here live and unscripted your Stanford
and Harvard Trend anesthesiologist and
I'm going to share with you what happens
when patients are lonely and they go
under anesthesia like in this real life
operating room as you may have heard
recently the U.S
Surgeon General Dr Vivek merthy just
announced a loneliness epidemic
and that has great consequences all over
medicine even when you're under
anesthesia having surgery because
loneliness has very real effects on your
body physical signs and symptoms come up
when patients are suffering from
unmitigated or untreated loneliness
and that shows up when you're connected
to the ventilator behind me and when you
have anesthetics on board and even in
those moments when you're breathing
through that mask getting the oxygen and
other anesthesia gases so let's talk
about what happens to patients who are
lonely and it wouldn't start but
wouldn't it be right to start without a
real life story I had a 75 year old
patient not too long ago coming in for a
knee replacement and when he sat down on
the table I gave him the oxygen mask
and before I gave it to him I said what
are you looking forward to doing
with your new knee because I want
patients to wake up or rather fall
asleep with that sense of positivity to
set a seed in their mind for what
they're going to feel like when they
wake up in hopefully a positive way help
reminding them the purpose the meaning
of why we're having surgery in the first
place before that scary mask goes on
what did the patient tell me what do you
guys think that patient told me
what do you think the patient told me
and by the way Alexis Heidi Linda Chris
great to see everyone on here so many
others but I want to know oh hey Gentle
Spirit thank you for being a new
subscriber your support helps me do this
more often so I'll give you a shout out
to whoever gets it right what did this
patient tell me when their head was on
the pillow they're getting ready for a
whole new you know knee replacement
Sherry got it right Sherry says he
wasn't looking forward to anything so
this patient unbeknownst to me
had a serious serious disconnection with
their family and their Social Circle and
was suffering from a serious social and
emotional type of loneliness there are
three types of loneliness we typically
describe and he was suffering two of
those three
when he told me in this moment here
I don't even know why I want a new knee
anymore this was really concerning for
me as you could imagine and it impacted
their Anastasia so what happens when you
have this level of loneliness a couple
of things happen there are often
contributing factors that show up on the
monitors in your heart this patient not
surprisingly was also suffering from
depression
the people that he used to do his
physical activities with like jogging
running
weren't around anymore
that was why he originally wanted the
knee replacement
and like Darlene says it is sad and
there is an element of hopelessness in
here this is not the time to be having
surgery because when you fall asleep
what signs are manifested in your body
when you fall asleep with that level of
hopelessness or loneliness
it increases your risk of heart disease
it increases your risk of stroke
it increases your risk of Alzheimer's
type dementia which when you're waking
up from anesthesia after all these gases
have wreaked havoc on your brain the
Civil fluorine the laughing gas here n2o
the liquid anesthetics like propofol or
ketamine or whatever they might be
midazolam opioids like Fentanyl the pain
of the surgery these can all unmask what
we call
emergence delirium
causing you you know all those stories
I've shared with you of people that wake
up kicking screaming doing all these
wacky things because the brain when it
has been lonely for so long is so prone
to depression to generalized anxiety or
state anxiety these are real conditions
and they really show up on the table
and they are preventable it's not
a fatalistic
diagnosis it's not a terminal diagnosis
it's one of the remarkable
realities of the human body we have
nearly Unbound resilience of course it's
not easy to tap into and I'm not saying
you should feel bad if you feel lonely
because that's also counterproductive
but
this patient even had a tremendous
amount of resilience innately in there
it was covered up what did I do with
this patient
what did I do with this patient this
doesn't happen all that
rarely to be honest this was a more
serious type of example but I paused you
can't just
put a mask on someone tell them to take
big deep breaths
of oxygen and funny smelling gases just
you know you can't
get to somebody who just told you
that they don't even know why they're
having this major surgery because what's
going to happen if they have this
surgery they have an increased risk of
delirium and increased risk of side
effects from the anesthesia most
importantly pain worse pain after
surgery how do you treat pain in the
elderly yeah give him painkillers like
