth cancer causing an airway collapse that makes a difficult airway into a killer airway.

 

[Voodoo]

Nothing wrong with this other than style points. I hope my inductions never even take 50% as long as this guy's.

 

[urge]

That was some cockamamy induction plan but it got the tube in... Goes to show whatever we do is not that hard.

Who thinks the guy was a CRNA? I do.

 

[Intensivist]

l think he is english, therefore, anaesthetist, MD.

 

[Paseo Del Norte]

l think he is english, therefore, anaesthetist, MD.

South African. The video came from a site hosted by a South African dentist. The patient was morbidly obese with HIV, who was going to have a biopsy of an oral/facial neoplasm. From what I gather, the dentist did the biopsy and recorded the anaesthesia provider. This was an anticipated difficult airway.

 

[chocomorsel]

I loved how he just grabbed her hand away from the facemask and pushed it away. I personally don't have a problem when patients grab their own masks. He could have at leask kindly told her not go grab the mask, but ehh, they are not exactly patient friendly in Africa from what I've heard from fellow Africans who've done rotations there.

 

[seattlegas]

I loved how he just grabbed her hand away from the facemask and pushed it away. I personally don't have a problem when patients grab their own masks. He could have at leask kindly told her not go grab the mask, but ehh, they are not exactly patient friendly in Africa from what I've heard from fellow Africans who've done rotations there.

In the country (not in africa) where I grew up is quite common for a dentis to slap a patient and use almost no anesthesia.

 

[chocomorsel]

OMG, thanks. I needed that laugh. Been up all night doing C-section after c-section.

I can just imagine that crap happening in an office, I'd laugh so hard that they'd have to send me out. It is however soo, soo wrong. I do however think that in this country, we do cater to the patients way too much. There's gotta be a nice middle ground so that patients can learn to take some friggin responsibility for themselves. We do need to be sterner with many if not most of them. I guess though we don't want to piss anybody off and have lawyers digging in our pockets.

 

[tucker27705]

I am in the OR watching this without the audio. Not sure what is going on, but it looks to me as though the pt is an anticipated difficult airway. The guy wants to take an awake look. Sedates with a little propofol. Has a look. Puts more lido on the blade for the second look after more sedation. Didn't watch to the end. Pt may not have liked it. But it looked safe.
I disagree that the guy doesn't have his stuff ready. He is intermittently waiting for the add'l prop to have time to circulate. He looks very calm and in control. Obviously there are other ways to do this. But this works and looks safe.
Tuck

 

[Bertelman]

I disagree that the guy doesn't have his stuff ready. He is intermittently waiting for the add'l prop to have time to circulate. He looks very calm and in control. Obviously there are other ways to do this. But this works and looks safe.
Tuck

Fair enough. I counted like 60 steps that he walked in a triangle from the head of the bed to the cart to the gas machine. Mid-induction he had to draw up more propofol. Mind you he hadn't even given 100 mg yet. I can guess it's going to take an amp of propofol, and then some, to tube that. That isn't a sign of preparedness in my mind.