Dr. Alopi (Alopi Patel)

We just imported it, right?

So taking deep breaths in and out.

And I'm going to start giving you some medication in your vein.

And as I'm giving that IV, you're going to feel me rubbing on the other hand.

And that rubbing is going to make you feel better.

And slowly you'll start feeling warmer and warmer.

pretend you're putting your toes in the sand, sipping those margaritas, and soon you'll be off to sleep.

And it's a type of anesthesia you can't really put in an IV.

It's being able to comfort a patient and help them anticipate what to expect next.

Most recipes, you need the same ingredients if you're making something like banana muffins, right?

But the amount you're making depends on how many people you're making it for.

Do you want something more salty or sugary?

Whatever.

brain surgery, back surgery, heart surgery.

You would not be able to do any of these surgeries, abdominal surgeries, without having the patient completely asleep and paralyzed or their muscles relaxed for the procedure.

Hi, my name is Dr. Patel, and I'm the anesthesiologist.

Yes.

The traditional sort of history of anesthesia kind of starts around the mid-1800s.

So the most popular form of anesthesia that was studied at that time was chloroform.

So ether was another one and nitrous oxide.

They're all various sort of inhaled anesthetics that can knock out a patient.

And we're going to go into the operating room now.

The first successful demonstration of anesthesia was in 1846, and this was done by William Morton.

William Morton was actually a dentist who was experimenting with different types of anesthesia, and ether was the one that he successfully demonstrated.

The day that he successfully demonstrated anesthesia was October 16th, 1846, in the Ether Dome in Massachusetts General Hospital in Boston.

So the room might be a little cold.

And that is now called World Anesthesia Day.

There might be a few people here.

So Queen Victoria actually had many children.

For almost all of her children, she did not have any anesthesia.

There was stigma back in the day about women having pain relief during labor and delivery because it was expected for a

God's intention, right, for the pain to be insufferable, to be able to have a child.

And it wasn't until Queen Victoria herself asked to have chloroform for her eighth baby or something.

And she essentially legitimized it, that you can have childbirth with a pain-relieving substance.

And since then, we've come so far in obstetric anesthesia in terms of

spinal anesthetic, epidural anesthesia for pain relief.

So depending on the types of anesthetics, it can affect their heart rate.

It can affect their blood pressure.

It can affect different types of blood flow, right?

So when the blood pressure goes down, it can affect the blood flow to the brain, to the heart.

We care about all the organs, but really the brain and the heart are the two most important organs that we really think about because we don't want too little oxygen to be in the brain or the heart.

So once the anesthesia enters the system, it's essentially just going in the bloodstream, traveling all across the body, and then being metabolized.

It can be metabolized by the kidneys, the liver, and then inhaled anesthetics are metabolized through the lungs, and then you breathe them out.

So anesthesia in general creates this very relaxing effect, right?

So it creates a slowing down of your nervous system.

So you have your parasympathetic nervous system and your sympathetic nervous system.

Your sympathetic is your

Fight or flight, right?

So you're go, go, going.

Anesthesia essentially relaxes the body.

So it can help decrease the heart rate.

It can help decrease the blood pressure and create a relaxation in the brain as well.

So when you're awake, your brain waves are going fast, right?

So they're just kind of go, go, going at a higher speed.

Okay, so while you're sleeping, we're going to go on vacation.

Yeah.

So the waves are just going super fast.

And then when you get anesthesia, IV or inhaled anesthesia, the brain waves come down.

They're slower and they're more relaxed.

And it just kind of creates the zen sort of mode for the brain or like an airplane mode, right, where things are just kind of low energy and able to be relaxed.

And during that induced coma or controlled coma phase,

significant surgical incisions or surgical stimulus can be done without the brain and the body feeling it.

Where do you want to go?

Tahiti.

Kind of, yeah.

It doesn't cut off communication necessarily.

That would be something like a local anesthetic, right?

