Having an operation could be safer! A discussion with my Anaesthetist.
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- Опубліковано 1 жов 2024
- Jim Roberts is an Anesthetist who works with me on Wednesdays. He is the lead doctor at the Royal National ENT Hospital in London and helps me with my OSA patients. He also teaches difficult airway techniques to fellowship doctors. We talk about the fact that many anaesthetists are using curved laryngoscopes when really in some cases these aren't adequate for patients with difficult airways (like in my patients!). Even video laryngoscopes are not ideal for these tasks. We talk (with any rehearsal :) about this problem, and consider the solutions.
This is a new type of content I want to try out. It is aimed at senior doctors but I hope I managed to make it accessible for the public as well.
The reason why I made this video is because if more people thought about airway care, we would have less risk during operations (particularly in patients with OSA). I hope this alters clinical practice in someone and therefore helps someone in a critical situation.
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** Disclaimer - The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional. **
Hello doctor, I myself a medical practitioner, age 27/M,I have Air flow restrictions probably due to Mallampati grade 2, structural abnormality and might be the reason I’ve moderate levels of Airflow restriction and have to make efforts for full inspiration. I’m a mouth breather sometimes unknowingly which I try to avoid. History of throat infections,tonsillitis and pneumonia is there. Through your videos I came to know about UARS related problems. And probably I’m facing almost all the related issues with having UARS.
I would like to know about specific treatment options for me as I’m planning for tonsillectomy to get done. Thanks 🙏
I have videos on tonsillectomy on my channel. I wish you the best.
Thanks to you and Jim for sharing your knowledge and ideas for what needs to change in the industry. I'm not in the medical field but I find the high level discussion extremely interesting. Now I can tell my friends and family that I know what a right-sided straight blade paramedian approach is!
Hahaha! I love sounding clever using snippets of information. Glad we could help.
Great video! Your clear and engaging explanation was fantastic. Both legends in their fields, this dynamic duo makes learning fun. More videos, please - they're a valuable resource for both patients and young doctors!
Fascinating. surely some of the answer is to train doctors in using the straight blade as well as the curved ones? Interesting to see what was happening while I was asleep. (Not ENT ops and as far as I know no difficulty with the equipment. I don't want to be awake when they are taking bits of my lung out, but it's really frustrating not knowing what is happening.... thanks for this.
Hi Jim, and Vik. I enjoyed this. Brought back happy memories of when Jim was one of our stellar trainees at the Whitt! Dr P.
Jim says he has fond memories of his time there and asked me to pass on his regards to you and the rest of the team there who might still remember him. The whitt was my first job as a PRHO with Mr Ron Miller. It looks all fancy now with the new extension. Thank you for writing in.
I thought you seemed familiar. I have just found your Anaesthetic attachment report from 1998! @@VikVeerENTSurgeon
What do I do if I’ve always had local anaesthetic to have y teeth out? I have some teeth that do need removing but I can’t suffer being awake. Any ideas please? I’ve sleep apnea also.
You might need them taken out in hospital. a bit overkill but at least the anaesthesia will be safer.
Just an average paramedic from the US here. Back in the days of reusable laryngoscope blades with non LED lights we had multiple geometry straight blades available to us other than a Miller blade. My favorites were a 3short Wisconsin and for big floppy epiglottis I liked a Gudel blade.
Intriguing. Thank you so much Vik and Jim. I love listening to you discuss issues in theatre, anatomy and surgical instruments and devices
I've had the pleasure of being put under by Jim and worked on by Dr Veer.
Never have I ever felt so relaxed prior to having metal objects shoved down my throat even made me laugh whilst trying to put me under.
If you ever want to do a live demo of these aged tools then I'm happy to put my name forward.
UA-cam live session would be so interesting for viewers on YT, LinkedIn etc.
You guys keep being awesome 👍
So kind of you to write in. Much appreciated
Great video Dr Veer, loving the longer form videos
Thank for seeing me last week. Recovery is very painful and slow!
