Anesthesia Patient Safety Podcast

What happens when we truly listen to patients' fears about anesthesia? The Anesthesia Patient Safety Foundation (APSF) discovered something remarkable: despite the wealth of medical information available, patients' most pressing questions about anesthesia remained largely unanswered in accessible language.

This episode delves into the groundbreaking work of the APSF Patient Engagement Workgroup, featuring insights from Maria Van Pelt. We explore how this initiative transformed patient concerns into actionable resources through methodical research, including comprehensive surveys and in-depth interviews. The resulting Patient Guide to Anesthesia and Surgery addresses common questions like "What if I don't wake up from...

Every anesthesia professional has encountered IV infiltration—but when neuromuscular blocking agents are involved, this common complication becomes a complex patient safety challenge with no established guidelines.

This episode delves into the critical management of infiltrated paralytics, a complication affecting 14% of peripheral IV catheterizations that can lead to delayed induction, compromised emergence, and potentially serious tissue injury. We're joined by Dr. Govind Rangrass, Professor of Anesthesiology and Critical Care, who shares why this overlooked issue deserves urgent attention: "When a paralytic is involved, the complexity skyrockets and there's almost no literature to guide us."

We br...

Ever wondered what happens when neuromuscular blocking agents infiltrate into surrounding tissue instead of flowing smoothly through an IV? The consequences can be serious and potentially life-threatening for patients recovering from anesthesia.

We dive deep into a complication that affects nearly 14% of the 150 million peripheral IV catheter insertions performed annually in the United States. While most healthcare providers have experienced IV infiltrations, few understand the unique dangers posed when paralytics like rocuronium leak into surrounding tissues. This scenario creates unpredictable pharmacokinetics with delayed absorption that can lead to secondary recurarization – muscle weakness and respiratory compromise that may oc...

Navigating the fine line between effective pain control and minimizing harm from opioid medications remains one of anesthesiology's greatest challenges. This episode dives deep into the evolving landscape of perioperative pain management, examining how clinicians can achieve the delicate balance required for optimal patient outcomes.

Dr. Paul Guillod joins us to share his perspective as both an anesthesiologist and pain management specialist, highlighting how opioid-sparing techniques create opportunities for interdisciplinary collaboration and improved surgical recovery. We examine the substantial risks of traditional opioid-based approaches: respiratory depression, delayed bowel function, delirium, and paradoxically, opioid-induced hyperalgesia.

The...

Perioperative stroke represents a rare but potentially devastating complication of anesthesia care. While occurring in less than 1% of non-cardiac surgical patients, this complication fundamentally threatens not just patient outcomes but their very identity. As Dr. Jacob Nadler poignantly notes in our podcast, "By maintaining brain health, we're preserving the essence of who our patients are—their memories, their personality, their ability to connect with friends and family."

The most significant recent development in this field comes from the 2024 joint guidelines that have dramatically shortened the recommended waiting period following stroke before elective surgery. What was once a ni...

A revolution in pain management has arrived. The FDA's approval of Suzetrigine in January 2025 introduces the first non-opioid analgesic for moderate to severe pain in over twenty years. This breakthrough medication targets the voltage-gated sodium channel, NAV1.8, effectively blocking pain signals at their source before they reach the brain.

What makes Suzetrigine remarkable is its precision. With over 30,000-fold selectivity for NAV1.8 channels, it delivers powerful analgesia without affecting the brain or heart, eliminating addiction risk, and minimizing side effects. Clinical trials involving over 2,100 patients demonstrated pain relief comparable to opioid-acetaminophen combinations but with a safety profile...

Cardiac arrest in the operating room presents unique challenges that standard Advanced Cardiovascular Life Support (ACLS) protocols simply were not designed to address. This eye-opening exploration with APSF author, Zachary Smith, reveals why traditional resuscitation guidelines fall short when emergencies strike during surgery and anesthesia care.