opioids what do opioids if given in
excess
or if they're not addressing the root
cause of pain what do they do to the
elderly
they increase the risk of dementia I
should say delirium which may we don't
yet know for sure but may increase the
risk of long-term consequences I want to
always do less is more well less is more
but truly the right amount is the
correct amount if they have an
underlying reason for their pain that
we're not addressing and just throwing
opioids at them
that might raise the risk
of consequence side effects after in the
elderly and we don't have ways of
reversing those side effects so
I did pause and I believe meow was the
least popular person in the operating
room that day because nobody likes a
delayed a surgery and especially nobody
likes it when anesthesia causes a delay
it's like if you have any friends who
work in hospitals it is the like least
favorite thing of anyone they call it an
anesthesia delay and it's uh it's really
frustrating but uh you know we had to
take a pause and check in about why are
we doing this I asked the surgeon to
come by
we had a little last minute talk was it
the most ideal probably not I wish we
could have done this talk one week ago
or two weeks ago or a month ago but
given the circumstances of the broken
Health Care system that we worked in I
asked the others to leave not be chit
chatting and Whispering this person so
undecided so insecure all that judgment
does not help a patient who's struggling
with that degree of loneliness and
concomitant depression when they're on
the stable
um
Linda says it's a meat factory I can't
disagree with you Linda I can't disagree
with you
now I gotta do a couple shout outs here
Java good to see you Autumn I'm so happy
to hear that you had successful knee
Replacements and uh do so many Fantastic
comments Christy says good morning
it's afternoon here I had dental
treatment under IV sedation midazolam I
remember waking and moving in pain
I'm happy that you're on better now but
I'm sorry that you had that experience
but that is what midazoland does I don't
actually have any more I've already
wasted my bedazzling for the day but I
give it nearly every day
uh it is
relatively safe in the dentist's office
but it doesn't always cover the pain
Darlene says the elderly need soft touch
eye to eye contact you are so correct
Darlene you're absolutely correct
so I I want to just raise something else
up here um
this is about Generation Z because
loneliness isn't just for the old people
do you guys know any Jen's ears these
young kids that are addicted to their
phones I'm gonna have a whole video on
what gen Z patients are like under
anesthesia so please be on the lookout
for that
but suffice to say that gen Z has a
degree of loneliness that is in some
ways unprecedented ever in human history
before I actually tell you a little bit
more about that just a quick shout out
as you know um well I guess Shameless
plug rather after a long day in the
operating room I'd appreciate it if you
do appreciate what I share with you
to hit that like button or share with
others or subscribe to keep up with all
of my lives where I share your potential
to heal in ways that you probably never
thought possible and what happens in the
subconscious that's opened up under
anesthesia so I really appreciate your
support and of course sharing what
you've learned with others that help
others advocate for themselves and like
I said the broken Health Care system
that we unfortunately live in
so uh yeah gen Z gen Z is is kind of a
curious one someone already said social
media let me give him a shout out proud
American says yes it's social media
when I'm talking to patients before they
come into the operating room you may not
believe this hey Sterling thank you so
much
um I'm talking to patients about what's
going to happen to their body under
anesthesia
on this bed
on the ventilator
and more often than not they're texting
on their phone while I'm talking to them
I don't mean any disrespect to anyone
I'm not making fun of them but I'm
raising a really powerful point that
their attention and this is not all
Jen's ears hey there are some very very
mature gen's ears out there it's not all
of them but it's enough that I have a
serious concern about where is the focus
before something like surgery I would
hope that my patients I've called them
the night before a little bit of
Preparatory you know just answering
questions helping them feel prepared I
want that mindset to be in the right
place when we enter this room remember
you walk through this door here
you come in to this room and I want your
mindset to be focused on you and healing
not you in an egocentric way but your
healing when somebody is on their phone
before their surgery you know we already
know that social media can be anxiety
inducing
it is likely a distractor
from that focus and that attention on
healing the self or preparing to heal
the self
uh very curious I don't know what your
