Anesthesia Patient Safety Podcast

If you’ve ever heard “it’s just pressure” during a C-section and felt your gut twist, you’re not alone, and it may be a patient safety issue hiding in plain sight. We sit down with Dr. Ruthi Landau, the Virginia Apgar Professor of Anesthesiology and Director of Obstetric Anesthesiology at Columbia University, to get practical about what patients actually feel during cesarean delivery anesthesia and what we can do when those sensations become uncomfortable.

We talk through why labeling sensations as pressure versus pain misses the point, and why the better clinical question is simple: “Is it uncomf...

Pain during cesarean delivery is not “just pressure,” and it is not rare. We dig into why inadequate pain control during C-section remains underrecognized even as patient-reported data suggest it may be one of the most common anesthetic complications in obstetric anesthesia, with consequences that can reach far beyond the operating room including PTSD, postpartum depression, disrupted bonding, and lasting distress about birth.

We walk through what the research has measured so far (conversion to general anesthesia, neuraxial replacement, and intravenous rescue medications) and what those markers can miss when the team does not recognize pain in real...

Eye pain in the PACU can feel like an automatic page to ophthalmology, but it doesn’t have to be. We break down postoperative corneal abrasions on the show today. 

We share practical, clinician-ready guidance drawn from a multidisciplinary PACU corneal abrasion protocol developed with anesthesiology and ophthalmology expertise. You’ll hear exactly what to ask and look for when a patient reports blurry vision or a gritty sensation, the red flag that changes everything (vision loss), and how fluorescein stain plus a cobalt blue light exam can quickly sort a true corneal defect from keratoconjunctivitis or dry e...

“Opioid-sparing” sounds like an automatic win until you look closely at what replaces the opioids. We take on one of the toughest questions in modern anesthesiology: how do we reduce opioid-related harm without trading it for medication interactions, kidney injury, bleeding risk, rebound pain, or poorly controlled postoperative pain?

We break down what individualized multimodal analgesia really means in day-to-day anesthesia practice. That starts before the first dose is ordered, with a preoperative assessment that weighs comorbidities, baseline renal function, hydration status, and potential drug-drug interactions. We also dig into the medication safety side of multimodal protocols, incl...

A virus can feel “far away” right up until it lands in a preop bay with a fever, abdominal pain, and a story that only makes sense weeks later. We walk through what anesthesia, perioperative, and critical care teams need to know about hantavirus, why the incubation period (often 7 to 42 days) complicates detection, and how the Andes virus changes the conversation because it is the only hantavirus known to spread person to person.

We start with the basics that matter at the bedside: common transmission pathways like inhalation of aerosolized particles from rodent droppings, the two major clin...

Twenty-two steps to reach an airway is not a quirky workflow problem, it’s a patient safety problem. We’re turning our attention to a neuro-interventional radiology (Neuro IR) suite where cables, monitors, and a poorly positioned anesthesia machine created a cramped, high-friction non-operating room anesthesia (NORA) environment. Joined by John Edwards, CRNA, we unpack how a real-world quality improvement project at the University of Kentucky Medical Center turned staff frustration into an evidence-based anesthesia workspace redesign.

We start with what triggered the change: frontline clinicians describing barriers to optimal patient care, unsafe ergonomics, and a layout that...

Condensation in an anesthesia circuit looks harmless until it starts skewing flow sensor readings or creating the kind of warm, wet environment where microbes can thrive. We pick up the story after the investigation into moisture and mold concerns in GE operating room ventilators, then move straight into the questions clinicians asked most: which filters matter, how low-flow anesthesia changes the moisture equation, and what “moisture mitigation” actually means at the bedside.

We walk through APSF guidance on filtration, including why a high-quality filter between the expiratory limb and the anesthesia machine is a key defense for keep...

Black particles in a breathing system are the kind of finding that makes every anesthesia professional stop and look twice. We’re sharing what a large health system uncovered after concerns for mold and moisture accumulation surfaced inside certain GE Healthcare anesthesia workstations used in operating rooms, especially during longer cases and in humid conditions. What started with a routine inspection quickly scaled into a broad audit of OR ventilators, a review of internal moisture points, and an urgent push for real-world mitigation.

We walk through what the investigation found, what cultures grew, and the question everyone as...