The dynamics of cardiac arrest differ dramatically in the perioperative environment. While out-of-hospital arrests typically stem from arrhythmic events, OR emergencies often result from hemorrhage, embolism, hypoxemia, or critical drug reactions like malignant hyperthermia or local anesthetic toxicity. These scenarios demand immediate, specialized interventions beyond standard ACLS algorithms.

Physical...

The standard of care for monitoring blood pressure during surgery hasn't changed in nearly 40 years, despite technological advances that could prevent serious complications and save lives. This eye-opening episode takes listeners inside a recent Capitol Hill briefing where healthcare professionals, lawmakers, and patient safety advocates made the case for continuous blood pressure monitoring as a critical patient safety measure.

Alarming statistics frame the urgency of this issue: one in nine Americans undergoes surgery annually, with 88% experiencing potentially dangerous hypotension. Traditional arm cuffs that measure blood pressure only every few minutes leave dangerous blind spots where rapid drops...

Ready for a refreshing summer dive into the latest anesthesia safety research? This episode explores three groundbreaking studies that could transform perioperative practice and patient outcomes.

First, we examine a fascinating randomized clinical trial on "just-in-time" training for inexperienced clinicians performing infant intubations. The results are impressive: trainees who received just 10 minutes of structured training immediately before the procedure achieved a 91.4% first-attempt success rate—significantly better than the 81.6% rate in the standard training group. Could this approach revolutionize how we prepare for all high-stakes medical procedures? The study suggests decreased cognitive load and improved competency with this ta...

Navigating the complex landscape of patient safety requires vigilance, knowledge, and adaptability. Today's episode takes us on a journey through two critical safety concerns that exemplify the challenges anesthesiologists face in diverse clinical settings.

We begin with an eye-opening exploration of cosmetic surgery safety in Colombia, which has emerged as a top global destination for aesthetic procedures. Despite performing nearly 500,000 cosmetic surgeries annually, Colombia faces alarming safety statistics—mortality rates potentially ten times higher than global averages for anesthesia-related deaths. This stark disparity highlights how regulatory gaps, substandard facilities, and inadequate patient selection can create perfect storms fo...

Dr. Elizabeth Malinzak takes us behind the scenes of a fascinating educational initiative bridging knowledge gaps in anesthesiology. As a pediatric anesthesiologist at Duke University and liaison between the Anesthesia Patient Safety Foundation and Open Anesthesia, she's spearheaded the development of over 30 patient safety and quality improvement summaries designed for today's learners.

Malinzak reflects on crucial topics like crisis resource management, fatigue mitigation, and handover protocols that weren't part of traditional training. This educational void inspired her to create accessible, concise resources that meet modern learning preferences. Gone are the days of textbook deep-dives; today's professionals need...

Intrahospital transport of critically ill patients presents significant safety risks that can be mitigated through proper guidelines, checklists, and handoffs between care teams. The episode examines transport-related adverse events and complications while providing practical tools to enhance patient safety during these vulnerable transitions.

• Multiple categories of intrahospital transport adverse events including respiratory, cardiovascular, neurological and equipment-related complications
• Risk factors for transport complications including patient characteristics, transport circumstances, and team experience
• Society of Critical Care Medicine guidelines focusing on four components: communication, personnel, equipment and monitoring
• Comprehensive perioperative transport checklist covering identification, airway, breathing, circulation, neurolog...

The journey between hospital departments can be the most dangerous part of a patient's perioperative experience. This eye-opening episode dives deep into the hidden risks of intra-hospital patient transport. We examine the current literature on transport safety with particular focus on the challenges faced by anesthesia professionals. The data is sobering — between 4-9% of transported patients require medical intervention due to transport-related complications. With increasing production pressure, decreased support personnel, and rising patient acuity, we ask the critical question: are we transporting patients safely?

We break down transport-related adverse events into essential categories: respiratory, cardiovascular, neurological, and eq...

