WEBVTT

NOTE duration: "00:04:50.645"


NOTE Confidence: 0.9966649

00:00:04.799 --> 00:00:06.500
We have nerve endings

NOTE Confidence: 0.76694125

00:00:06.879 --> 00:00:07.379
everywhere,

NOTE Confidence: 0.8993923

00:00:08.240 --> 00:00:09.460
literally everywhere.

NOTE Confidence: 0.89772356

00:00:10.000 --> 00:00:10.820
And ordinarily,

NOTE Confidence: 0.9881723

00:00:11.519 --> 00:00:12.980
from these nerve endings,

NOTE Confidence: 0.99930936

00:00:13.360 --> 00:00:14.980
pain gets transmitted.

NOTE Confidence: 0.9855684

00:00:15.755 --> 00:00:16.555
You can kind of think

NOTE Confidence: 0.9855684

00:00:16.555 --> 00:00:17.454
of them as

NOTE Confidence: 0.9980435

00:00:18.235 --> 00:00:19.994
your early warning system. They

NOTE Confidence: 0.9980435

00:00:19.994 --> 00:00:20.954
are the first line of

NOTE Confidence: 0.9980435

00:00:20.954 --> 00:00:22.475
defense that you have against

NOTE Confidence: 0.9980435

00:00:22.475 --> 00:00:23.695
threats in your environment.

NOTE Confidence: 0.96273136

00:00:24.715 --> 00:00:25.435
So it could be a

NOTE Confidence: 0.96273136

00:00:25.435 --> 00:00:27.035
cut. It could be an

NOTE Confidence: 0.96273136

00:00:27.035 --> 00:00:29.035
incision. It could be, something

NOTE Confidence: 0.96273136

00:00:29.035 --> 00:00:30.575
blunt. That initiates

NOTE Confidence: 0.9995386

00:00:31.240 --> 00:00:32.380
a chemical response

NOTE Confidence: 0.93699986

00:00:32.840 --> 00:00:34.120
that is transmitted to the

NOTE Confidence: 0.93699986

00:00:34.120 --> 00:00:35.960
spinal cord then travel to

NOTE Confidence: 0.93699986

00:00:35.960 --> 00:00:37.320
the brain and that's how

NOTE Confidence: 0.93699986

00:00:37.320 --> 00:00:39.020
pain is essentially perceived.

NOTE Confidence: 0.94447285

00:00:39.720 --> 00:00:40.860
Now this is in comparison

NOTE Confidence: 0.94447285

00:00:41.000 --> 00:00:42.600
to chronic pain. Chronic pain

NOTE Confidence: 0.94447285

00:00:42.600 --> 00:00:43.820
is essentially a

NOTE Confidence: 0.9928193

00:00:44.284 --> 00:00:45.485
response. Right? So this is

NOTE Confidence: 0.9928193

00:00:45.485 --> 00:00:47.645
an ongoing false alarm that

NOTE Confidence: 0.9928193

00:00:47.645 --> 00:00:48.845
really does not provide you

NOTE Confidence: 0.9928193

00:00:48.845 --> 00:00:50.305
or the body any benefit.

NOTE Confidence: 0.9912935

00:00:51.005 --> 00:00:52.945
Pain medications and anesthetics

NOTE Confidence: 0.99331903

00:00:53.565 --> 00:00:54.065
utilize

NOTE Confidence: 0.96115154

00:00:54.845 --> 00:00:56.285
a very large number of

NOTE Confidence: 0.96115154

00:00:56.285 --> 00:00:57.184
different mechanisms.

NOTE Confidence: 0.97431904

00:00:57.485 --> 00:00:59.520
But in general, it's interrupting

NOTE Confidence: 0.97431904

00:00:59.580 --> 00:01:00.400
those pathways.

NOTE Confidence: 0.99127114

00:01:00.860 --> 00:01:01.600
From wherever

NOTE Confidence: 0.96389645

00:01:01.980 --> 00:01:03.660
the insult or the incision

NOTE Confidence: 0.96389645

00:01:03.660 --> 00:01:05.100
is or the puncture is

NOTE Confidence: 0.96389645

00:01:05.100 --> 00:01:06.700
and disrupt that communication to

NOTE Confidence: 0.96389645

00:01:06.700 --> 00:01:07.760
the spinal cord.

NOTE Confidence: 0.9945947

00:01:08.220 --> 00:01:09.840
So that pain is ultimately

NOTE Confidence: 0.9985912

00:01:10.459 --> 00:01:11.360
not experienced.