Delirium, pain, and prolonged ventilation can feel like “expected” bumps in perioperative care until you look closely at the data. We walk through four recent APSF In the Literature reviews and pull out what’s actually actionable for anesthesia patient safety right now, with clear numbers and real-world implications.

First, we dig into a randomized controlled trial of S-ketamine for elderly patients undergoing total hip or total knee arthroplasty under neuraxial anesthesia. With general anesthesia out of the equation, the study reports a notable drop in postoperative delirium, raising practical questions about when S-ketamine belongs in your plan a...

The world has the knowledge to make anesthesia safer, but too often it’s the basics that are missing where the need is greatest. We’re talking about perioperative patient safety in low- and middle-income countries (LMICs), where a smaller share of surgical volume can still carry a massive share of perioperative death and disability. That imbalance isn’t inevitable, and it isn’t solved by one tool or one training course. It changes when systems change. 

We walk through the biggest systemic barriers starting with anesthesia workforce shortages and the downstream effects on access, delays, and confidenc...

Catastrophic neurologic injury after a routine anesthetic is the kind of signal that stops you in your tracks, and that’s exactly why we’re talking about new perioperative recommendations for patients with maternal Venezuelan ancestry. We’ve seen reports of otherwise healthy adults and children who deteriorated after general anesthesia, with sevoflurane appearing repeatedly in the documented events. That pattern has led the American Society of Anesthesiologists and the Society for Pediatric Anesthesia to issue updated guidance aimed at preventing harm while the science catches up. 

We walk through what clinicians need to know about the suspect...

The fastest way to weaken patient safety isn’t a missing checklist, it’s a team that stops trusting each other. We dig into “infinite anesthesia” and the next step, “leading infinitely,” a practical relational leadership approach designed to build psychological safety, empathy, humility, and civility in perioperative care.

We share why anesthesia professionals are uniquely positioned to lead across the full health system: we work at the intersection of surgeons, proceduralists, nurses, and hospital leaders, and we see how small culture signals impact big operational and safety outcomes. You’ll hear how trust-based teamwork can improve clinician well...

Workforce shortages and rising demand are squeezing perioperative teams from every side and that pressure can turn colleagues into rivals. We push back on that mindset and explore a different way to think about the future: “infinite anesthesia,” a long-term approach to anesthesia patient care and anesthesia patient safety that prizes trust, teamwork, and a workplace where every clinician is valued.
 
We share highlights from the APSF Newsletter article “Leading Infinitely in Perioperative Care” and hear directly from author, Dr. Matt Sherrer, on why relational leadership has to extend beyond anesthesia, nursing, and the operating room. When surgeons...

Measles can walk into your OR before the rash ever shows up, and that’s what makes perioperative measles planning so high stakes. We break down the timing that drives everything: incubation, the contagious window from four days before rash onset through four days after, and how recent exposure during an outbreak should change your elective surgery decisions.

We also zoom out to the bigger picture behind today’s resurgence of measles, including declining vaccination rates and travel-related reintroduction. Then we get practical about what anesthesia professionals need at the bedside: how to confirm immunity status, what symp...

A difficult airway is hard enough in a modern hospital. Now imagine managing it on a ship, far from resupply, where “availability supersedes preference” and a device that worked last month might quietly drift out of spec. That’s the tension we unpack while exploring reusable versus single-use airway devices in humanitarian anesthesia and why planning is what protects patients when seconds count.

We’re joined by Matt McGee, a Navy anesthesiologist who served as department head for anesthesiology aboard the USNS Comfort during Continuing Promise 2025. He walks us through what his team saw with reusable airway tools af...

Work stress doesn’t come only from long days and hard cases in the operating room. It also comes from the invisible rules a team lives by: who gets heard, how conflicts get handled, what “efficiency” really means, and whether anyone feels safe enough to speak up. We take on operating room culture change through the lens of pro-social behavior and explain why small, voluntary actions like cooperation, gratitude, and direct support can translate into lower burnout, clearer communication, and stronger patient safety.

We walk through Elinor Ostrom’s Nobel Prize winning core design principles for effective group co...