Sodium-glucose cotransporter-2 (SGLT2) inhibitors have revolutionized treatment for type 2 diabetes, heart failure, and chronic kidney disease—but they're creating new challenges for anesthesia professionals. With more patients on these medications heading to surgery, understanding their unique perioperative risks has never been more critical.

At the heart of this issue lies euglycemic ketoacidosis—a potentially life-threatening complication that's particularly insidious because it lacks the classic hyperglycemia that would normally trigger suspicion. We dive deep into the latest evidence, revealing that patients on SGLT2 inhibitors have an increased risk of developing postoperative ketoacidosis compared to those not taking these medi...

This is a Fresh Flow Podcast Takeover Show. The need for strong leadership in anesthesiology has never been more crucial. Join us as we discuss structured mentorship programs and the skills required to develop effective leaders in anesthesia. Dr. Mesrobian shares insights into cultivating future leaders and the importance of training in operational management.

Here are some of the highlights:

• Operating room management and operational efficiency directly impact physician wellness by reducing unpredictability
• Balancing the demand side of anesthesia services represents a crucial opportunity for the specialty
• Scale allows large organizations to develop standa...

Fear of the unknown is one of the most significant sources of anxiety for surgical patients. What exactly happens when we're "put under"? Could we wake up during surgery? What side effects should we expect? Our latest episode tackles these common concerns by exploring the APSF's Patient Guide to Anesthesia and Surgery.

We walk through a simulated pre-surgical consultation, addressing the questions that weigh heaviest on patients' minds. We also explore factors affecting wake-up time, from medication choices to individual metabolism, and why some patients experience delayed emergence.

The episode provides a comprehensive overview of...

Fear of the unknown can make surgery and anesthesia unnecessarily stressful. Approximately 90% of patients experience some degree of anxiety about "going under" before their procedure – worrying about pain, waking during surgery, or post-operative grogginess. But what if patients had reliable answers to their most pressing questions?

The Anesthesia Patient Safety Foundation has developed a groundbreaking resource to address this need. In this episode, we introduce the Patient Guide to Anesthesia and Surgery – a comprehensive tool designed to demystify the perioperative experience. Salvador Gullo Neto, lead of the APSF Patient Engagement Workgroup, explains why patient involvement matters: "If the...

The safe management of non-cardiac implantable electrical devices during surgery requires careful planning and knowledge of device-specific considerations. We continue our discussion from last week with actionable recommendations for each stage of perioperative care.

• Electrocautery poses significant risks including device reprogramming, thermal burns, and damage to neural tissue
• Turn off devices or set to safe surgery mode before using electrocautery
• Bipolar cautery is safer than monopolar; if monopolar is needed, use lowest power setting
• Place grounding pads to minimize current through the device generator
• Somatosensory evoked potentials (SSEPs) are relatively safe while motor evoked pot...

The podcast explores comprehensive recommendations for managing patients with non-cardiac implantable electrical devices during surgical procedures, emphasizing preoperative assessment, device interaction prevention, and safety protocols.

• Types of devices include vagal nerve stimulators, deep brain stimulators, and spinal cord stimulators
• Preoperative evaluation is crucial for identifying devices and contacting managing clinicians
• Algorithm provided for assessing potential interactions with electrocautery, MRI, and neuromonitoring
• Diathermy is absolutely contraindicated in patients with non-cardiac implantable devices
• Critical information needed includes device type, manufacturer, lead locations, and latest interrogation results
• Recent urgent safety alert issued about medication vial coring risks...

Surgical fires are devastating yet entirely preventable events that continue to occur in operating rooms around the world. This eye-opening episode features biomedical engineer Mark Bruley and anesthesiologist Dr. Jeffrey Feldman, who share decades of expertise investigating and preventing these catastrophic incidents.