I hope you had chance to film my procedure for your channel
Thanks
Sorry about the pain, I did try and record it but my nurse wasn't able to suss out how to use the camera properly. I think I have footage of the tongue base, but I need to have a look at it.
I hope you recover swiftly. keep going!
Remember the days before car reversing cameras? All we had were skills, angles, landmarks and observations. Just like you spoke about, not being taught a skill or using that skill often enough, can limit solutions.
Mentoring, innovation and discussion will always be a good thing and never bad.
This topic sounds like a topic for a breakout session where issues/observations are raised, solutions are discussed/sourced and a presentation of results towards the end of a conference.
Like with alot of other professions, younger less 'experienced' individuals do not want to buck the norm or come across dumb.
I don't think this is an innovation issue. I think it's a culture issue.
By allowing questions to be asked (no matter how insignificant) means everyone has to go back, step by step, to source an answer.
UA-cam viewers such as myself, we generally have no skills in the topic watched (it's why we watch these videos). As such, we ask some questions that may seem trivial to others.
My question is:
Most of what was spoken about was regarding angle of entry.
How come a guide line via nasal entry is not used?
As in, feed past the vocal cords, then the guideline is hooked and pulled through the mouth to allow for a larger diameter tube to be inserted.
Cross contamination? Time restraints when put to sleep?
Thanks for the nice comments!
the nasal intubation is used, but a bougie (guidewire) into the nose will normally follow the back wall of the throat leading directly into the stomach rather than into the airway. also we would worry about how to grab the bougie from the mouth without traumatising the pharynx and often you can't see the back wall of the throat in these people. lastly if we accidentally let go of a guidewire it might end up stuck in the lungs. the tongue and the angle is the biggest problem, trying to get round that corner safely when all the tissues have collapsed in place.
one way is to put the tube in whilst someone is awake - but that can be traumatic for patients. there are actually loads of different ways, I just think we all need lots of tools in our tool box rather than relying on just one technique and think that it'll solve all problems. it is safer for patients to provide an airway that works for them. IMHO
@@VikVeerENTSurgeon Thank you so much for your reply and explanation 🙂. It is very much appreciated.
Hey Vik, very informative video from you + Jim!
I got my appointment through for turbinate reduction for the 23rd of Jan at 9:55. I thought I was going to get a call to ask what time slots they have. been trying to ring number on letter about that appointment but says number very busy + have emailed them but still not heard back to ask if there is a chance of a later appointment!
Also as you know I have tinnitus - but also that I do also hear my pulse in both ears(Pulsatile tinnitus) which is really annoying-and needs to be looked at asap.
Reply when you can cheers 👍🏻
You’re obsessing about intubation when it is oxygenation that is required to keep patients safe. I have done ENT lists for 25 years and have seen surgeon’s struggle and fail at getting a view. Positioning to aid bag and mask oxygenation which is the real life saver is the same position to use a macintosh blade , encouraging miller or straight blade use means positioning that isn’t ideal for oxygenation. Don’t make the ultimately basic mistake of confusing your priorities.
I think Dr Roberts was talking more about my patients (AHI >100, BMI >40, small chin, limited neck movement etc) who are often in a can't intubate, can't bag-valve-mask situation with a Mac grade 3/4. You are absolutely right though, oxygen is really important particularly beforehand when Dr Roberts pre-oxygenates and watches the end-tidal go up to about 80 before going ahead with one of these patients. Some of my anaesthetists sometimes use optiflow during the intubation to increase the window of safety during these difficult intubations. I have another video about the risks of surgery which touches on these points. thank you for commenting doctor.
@@VikVeerENTSurgeon hi Vik thanks for the reply. I use periinduction oxygenation for every patient using a buccal delivery route . And I work in a tertiary referral centre so my patients are equally tricky. If you pre oxygenate and use buccal oxygenation the key to avoiding a Cico scenario is a patent upper airway occurring as soon as possible. Getting a mac blade into the airway quickly immediately after induction is easier than with a straight blade. See paper pubmed.ncbi.nlm.nih.gov/31094782/