So a local anesthetic does cut off communication where it just doesn't allow that pain signaling to go through.

Ooh, I like Tahiti.

But an anesthetic like an IV anesthetic or an inhaled anesthetic just kind of relaxes it so you don't really have that stimulation as much.

And it creates this low energy mode, essentially that airplane mode where...

You just don't feel it as much.

So we're going to go to Tahiti.

If there's significant enough pain, you can definitely feel it, but you won't recall it.

And that's another important aspect of anesthesia, right?

So there's anesthesia, which is that not feeling sensation, analgesia, which is not feeling pain, muscle relaxation, and then memory loss, right?

We're going to go to Bora Bora in Tahiti and we're sitting on the beach.

So when you have anesthesia, your body is not feeling certain things.

When you have the pain medications, you're creating that pain-free state, right?

muscle relaxation, which is muscle relaxants, and then memory recall.

You're not going to recall anything either.

Yeah, most of the time you won't remember anything.

So we call that recall in anesthesia.

So if we do that recipe just right in the kitchen of the operating room, basically, if we do everything just right, most patients will not remember anything from their anesthetic.

How is anesthesia different from sleep?

So that's a great question.

Sleep has its own sort of neurochemistry and physiology, and there are REM waves associated with it.

You can have dreaming associated with sleep.

But anesthesia, you can sleep for five minutes and feel like you've got the most restful sleep.

But you didn't actually go into REM sleep.

It's more of like this state of unconsciousness and you might feel relaxed.

But it is different than true sleep.

You're not having the same brainwave changes and you're not necessarily having the same dreams that you would under natural sleep state.

Absolutely.

And it is such a privilege to be with patients at that time.

I think it is one of the most vulnerable times for most patients, right?

To feel like, okay, I am not going to have sensation or power or autonomy over my own body anymore.

And you're giving it to the hands of the anesthesiologist at that time.

And it's a powerful place to be in, but also a very important position to really be able to empower and identify the concerns that your patient has.

Absolutely.

I have one story that I can think of that really resonated with me about this is why I wanted to do anesthesiology and be an anesthesiologist.

We're sitting on the beach, putting our toes in the sand.

There's this very high risk patient that needs surgery ASAP for hematoma, which is a blood clot, but she also has a massive blood clot in her lungs.

So that's a very tricky situation to be in.

The patient was already very nervous and I was able to connect with the patient.

I said, hey, you have a blood clot.

We have a couple options.

I'm going to talk to the surgeon as soon as they get here and we're going to see how we can do this.

And I spoke to the patient the entire time.

We put on her favorite music.

It was Yanni.

I had never heard of him.

It was like a Greek musician.

I know Yanni.

And do you want a margarita, a mojito?

And it was my first time listening.

Very spirited.

Very, yeah.

And, you know, we just listened to music and I held her hand and I sat with her and the surgeon did his stuff as fast as he could to evacuate the hematoma.

We stabilized, put on pressure dressing, all of that stuff.

And the patient was so grateful.

It is such a big part of the patient experience to be there as a human next to that person and not just a face peering down like that human aspect of anesthesiology is why I love this field.

What are we drinking today?

Absolutely.

So always be honest with your anesthesiologist is what I would say.

Your anesthesiologist and your grandmother have one thing in common, which is we want to know when did you eat last because we want to make sure that you can have a safe anesthetic on an empty stomach, as we say.

But really be honest with your anesthesiologist is the most important thing.

Don't lie.

Do not lie.

Whether it's whether you used cocaine or marijuana, we do not judge.

We are there to protect you and to help you.

And also, it's super safe.

Anesthesia has evolved so much over the last 30 years, especially since the invention of certain monitors for heart rate and oxygen.

What type of flavor?

Anesthesiologists are trained physicians with thousands of hours of care, and we're here to help you and walk you through the process.

We'd get away.

I'm going to put this mask on your face.

It's going to be a little tight.

Pretend this is fresh oxygen from Tahiti.