The conversation reveals why the seemingly simple recommendation to limit open oxygen delivery to 30% is so critical for patient safety. Through forensic investigations and laboratory testing, we learn how oxygen-enriched environments transform common surgical materials into dangerously flammable substances. The experts describe the "two-fold risk" created when oxygen concentrations exceed safe limits: materials ignite more...

Sugammadex safety considerations span across patient populations with renal impairment, pediatric patients, and pregnant or breastfeeding individuals, requiring nuanced clinical decision-making based on current evidence and ongoing research.

• Sugammadex reversal of moderate blockade is safe and faster than using neostigmine/cisatracurium for patients with renal impairment
• Quantitative neuromuscular monitoring is essential to ensure adequate reversal (TOF >90%)
• FDA approval exists for children 2+ years with the same dosing parameters as adults
• Infants

Discover the critical safety considerations when using Sugammadex, the seemingly "magical" neuromuscular blockade reversal agent that's fundamentally changed anesthesia practice. We delve deep into the science behind this medication and examine its use in three challenging patient populations: those with renal failure, pregnant patients, and pediatric patients.

For patients with kidney dysfunction, we explore the fascinating pharmacokinetics of Sugammadex and how its primarily renal excretion creates potential complications. With a normal half-life of approximately two hours extending to a 19 hours in severe renal impairment, understanding the risk of recurarization becomes essential. Despite these challenges, recent research suggests...

Medication safety remains a cornerstone of anesthesia practice with complex environments and high-stakes decisions requiring vigilant attention to prevent errors. This collaboration between APSF and OpenAnesthesia spotlights critical aspects of perioperative drug safety with practical insights from Dr. Juan Li, a cardiothoracic anesthesia fellow at Beth Israel Deaconess Medical Center.

• Perioperative anaphylaxis requires immediate recognition of cardiovascular, respiratory, and cutaneous manifestations
• Neuromuscular blocking agents and antibiotics represent common triggers for anaphylactic reactions
• Preoperative assessment must include thorough allergy history, medication reconciliation, and identification of drug-drug interactions
• Standardized drug concentrations, preparation methods, and equipment minimize medicati...

Climate change has arrived in the operating room, and pediatric anesthesiologists are taking action. Dr. Eva Lu-Boettcher, pediatric anesthesiologist and Director of Anesthesia Quality and Safety at the University of Wisconsin Children's Hospital, shares her journey toward sustainable anesthesia after witnessing firsthand the effects of climate change—including her Wisconsin community experiencing the world's worst air quality from wildfires.

The healthcare sector contributes a staggering 8% of total U.S. greenhouse gas emissions, with anesthesia practices like high fresh gas flow during pediatric mask inductions representing significant contributors. Dr. Lu-Boettcher reveals how simple adjustments to match fresh gas fl...

Dr. Liz Hansen takes us behind the scenes of a remarkable transformation at Seattle Children's Hospital, where pediatric anesthesiologists have reduced their greenhouse gas emissions by over 90% without compromising patient safety. A lifelong environmentalist and bike commuter, Dr. Hansen was shocked to discover that anesthesia gases contributed to 7% of her hospital's total emissions. This revelation sparked a personal and professional journey to align her clinical practice with her environmental values.

The conversation reveals practical strategies for reducing anesthesia's carbon footprint, from eliminating nitrous oxide to implementing low-flow techniques. Dr. Hansen shares how her team gradually won over...

In our latest episode, we dive headfirst into the growing issue of medical misinformation and its alarming effect on anesthesia patient safety. As patients increasingly turn to social media for health information, the risks of encountering inaccurate content have soared, posing challenges for healthcare professionals.

Join us as we explore a recent article by George Tewfik and Raymond Malapero from the February 2025 APSF Newsletter, focusing on how misinformation can threaten patient safety, especially during critical procedures. We'll outline the detrimental consequences of misinformation, breaking them down into three distinct categories: fear and anxiety, delay of treatment, and...