The fastest way to make an operating room feel unsafe isn’t a broken monitor, it’s a team that stops acting like a team. We dig into pro-social behavior: the small, voluntary actions that support other people and the group, including kindness, cooperation, and gratitude, and why these behaviors can lower cognitive load, strengthen communication, and improve anesthesia patient safety when the schedule gets tight and the stakes are high.

We share highlights from the February 2026 APSF Newsletter feature “Reduce Burnout, Improve Safety and Efficiency: Consider Pro-Social Behavior,” with insights from APSF leader Jeffrey Feldman. He connects...

Cannabis has gone mainstream, but perioperative risk has not improved. THC products are far more potent than they were decades ago, emergency room visits are climbing, and many patients still walk into surgery thinking that it’s safe. We want anesthesia professionals to have a clearer, evidence-informed way to think about cannabis and anesthesia before the next case. 

We open the latest APSF newsletter feature article, “Cannabis and Anesthesia,” and bring in author Trisha Meyer to frame why this topic matters now. Together, we walk through the pharmacology that shows up at the bedside: THC vs CBD, CB1 and...

Postoperative delirium is one of the most common adverse events after surgery for older adults, and it can change a patient’s recovery, independence, and quality of life. We take a practical, evidence-focused look at what anesthesia teams can actually do to support perioperative brain health, using the latest recommendations from the APSF Brain Health Patient Safety Advisory Group.

We walk through the four questions clinicians keep asking at the bedside. First, does intraoperative hypotension drive delirium? We break down why the data is mixed, what mechanisms make hypotension plausible, and why individualized hemodynamic goals with rapid co...

Transfers don’t have to feel like controlled chaos. We break down how to move a critically ill patient from the OR to the ICU with confidence by pairing structured handoffs with disciplined infection prevention—so information moves seamlessly while pathogens hit a dead end.

We start by revisiting the ICU’s influence on anesthesia practice through the story of ARDS and lung-protective ventilation. The shift to 6 ml/kg ideal body weight didn’t just save lungs in the unit; it reshaped intraoperative strategy to reduce ventilator-induced injury for surgical patients. From there, we zoom into the human fa...

A small air bubble, a missed monitor cue, a late call for help—tiny moments that can change everything. We sit down with Dr. Max Feinstein to unpack how real-world anesthesia education builds safer clinicians, why attention is our most precious resource, and how culture—not heroics—prevents harm. From clear talk about morbidity and mortality to practical tactics like just-in-time simulation and curated literature, we map out a grounded approach to training that sticks under pressure.

For new attendings, the leap to autonomy can feel surreal. We talk through imposter syndrome, the virtue of asking for help e...

Curiosity can change a career—and a field. We sit down with pediatric cardiac anesthesiologist and creator Dr. Max Feinstein to trace how a love of ethics, a pandemic schedule, and a phone camera evolved into a mission to make anesthesia safer through clear, accessible education. From the first CA1 walk throughs to high-stakes cardiac cases, Max explains how video demystifies monitors, medications, and moments that raise anxiety for patients and challenge new clinicians.

We dig into the roots of patient safety—why medication errors still matter, how standardized setups and closed-loop communication reduce risk, and where pedi...

When air meets uncertainty, judgment matters most. We dig into the evolving landscape of airway management where video laryngoscopy, supraglottic devices, and even ECMO promise better outcomes, yet cognitive errors and non‑OR settings still account for many of the most devastating events. Drawing on recent studies, malpractice claims, and national audits, we map the pressure points that turn a difficult intubation into a crisis and show how to defuse them with clearer plans, tighter teamwork, and sharper skills.

We start with three high‑yield rules that change outcomes fast: cap the number of attempts, anticipate physiologic cras...

What if the anesthesia workstation could see trouble coming and stop it before it starts? We explore how anesthesia moves from reactive to predictive by blending AI, medical-grade wearables, and closed loop systems with a strong safety culture. The story of Alex—a 75-year-old who developed postoperative delirium and fell—anchors the stakes and shows how early signals, if recognized and acted on, can change a life.

We break down practical uses of machine learning in the perioperative space: forecasting hypotension minutes ahead, integrating multimodal physiologic data for real-time decision support, and taming alarm fatigue with smarter, cont...