NOTE Confidence: 0.9715521

00:01:14.975 --> 00:01:16.415
There are a few different

NOTE Confidence: 0.9715521

00:01:16.415 --> 00:01:17.694
types of anesthesia that we

NOTE Confidence: 0.9715521

00:01:17.694 --> 00:01:19.375
use now. One is a

NOTE Confidence: 0.9715521

00:01:19.375 --> 00:01:20.895
local anesthetic, right, which many

NOTE Confidence: 0.9715521

00:01:20.895 --> 00:01:22.255
of you have probably experienced

NOTE Confidence: 0.9715521

00:01:22.255 --> 00:01:23.295
in your doctor's office or

NOTE Confidence: 0.9715521

00:01:23.295 --> 00:01:24.435
your dentist office.

NOTE Confidence: 0.9589411

00:01:24.735 --> 00:01:26.755
We have regional anesthetic techniques,

NOTE Confidence: 0.956819

00:01:27.110 --> 00:01:28.890
what we call monitored anesthesia

NOTE Confidence: 0.956819

00:01:28.950 --> 00:01:29.990
care which is a very

NOTE Confidence: 0.956819

00:01:29.990 --> 00:01:30.810
deep sedation

NOTE Confidence: 0.90311646

00:01:31.190 --> 00:01:32.650
and then general anesthesia.

NOTE Confidence: 0.98928165

00:01:34.709 --> 00:01:35.770
Regional anesthesia

NOTE Confidence: 0.9947085

00:01:36.069 --> 00:01:37.909
is an anesthetic technique by

NOTE Confidence: 0.9947085

00:01:37.909 --> 00:01:39.209
which we administer

NOTE Confidence: 0.9628682

00:01:39.590 --> 00:01:41.365
local an aesthetic in and

NOTE Confidence: 0.9628682

00:01:41.365 --> 00:01:43.525
around large nerves that provide

NOTE Confidence: 0.9628682

00:01:43.525 --> 00:01:46.165
sensation to significant sections of

NOTE Confidence: 0.9628682

00:01:46.165 --> 00:01:48.105
our extremities or torso.

NOTE Confidence: 0.9905297

00:01:48.965 --> 00:01:50.885
Those are sometimes done on

NOTE Confidence: 0.9905297

00:01:50.885 --> 00:01:52.185
nerves in the periphery

NOTE Confidence: 0.98975897

00:01:52.870 --> 00:01:54.869
and sometimes they're done on

NOTE Confidence: 0.98975897

00:01:54.869 --> 00:01:56.490
nerves closer to

NOTE Confidence: 0.982894

00:01:56.790 --> 00:01:58.310
the spinal cord. And that

NOTE Confidence: 0.982894

00:01:58.310 --> 00:01:59.690
doesn't mean that it's dangerous

NOTE Confidence: 0.982894

00:01:59.750 --> 00:02:01.030
because it's closer to the

NOTE Confidence: 0.982894

00:02:01.030 --> 00:02:02.310
spinal cord. It just means

NOTE Confidence: 0.982894

00:02:02.310 --> 00:02:04.390
that you're getting more nerve

NOTE Confidence: 0.982894

00:02:04.390 --> 00:02:04.890
coverage

NOTE Confidence: 0.9671148

00:02:05.270 --> 00:02:06.470
the closer you get to

NOTE Confidence: 0.9671148

00:02:06.470 --> 00:02:07.770
the source of the nerves.

NOTE Confidence: 0.97547233

00:02:08.725 --> 00:02:10.325
So for laboring women, the

NOTE Confidence: 0.97547233

00:02:10.325 --> 00:02:12.005
injection is around the low

NOTE Confidence: 0.97547233

00:02:12.005 --> 00:02:13.845
back, and so it numbs

NOTE Confidence: 0.97547233

00:02:13.845 --> 00:02:15.205
all the nerves from that

NOTE Confidence: 0.97547233

00:02:15.205 --> 00:02:16.325
injection site and a little

NOTE Confidence: 0.97547233

00:02:16.325 --> 00:02:17.065
bit above

NOTE Confidence: 0.98072964

00:02:17.445 --> 00:02:19.145
down to the feet.