Join us as we dive into the critical topic of medical misinformation and its alarming impact on patient safety, particularly in the field of anesthesia. In this compelling episode, we unpack how misconceptions shape patient trust and communication with healthcare providers. Our conversation features insightful commentary from Dr. George Tewfik, who highlights real-world examples of how misinformation spreads and influences patient decisions. 

The rapid rise of social media as a primary information source has created a fertile ground for myths and misconceptions to thrive, leading to heightened anxiety among patients about anesthetic procedures.  Misinformation, such as exaggerated ri...

This episode delves into key findings in the literature, focusing on the nuances of neuromuscular blockade in pediatric patients and novel advancements in intubation techniques to enhance patient safety. We explore significant insights from recent studies that highlight age-related differences in recovery times from neuromuscular blockade and practical recommendations. We also discuss a novel flexible stylet for intubation and the implications of intravenous catheter design during emergency needle decompression.

Highlights include:

• Exploring age-based variability in neuromuscular recovery 
• Understanding the effects of volatile anesthetics on younger patients 
• Emphasizing the importance of quantitative monitoring in pediatri...

Feeling overwhelmed about staying up to date with the anesthesia literature? We hope you will check out the APSF's In The Literature section. This resource brings you straightforward summaries of recent high-impact articles related to anesthesia patient safety. This episode highlights crucial updates in the literature concerning diabetes management, the impact of fatigue on anesthesia professionals, research about GLP-1 receptor agonists, and the use of methadone for next-day discharge surgery. These insights aim to enhance patient safety and improve the overall quality of anesthesia care.

• Updates on blood glucose management guidelines for diabetic patients 
• Findings on the r...

This episode discusses the implementation of ISO 80369-6 neuraxial connectors in Japan, analyzing the challenges faced and the implications for patient safety. The conversation highlights the importance of clinician involvement and the need for clear communication and trials during the transition to new medical standards.

• Overview of ISO 80369-6 and its significance in anesthesia care
• Challenges faced in Japan during the implementation of new connectors
• Historical context of the LOR connector and its risks
• Importance of clinician involvement in product testing and standard formulation
• Call for vigilance and advocacy among anesthesia professionals for patient sa...

The episode explores the challenges and lessons learned from Japan's recent implementation of ISO 80369-6 standards in anesthesia practices, highlighting the critical importance of clinician involvement in developing safety protocols. We discuss the historical context, issues with communication, and various complications arising from the transition to new safety standards.

• Importance of ISO standards in enhancing patient safety
• Role of clinician input in developing safety protocols
• Japan's experience with the implementation of ISO 80369-6
• Historical context of neuraxial connection standards
• Issues arising from lack of communication during transitions
• Challenges faced by healthcare professionals adjusting to...

Unlock the potential to save lives with our exciting discussion on the Anesthesia Patient Safety Foundation's Technology Education Initiative course. Featuring Dr. Michael Kazior, an esteemed anesthesiologist and intensivist, we spotlight the crucial skills of manual external defibrillation, cardioversion, and pacing. Dr. Kazior shares his personal journey and highlights the stark educational gaps in defibrillator usage among anesthesia professionals. This course, born from the collaboration between the APSF and the American Society of Anesthesiologists, promises an interactive learning experience that aims to bolster confidence and competence in using these vital life-saving devices. Additionally, this course is a robust addition...

Can we significantly reduce pediatric medication errors in anesthesia care? This podcast episode explores the urgent need to address medication errors in pediatric anesthesia, highlighting effective strategies to improve patient safety. We discuss the implementation of tools such as the Anesthesia Medication Template, pre-filled syringes, and barcode scanning systems, as well as insights from experts on enhancing current practices.

• Examination of medication error statistics in pediatric anesthesia
• Discussion of the Anesthesia Medication Template (AMT) and its benefits
• Overview of pre-filled syringes as a safety measure
• Insights on challenges with pre-filled syringes
• Evaluation of barcode sc...