Maternal safety has never mattered more, and the stakes span far beyond the delivery room. We revisit four decades of progress in obstetric anesthesia—from safer neuraxial techniques and airway strategies to medication safeguards—and then get honest about what still puts patients at risk. With author insights and frontline examples, we connect the dots between evidence, teamwork, and the lived experience of childbirth to show where anesthesia can lead meaningful change.

Rising patient complexity reshapes our role. We lean into risk stratification with the Obstetric Comorbidity Index, proactive antenatal planning, and sustained postpartum follow-up. We address mate...

A cocaine-positive patient rolls into the OR and the monitors look fine—until twenty minutes after induction, when the blood pressure plummets. We unpack that swing from sympathetic surge to sudden crash through two real cases: an emergent trauma laparotomy complicated by asystole and a chronic intranasal user with profound hypotension that only responded to direct-acting vasopressors. From there, we connect the dots to the pharmacology that makes these events predictable and, with the right plan, manageable.

We talk candidly about what matters before wheels-in: timing of last use, objective signs of toxicity, and targeted testing. You’ll h...

A remarkable safety story runs through regional anesthesia, from the era of blind needle placement to a modern practice guided by real-time ultrasound, lipid rescue, and reliable team checklists. We walk through the key milestones that cut complications, accelerated block onset, and lowered conversion to general anesthesia, while keeping a clear eye on the hazards that remain. Along the way, we explain how a simple seven-point timeout helps prevent wrong-sided blocks and why ultrasound has reshaped dosing, local anesthetic spread confirmation, and failure rates.

We also dig into the numbers around local anesthetic systemic toxicity and neurologic...

A single syringe swap should never decide a patient’s fate. We pull back the curtain on forty years of anesthesia medication safety to show what truly works—then tackle the hard part: getting proven safeguards into every OR, every time. From look-alike vial hazards to standardization that actually sticks, this conversation blends frontline realities with practical steps leaders can implement now.

We dig into the high-stakes TXA wrong-drug, wrong-route crisis and explain why eliminating vials and moving to ready-to-administer IV bags is a must. Along the way, we unpack new FDA label warnings, the APSF–ISMP joint...

Seconds define outcomes in the OR, and medication safety lives in those seconds. We take you inside four decades of work by the Anesthesia Patient Safety Foundation to show how our field shifted from relying on vigilance to building systems that make the right action the easy action. Along the way, guest contributor, Dr. Elizabeth Rebello, shares why standardization, technology, and culture are not buzzwords but lifelines when a single clinician must select, prepare, and administer drugs under pressure.

We break down the STPC framework born from the 2010 Stoelting Conference—standardization, technology, pharmacy/pre-filled/pre-mixed, and culture—and...

Nausea shouldn’t be the most memorable part of surgery. We take a clear, evidence-based look at postoperative nausea and vomiting, from identifying who’s at risk to building smarter prophylaxis bundles and choosing the right rescue when prevention falls short. With guest insights from Dr. Connie Chung, we unpack the Fourth Consensus Guidelines, translate them into practical workflows, and explore how Amisulpride—an atypical D2 antagonist—changes the game with an FDA indication for rescue after failed prophylaxis.

We start by shrinking baseline risk: consider regional anesthesia when feasible, leverage TIVA with propofol, avoid nitrous and volatile...

Safety for children under anesthesia shouldn’t depend on luck or location. We walk through 100+ years of progress in pediatric anesthesia and focus on the next wave of innovations that can make first attempts safer, dosing smarter, and systems more reliable—especially for neonates and infants who face the highest risk.

We start with the historical milestones that changed outcomes: pulse oximetry, capnography, standardized monitoring, and the rise of pediatric training and ICUs. Then we examine where progress must accelerate. Video laryngoscopy is improving first-pass success and reducing desaturation by giving teams a brighter, shared view of the...

A routine dental visit should never turn into a medical emergency. We sit down with Dr. Rita Agarwal, pediatric anesthesiologist and patient safety advocate, to unpack why dental anesthesia operates on a separate track from hospital-based care—and how that gap can put patients at risk. From the heartbreaking story of six-year-old Caleb Sears to the hard truths about monitoring requirements, staffing models, and training, this conversation brings clarity to a topic most families and many clinicians assume is standardized.

We dive into what “sedation” really means in dentistry, why route-based labels can hide true depth of anesth...