NOTE Confidence: 0.9925583

00:02:21.000 --> 00:02:22.680
General anesthesia means that your

NOTE Confidence: 0.9925583

00:02:22.680 --> 00:02:24.360
body is completely asleep. You're

NOTE Confidence: 0.9925583

00:02:24.360 --> 00:02:26.120
not experiencing pain. What we

NOTE Confidence: 0.9925583

00:02:26.120 --> 00:02:27.500
are doing is creating

NOTE Confidence: 0.9977983

00:02:27.960 --> 00:02:28.460
a

NOTE Confidence: 0.9702534

00:02:28.760 --> 00:02:30.520
space around both the brain

NOTE Confidence: 0.9702534

00:02:30.520 --> 00:02:31.639
and the body which is

NOTE Confidence: 0.9702534

00:02:31.639 --> 00:02:32.139
characterized

NOTE Confidence: 0.99719894

00:02:32.440 --> 00:02:33.260
by unconsciousness,

NOTE Confidence: 0.9947233

00:02:34.215 --> 00:02:34.715
analgesia,

NOTE Confidence: 0.999285

00:02:35.575 --> 00:02:36.075
amnesia

NOTE Confidence: 0.86149263

00:02:36.375 --> 00:02:37.115
and paralysis

NOTE Confidence: 0.91848975

00:02:37.735 --> 00:02:39.275
with the maintenance of physiologic

NOTE Confidence: 0.91848975

00:02:39.495 --> 00:02:39.995
function.

NOTE Confidence: 0.99615717

00:02:40.375 --> 00:02:42.375
And that physiologic function is

NOTE Confidence: 0.99615717

00:02:42.375 --> 00:02:43.514
monitored and maintained

NOTE Confidence: 0.9943404

00:02:43.815 --> 00:02:44.715
by your anesthesiologist

NOTE Confidence: 0.911776

00:02:45.335 --> 00:02:46.455
while you are as we

NOTE Confidence: 0.911776

00:02:46.455 --> 00:02:47.595
say sleeping.

NOTE Confidence: 0.99487567

00:02:50.210 --> 00:02:51.669
Another type of anesthesia

NOTE Confidence: 0.9621528

00:02:51.970 --> 00:02:53.350
is IV anesthesia,

NOTE Confidence: 0.9120983

00:02:53.730 --> 00:02:55.750
which like general anesthesia,

NOTE Confidence: 0.97323805

00:02:56.130 --> 00:02:58.630
it does afford one hypnosis

NOTE Confidence: 0.97323805

00:02:58.850 --> 00:03:00.585
and level of numbness, but

NOTE Confidence: 0.97323805

00:03:00.985 --> 00:03:02.745
usually you're not deep to

NOTE Confidence: 0.97323805

00:03:02.745 --> 00:03:04.045
the point where you need

NOTE Confidence: 0.97323805

00:03:04.264 --> 00:03:06.185
a breathing device for your

NOTE Confidence: 0.97323805

00:03:06.185 --> 00:03:07.865
airway to be protected. This

NOTE Confidence: 0.97323805

00:03:07.865 --> 00:03:09.005
is commonly seen

NOTE Confidence: 0.992385

00:03:09.305 --> 00:03:10.764
in cases like colonoscopies,

NOTE Confidence: 0.95040905

00:03:11.465 --> 00:03:11.965
endoscopy,

NOTE Confidence: 0.99899596

00:03:12.345 --> 00:03:13.245
or eye surgery.

NOTE Confidence: 0.99823165

00:03:14.790 --> 00:03:16.169
Your basic physiology

NOTE Confidence: 0.9549805

00:03:16.870 --> 00:03:18.410
is not only being maintained,

NOTE Confidence: 0.8176324

00:03:18.950 --> 00:03:20.010
but an anesthesiologist

NOTE Confidence: 0.96869224

00:03:21.430 --> 00:03:22.490
focusing on

NOTE Confidence: 0.99852407

00:03:22.790 --> 00:03:23.610
you holistically

NOTE Confidence: 0.9868948

00:03:24.310 --> 00:03:25.750
and helping to make sure

NOTE Confidence: 0.9868948

00:03:25.750 --> 00:03:27.270
that you stay in good

NOTE Confidence: 0.9868948

00:03:27.270 --> 00:03:27.770
balance.

