Really, sir. What were you thinking?
I’m talking to you—the anesthesia provider (I hate to think that you might be an anesthesiologist) who allowed himself to be videotaped while a patient injected his own induction dose of propofol. Most people know something about propofol even if they aren’t in the anesthesia business–that’s the medication that Dr. Conrad Murray gave Michael Jackson to everyone’s sorrow.
I would insert the link here, but the video has been removed from YouTube.
Apparently the patient, a young man in his late teens or early twenties, needed anesthesia and decided it would be great fun if he could give his own drugs and film the adventure. “Jackass” comes to the operating room.
The video shows the young man lying on an operating table with an anesthesia machine and monitors in view. A tall, middle-aged man in blue scrubs, with a mask dangling around his neck, puts a pulse oximeter on the patient’s finger and hands him a 20-cc syringe of what appears to be propofol. The young man starts to inject it and pushes the first 10 cc into the IV tubing, then laughs and says he feels dizzy. He’s told to finish the injection, which he does, barely. Then his eyes roll back.
Up to that point I assumed that the whole episode was staged and the propofol was dripping onto the floor out of view of the camera. Imagine my surprise when the man at the head of the table, wearing no gloves, picked up an laryngeal mask airway and inserted it into the unresponsive patient’s mouth. Since there had been no oxygen given up to that point, it was no surprise to hear the pitch of the pulse oximeter begin that ominous stepwise drop we’ve all heard before.
Luckily for the patient, an anesthesia circuit was available to connect to the LMA. Then the man in blue picked up the EKG leads, apparently intending to attach them to the patient, and announced the end of “another successful induction”.
Fade to black.
Where shall we start the critique of this cinematic masterpiece? I’d love to see the look on the face of the top administrator in the facility where this event took place. How many violations of protocol can you fit into less than five minutes? Let us count the ways: no mask, no gloves, no oxygen, no EKG. I wanted to watch again and see if a blood pressure was even taken prior to induction.
There are a number of online comments on various sites about this travesty of anesthesia care. Nurse anesthetists maintain that only an anesthesiologist could be so cavalier. Anesthesiologists hope otherwise. If and when the perpetrator is identified, the other side will make hay of his poor practice and careless attitude.
Inducing coma is a serious business. I don’t mind so much about letting the patient push his own propofol. That’s not very different from letting a small child hold his own facemask and pretend he’s an astronaut so that he can have a calm and happy induction. But filming an anesthesia induction for teaching purposes is legitimate; filming it frivolously is not. Some heedless young YouTube watcher could decide that it would be cool to score some propofol and try this at home.
And back to you, sir—you in the blue scrubs at the head of the table. What did you think the patient was going to do with this video? Just take it home to show his mom? Save it as a Christmas surprise to view with the other family home movies? Did you not realize he would immediately post it on the Internet for the world to see, hoping perhaps for a featured spot on Tosh 2.0? Are you that clueless about social media and the relentless spread of videos that go viral?
If you were that clueless, I bet you’ve learned your lesson by now. Unless you own the facility where this event took place, I’d be surprised if you still have privileges. However this adventure ends for you, you’ve certainly lost the respect of your peers and colleagues. I hope that few minutes on center stage was worth it.
Karen S. Sibert is an Associate Professor of Anesthesiology, Cedars-Sinai Medical Center. She blogs at A Penned Point.