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 standardized programs in patient experience and safety
• Anesthesiologists possess unique abilities to manage complex operations that no one else in the hospital can match
• Current residency programs need to incorporate leadership and operational training
• Developing future leaders requires identifying those with leadership attributes and providing structured mentorship
• The lines between academic and private practices are blurring as all face similar challenges
• Hospital partners increasingly expect "skin in the game" with performance metrics tied to financial support
• Standardization of processes offers opportunities to improve efficiency while maintaining safety

To learn more about improving perioperative processes, check out the Fresh Flow podcast, a collaboration between University of Alabama Medicine and the Association of Anesthesia Clinical Directors.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/256-skin-in-the-game-a-fresh-flow-podcast-takeover/

© 2025, The Anesthesia Patient Safety Foundation

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 potential side effects, from common temporary issues like dry mouth and nausea to rare serious complications. We discuss allergic reactions to anesthetics, distinguishing between true allergies, pseudo-allergic responses, and typical side effects. Throughout the conversation, we emphasize how patients can reduce their risks through open communication with their healthcare team, following pre-surgery instructions, and disclosing their complete medical history.

Knowledge is power, especially when facing surgery. By understanding what happens during anesthesia and how medical professionals ensure safety throughout the process, patients can approach their procedures with greater confidence and participate more actively in their care. Share this episode with anyone preparing for surgery who deserves clear, factual information about what to expect during their anesthetic journey.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/255-what-you-need-to-know-before-going-under/

© 2025, The Anesthesia Patient Safety Foundation

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 patient is the primary stakeholder in their own safety, why are they left out of these conversations?" 

We explore the guide's three detailed sections – Anesthesia FAQ, Surgery FAQ, and Pain Management FAQ – covering everything from different types of anesthesia to essential questions patients should ask their clinicians before surgery. The guide addresses common concerns like the risks of anesthesia, what to expect during recovery, and options for managing post-operative pain. For medical professionals, it serves as a valuable reference during patient consultations.

Healthcare has evolved from being done "for" patients to being done "with" patients as active participants. This shift represents the future of medical care – a collaborative approach where informed patients and dedicated healthcare professionals work together to achieve the best possible outcomes. We hope that you will check out this invaluable resource today and share it with patients, colleagues, and loved ones. Visit APSF.org or check our show notes for more information.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/254-the-patients-guide-to-anesthesia-and-surgery/

© 2025, The Anesthesia Patient Safety Foundation

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 potentials (MEPs) should be avoided
• Newer devices may be MRI conditional but require specific protocols including device interrogation
• Regional anesthesia should use ultrasound guidance rather than nerve stimulation techniques
• Neuraxial anesthesia is not contraindicated for spinal cord stimulator patients but must be placed below insertion level
• ECT can be performed with device turned off and careful electrode placement
• Devices should be turned back on before emergence from anesthesia
• Postoperative evaluation should include checking for thermal injuries and neurologic changes

Thanks for joining us for our 253rd episode! Wow, 250 and counting! Go tell a friend or colleague about our show as we work toward 500 episodes. If you enjoy the Anesthesia Patient Safety Podcast, please give us a five-star rating, subscribe, and share with colleagues.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/253-when-electrocautery-meets-implanted-devices-what-every-anesthesia-professional-needs-to-know/

© 2025, The Anesthesia Patient Safety Foundation

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 with specific interim recommendations

If you have any questions or comments, please email us at [email protected]. Visit apsf.org for detailed information and check out the show notes for links to all topics discussed.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/252-managing-neurologic-stimulators-a-critical-guide-for-safe-anesthesia/

© 2025, The Anesthesia Patient Safety Foundation

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 easily and flames spread exponentially faster, putting patients at serious risk of harm.

The experts outline clear, evidence-based approaches to prevent surgical fires, including the use of oxygen blenders for precise control and securing the airway when higher oxygen concentrations are clinically necessary. They share encouraging data showing significant reductions in surgical fire incidents over the past decade, while emphasizing that complete elimination is both possible and necessary.

Whether you're an anesthesia professional, surgeon, or perioperative nurse, this episode provides essential knowledge to protect your patients from this preventable complication. Visit the APSF website for comprehensive resources, including videos and algorithms, to implement surgical fire prevention protocols at your institution. By understanding and applying these recommendations, we can work together to ensure no patient is ever harmed by a surgical fire again.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/251-surgical-fires-the-30-oxygen-rule/

© 2025, The Anesthesia Patient Safety Foundation

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 <2 years require special consideration due to immature neuromuscular systems and distinct physiology
• Recurarization cases exist but are rare, primarily in very young patients
• Pregnancy considerations include theoretical concerns about progesterone binding
• Breastfeeding compatibility varies based on lactation stage, with early postpartum period requiring more caution
• Continued research needed to establish definitive guidelines, especially for neonates, infants, and lactating patients

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/250-sugammadex-in-special-populations-what-every-anesthesia-professional-needs-to-know/

© 2025, The Anesthesia Patient Safety Foundation

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 Sugammadex may still offer advantages over traditional reversal agents in these patients.

Pregnant patients present another complex scenario. Does Sugammadex bind to progesterone? What might this mean for maintaining pregnancy? We examine the current Society for Obstetric Anesthesia and Perinatology guidelines alongside emerging research that offers glimpses of hope for safe use. From animal studies to limited human case reports, we unpack what we know and the significant questions that remain unanswered.

The conversation extends to breastfeeding considerations and emergency scenarios where the risk-benefit analysis shifts dramatically. Through expert insights and references to the latest studies, we provide practical knowledge for anesthesia professionals navigating these challenging clinical situations. This episode serves as a crucial reminder that despite advances in pharmacology, patient safety still demands individualized care, vigilant monitoring, and thoughtful application of evolving evidence.

Want to further enhance your patient safety skills? Check out the Manual External Defibrillation course available at no cost through the ASA learning management system. Join us next week as we continue our discussion with a focus on pediatric patients and Sugammadex use.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/249-sugammadex-safety-special-populations-special-concerns/

© 2025, The Anesthesia Patient Safety Foundation

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 medication errors
• Technology integration through barcode readers and computerized decision support enhances safety
• Pharmacy support with pre-mixed solutions and pre-filled syringes reduces preparation errors
• Post-operative monitoring remains critical for catching delayed medication reactions
• Safety culture should emphasize root cause analysis rather than punishment for medication errors
• Implementation of standard protocols is essential for managing new medications with limited safety data

Visit APSF.org and Openanesthesia.org for detailed information and resources on medication safety in anesthesia practice.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/248-beyond-the-mask-an-openanesthesia-collaboration-on-perioperative-drug-safety/

© 2025, The Anesthesia Patient Safety Foundation

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 flow with a patient's minute ventilation can dramatically reduce carbon emissions without compromising safety or induction effectiveness.

What makes Dr. Lu-Boettcher's approach particularly fascinating is her application of behavioral science and "nudge theory" to achieve lasting change. By implementing default ventilator settings, providing comparative feedback to providers, and creating electronic reminders, her team achieved a remarkable 41% increase in compliance with sustainable practices. 

Ready to make your anesthesia practice more sustainable? Listen now to learn practical techniques for greener pediatric anesthesia care that maintains the highest safety standards while protecting our planet. The future of anesthesia must balance excellent patient care with environmental stewardship—and the time to start is now.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/247-nudge-your-way-to-greener-pediatric-anesthesia/

© 2025, The Anesthesia Patient Safety Foundation