NOTE Confidence: 0.96969944

00:03:31.815 --> 00:03:32.695
One of the things that

NOTE Confidence: 0.96969944

00:03:32.695 --> 00:03:34.315
we are seeing in anesthesia

NOTE Confidence: 0.96969944

00:03:34.535 --> 00:03:36.215
is really a move towards

NOTE Confidence: 0.96969944

00:03:36.215 --> 00:03:37.435
what we call a perioperative

NOTE Confidence: 0.96969944

00:03:37.655 --> 00:03:39.835
home. Where patients are not

NOTE Confidence: 0.96969944

00:03:40.055 --> 00:03:40.855
under the care of an

NOTE Confidence: 0.96969944

00:03:40.855 --> 00:03:41.355
anesthesiologist

NOTE Confidence: 0.96286994

00:03:41.735 --> 00:03:43.435
only during the immediate preoperative

NOTE Confidence: 0.96286994

00:03:43.495 --> 00:03:45.540
and intraoperative period but really

NOTE Confidence: 0.96286994

00:03:45.540 --> 00:03:47.300
becoming involved in care three

NOTE Confidence: 0.96286994

00:03:47.300 --> 00:03:48.500
to six months prior to

NOTE Confidence: 0.96286994

00:03:48.500 --> 00:03:49.879
a patient coming to surgery,

NOTE Confidence: 0.91299635

00:03:50.180 --> 00:03:51.540
during surgery and then their

NOTE Confidence: 0.91299635

00:03:51.540 --> 00:03:53.080
postoperative care afterwards.

NOTE Confidence: 0.9932303

00:03:53.620 --> 00:03:55.640
And chronic pain medicine provides

NOTE Confidence: 0.9932303

00:03:55.860 --> 00:03:56.519
an ability

NOTE Confidence: 0.99910337

00:03:56.819 --> 00:03:57.319
to

NOTE Confidence: 0.9770672

00:03:57.625 --> 00:03:59.305
attenuate risk factors for the

NOTE Confidence: 0.9770672

00:03:59.305 --> 00:04:00.985
development of chronic pain after

NOTE Confidence: 0.9770672

00:04:00.985 --> 00:04:01.485
surgery,

NOTE Confidence: 0.98375785

00:04:01.785 --> 00:04:03.644
as well as to facilitate

NOTE Confidence: 0.98375785

00:04:03.705 --> 00:04:04.364
the development

NOTE Confidence: 0.99567336

00:04:04.745 --> 00:04:06.525
of comprehensive pain plans

NOTE Confidence: 0.9439629

00:04:06.825 --> 00:04:07.325
to

NOTE Confidence: 0.9519443

00:04:07.705 --> 00:04:09.625
minimize discomfort in the post

NOTE Confidence: 0.9519443

00:04:09.625 --> 00:04:11.144
operative period both in and

NOTE Confidence: 0.9519443

00:04:11.144 --> 00:04:12.045
out of the hospital.

NOTE Confidence: 0.92899716

00:04:13.810 --> 00:04:15.349
It's a very exciting time

NOTE Confidence: 0.92899716

00:04:15.409 --> 00:04:16.150
in anesthesia.

NOTE Confidence: 0.99878186

00:04:16.529 --> 00:04:17.509
We're always

NOTE Confidence: 0.9728813

00:04:17.889 --> 00:04:19.810
interrogating and really asking the

NOTE Confidence: 0.9728813

00:04:19.810 --> 00:04:20.310
questions.

NOTE Confidence: 0.9917928

00:04:21.089 --> 00:04:22.710
What does the data show?

NOTE Confidence: 0.9917928

00:04:22.770 --> 00:04:24.789
So that we can do

NOTE Confidence: 0.9917928

00:04:24.930 --> 00:04:26.449
this shared decision making with

NOTE Confidence: 0.9917928

00:04:26.449 --> 00:04:27.190
our patients.

NOTE Confidence: 0.9991134

00:04:28.415 --> 00:04:28.915
Anesthesiology

NOTE Confidence: 0.99952537

00:04:29.455 --> 00:04:30.755
has become extraordinarily

NOTE Confidence: 0.75757706

00:04:31.375 --> 00:04:31.875
safe,

NOTE Confidence: 0.9958074

00:04:32.255 --> 00:04:33.714
both because of the monitoring

NOTE Confidence: 0.9958074

00:04:33.775 --> 00:04:35.555
that we have, the medication

NOTE Confidence: 0.9958074

00:04:35.775 --> 00:04:37.615
that we have, and the

NOTE Confidence: 0.9958074

00:04:37.615 --> 00:04:38.115
vigilance

NOTE Confidence: 0.88899344

00:04:38.654 --> 00:04:39.635
that we have.