The fastest way to improve post-cesarean recovery is to start before the first incision—by setting expectations, testing the block, and validating what patients feel. We sit down with Dr. Ruth Landau, Virginia Apgar Professor and Chief of Obstetric Anesthesia at Columbia University, to map a safer path from the OR to the nursery: neuraxial-first analgesia, scheduled non-opioids, and small, truly PRN opioid prescriptions at discharge. She explains how intrapartum cesareans carry higher risk for discomfort and why simple shifts—active epidural management, timely redosing, and clear, compassionate communication—reduce pain, opioid exposure, and the chance of a traumatic birth...

Anterior mediastinal masses make even seasoned anesthesiologists pause, and for good reason: a stable, upright patient can decompensate with a single change in position or a single dose of the wrong drug. We walk through a clear, stepwise approach that starts with anatomy and symptom red flags, then translates imaging, echocardiography, and pulmonary function testing into real-world decisions at the bedside. The focus stays practical: how to pick the safest setting, when to avoid general anesthesia, and what to prepare before anyone touches the airway.

We break down adult and pediatric risk criteria, including mass-to-chest ratio, degree...

Ever walked into a new OR and spent the first ten minutes hunting for an airway bougie or a computer log-in that actually works? We dig into the hidden safety risks of a transient anesthesia workforce and share practical, fast-moving fixes that keep patients safe while keeping rooms open. With staffing shortages reshaping coverage models across the United States and beyond, locum clinicians are essential—but inconsistent environments, unclear escalation paths, and fragmented communication can turn small friction points into big hazards.

We unpack what the current evidence says—and doesn’t—about locum-related outcomes. A UK qualitat...

Imagine stepping into an operating room where oxygen isn’t guaranteed, capnography is rare, and one anesthesiologist might serve a million people. That’s the reality many patients face, and it’s exactly where meaningful change can save the most lives. We sit down with Dr. Kelly McQueen, professor of anesthesiology and department chair at the University of Wisconsin, to explore what it takes to deliver safe anesthesia in low and middle-income countries and how practical solutions—rooted in training, equipment reliability, and data—can close the gap.

We trace how safety became foundational in anesthesiology in high-resou...

What if the biggest risks in maternal care are not just clinical, but cultural? We dig into the hard truth that speaking up can feel risky, pain during cesarean is often underestimated, and rare obstetric crises can overwhelm memory. From there, we chart a path toward safer births with practical tools that any team can use: psychological safety to unlock communication, structured pre‑briefs and rapid debriefs, and cognitive aids that turn chaos into coordinated action.

We walk through the lived reality of intraoperative pain—why negative skin tests don’t guarantee visceral coverage, how fear of genera...

Power, control, and communication shape every birth—and too often, they decide whether care feels safe or traumatic. We dig into practical ways to prevent harm in obstetric anesthesia by centering trauma-informed care, reducing stigma around substance use disorder, and giving real choice during cesarean delivery.

We start by distinguishing complications from trauma and laying out the six pillars that make care safer: safety, transparency, peer support, collaboration, empowerment, and cultural humility. From there, we map prevention across three levels—primary disruption of trauma through clear communication and environment, secondary recognition and mitigation of events, and tertiary supp...

Maternal care is at a breaking point: delivering hospitals are disappearing while deaths that could be prevented keep climbing. We pull back the curtain on how structural racism, policy headwinds, and technology blind spots compound risk for birthing people—especially Black, Hispanic, rural, and low‑income patients—and what it takes to change the trajectory now.

We start by naming the problem with data: stable birth rates alongside a steep decline in maternity units have created care deserts. From there, we dig into disparities in obstetric anesthesia, including lower neuraxial labor analgesia use and higher rates of genera...

Welcome back to our 2025 Stoelting Conference Podcast Series. 

Fever isn’t the fail-safe it’s made out to be—especially in pregnancy. We walk through the subtle ways maternal sepsis hides in plain sight, why a quarter of those who died never had a fever, and how early warning tools, rapid antibiotics, and source control change the odds. From there, we pivot to maternal hemorrhage and show how quantifying blood loss with calibrated drapes plus a treatment bundle outperforms the old habit of visual estimation. We dig into TXA timing for high‑risk cesarean patients, the evidence gaps on t...