thoughts are do please let me know what
you think about that I I think that it's
a little bit difficult to communicate
when someone's glued to their phone
texting when I'm doing nerve blocks on
patients
some patients continue to text while I'm
doing the nerve block
um and it's a balance because it might
be a form of distraction to distract
from the discomfort of the needle and I
respect that there's a time and a place
for distraction in short bursts not in
over long term similar for suppressing
certain feelings
um
but when it's unbridled it's concerning
to me what else do gen's ears do um they
use sleep aids more than other folks so
when they're lonely and then that might
be contributing to depression or
generalized anxiety they're more likely
to grab a sleep aid or grab alcohol than
others and that can also be
concerning because those have very real
effects under anesthesia if you you can
see my videos they're very very real
effects that happen to your body when
you go into that subconscious plane
under anesthesia
uh
redheads redheads also need and they
need some
um they need more anesthesia for some of
the medications higher doses I should
say not all but that's interesting point
you bring up there
um it was Kathleen or no Gene Gene hibb
says that have I ever dealt with someone
with autonomic dysreflexia yes I have
Josiah and it requires very careful
management very good question
so to gen zero it's not getting
distracted here like like the Gen Z or
stereotype when they are reaching for
sleep aids more frequently than others
who are lonely it raises concern for not
addressing the root cause of loneliness
and when we don't address the root cause
we put Band-Aids and these Band-Aids all
have side effects whether it's the
marijuana the alcohol the sleep aids
so
these have implications under anesthesia
for the reasons I said earlier just like
for that 75 year old that 17 year old
also is priming their body for a
lifetime of complications This concerns
me and it concerns Dr Vivek Murthy the
Surgeon General
if you've ever felt isolated like that
or lonely and I should say that
loneliness and boredom share some
similarities but they're different and
they both need to be addressed and not
gaslighted
absolutely not Gaslight so I hope that
if you've ever known anyone who's lonely
that you take
an extra step to say hi to them because
ignoring them or pretending like it's
just you know ah they're lonely whatever
isn't doing him any good it may have
well it does have real
risks to our heart health our brain
health even our immune system
potentially and weakening our immune
system
so
the more connected you are not just you
feeling better when you say hi to that
person who you think is lonely when you
know the signs of loneliness you should
be able to read the signs of loneliness
they're pretty
uh
intuitive people that are withdrawn not
engaging with others in physical
activities maybe not going to a
religious activity or whatever church
not engaging in Recreational Sports
perhaps appearing
uninterested what we call anhedonia very
serious
perhaps they are exhibiting other signs
of anxiety or depression they have sleep
disturbances they're not eating this can
all be symptoms of loneliness
when you say hi to that person if you
can help re-engage them what do you do
for them well if they're having surgery
you can help their pain be less
decreased opioid requirements are
consistently noted in patients who feel
more connected
as are faster recoveries what we call
shorter length of stay so you can leave
the hospital faster after your surgery
the more connected you feel and of
course that's there's less anxiety and
less pain like we said emotional pain
and physical pain
That's The Power of connectedness so if
you have an opportunity
to help give even a smile I would
appreciate it if you do that
because you have more power over your
health than you've ever been told then
you probably have more power over other
people's happiness and health than you
thought possible without medications you
don't need propofol you don't need gases
or laughing gas or that benzodiazepines
they might make you feel good in the
moment with those chemicals that Target
your brain and hijack your your central
nervous system but
with your presence your mindful presence
to establish that connection you have
incredible power and it's like I said
more than you've probably ever been told
so if you could share that message to
help Empower others to advocate for
themselves in our broken Health Care
system
I wish you the best in that and I would
really appreciate that if you also like
the message that we talk about here
hitting that like button is always
appreciated and subscribing to keep up
with the lives until next time
have a good weekend and remember that
you have that incredible power it's your
presence
and you can't overdose on your presence
nor are there any side effects from it
not many medications fall in that
category I'll guarantee you that