Unlock the secrets of preventing pediatric perioperative medication errors with insights from our esteemed guests, Eva Lu-Boettcher and Rahul Koka. Pediatric patients face unique challenges due to variations in body weight and dosing calculations, making them particularly vulnerable to medication errors. Join us as we explore the discrepancies between self-reported and observed error rates and gain a deeper understanding of the workflow vulnerabilities anesthesia professionals encounter. We also share findings from the Wake Up Safe Collaborative, revealing the administration phase as the most error-prone and illustrating how preventative and mitigative barriers can effectively manage risks through a bowtie analysis.<...

What if a simple change in routine could save lives in the operating room? Join us as we explore this possibility with Jonathan Charnin, who shares his expertise and passion for improving hand hygiene practices in anesthesia. Hand hygiene may seem like a small detail, but it plays a crucial role in preventing the spread of pathogens and reducing surgical site infections.

We'll unravel the complexities behind implementing effective hand hygiene protocols and discuss the obstacles and opportunities that lie ahead. Discover the startling truth about how many hand hygiene events should occur during a routine anesthetic...

Join us on a fascinating exploration with Alli Bechtel, a dedicated anesthesiologist and the Anesthesia Patient Safety podcast host, who reveals the surprising journey from the United States to New Zealand in pursuit of a better work-life balance. Bechtel shares her unique insights into the supportive healthcare environment she found across the globe and the role of teamwork in ensuring patient safety in anesthesia. Her story provides a meaningful look at the personal and professional transitions involved in moving to a new country and how a close-knit hospital community can enhance medical practice.

Discover the evolution of...

What does it take to stay prepared for a rare but potentially life-threatening anesthesia complication like malignant hyperthermia (MH)? Join us as Dr. Henry Rosenberg, a trailblazer in the field and founder of the Malignant Hyperthermia Association of the United States, shares his insights on the evolution of MH diagnosis and management. We promise you'll gain a deeper understanding of the transition from traditional muscle biopsy contracture tests to cutting-edge DNA diagnostic methods.

Preparedness and vigilance are key themes as we explore the responsibilities of anesthesia professionals in ensuring patient safety for those susceptible to MH. We...

Unlock the future of perioperative medicine with insights into remimazolam, the cutting-edge benzodiazepine poised to transform anesthesia practices. We uncover the remarkable features of remimazolam, from its rapid onset and short duration to its unique reversibility and minimal impact on cardiac and respiratory systems. Discover why this novel sedative is gaining traction for neurosurgery and neurology applications, especially for short procedures in the U.S. market.

Explore the nuances of remimazolam's pharmacology, its economic considerations, and how it stands out in complex cardiovascular cases and interventional radiology. With practical insights into its effective use even in MRI...

What happens when a defective CO2 absorbent canister leads to ventilation failure during surgery? Our latest episode uncovers the hidden risks of hypoventilation and leaks in anesthesia machines following intra-procedure CO2 canister replacement. We discuss the critical role of manufacturers in providing warnings about potential equipment failures, the importance of backup systems, and the environmental considerations of CO2 absorbent usage and low flow anesthesia. By examining real-world scenarios and various ventilator types, we equip you with strategies to enhance patient safety, all while balancing the benefits of reduced gas flows with the ecological impact of absorbent materials. Tune in...

What if a simple component replacement could jeopardize patient safety during surgery? Join us as we discuss critical anesthesia safety concerns with our special guest, Dr. Yuki Kuruma, an experienced anesthetist from Japan's Saiseikai Matsusaka General Hospital. Kuruma sheds light on the potential dangers of replacing CO2 absorbent canisters and the risk of hypoventilation caused by defective canisters. Reflecting on a significant 2013 incident involving a canister leak, we uncover why these issues remain pressing today and the urgent need for heightened awareness among anesthesia professionals.

In addition to safety risks, this episode offers a valuable platform for...