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 injury, translating data into everyday decisions at the bedside. You’ll hear how improved dosing protocols, reduced volumes with ultrasound guidance, and rapid access to lipid therapy drive cardiac toxicity toward zero. We unpack the real contributors to failed blocks—anatomic variation, communication barriers, obesity, surgical factors, and experience—and share practical, high-yield steps for safer performance, from short-bevel needle selection to injection pressure monitoring and clear patient counseling.

Looking forward, we explore the next wave of tools transforming the block room: 3D and 4D ultrasound for richer visualization, needle tip tracking for faster and steadier trajectories, and pressure monitoring that warns before harm. We spotlight how AI could assist with ultrasound interpretation, trajectory planning, and complication prediction, while wearables and high-fidelity simulation extend safety beyond the procedure to early detection and better training. If you care about preventing never events, reducing LAST, and building a resilient regional anesthesia workflow, this conversation lays out what works now and what’s coming next.

Enjoyed the insights? Subscribe, share with a colleague, and leave a review to help more clinicians advance patient safety.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/290-from-blind-needles-to-ultrasound-the-safety-revolution-in-regional-anesthesia/

© 2026, The Anesthesia Patient Safety Foundation

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 recommendations, and the forcing functions that prevent catastrophes, including NRFit for neuraxial routes and barcode verification at the point of care. We also surface quieter threats—vial coring, variable concentrations, and chaotic storages—and show how color-coded, readable labels and organized carts reduce cognitive load when seconds matter.

Opioid safety gets equal focus. We connect preoperative risk assessment, multimodal analgesia, and smart postoperative monitoring to reduce opioid-related harm without compromising comfort. Technology has matured too: AI-driven clinical decision support can flag dosing and drug-choice risks in real time, but only if woven into workflows that clinicians trust. Throughout, we return to the implementation gap: success depends on leadership support, supply chain alignment, failure mode analysis, transparent reporting, and peer support that sustains a just culture.

If you care about safer anesthesia—standardized labels and concentrations, prefilled syringes, organized storage, barcode checks, and a culture that learns—this is your playbook. Listen, share with your team, and help push your institution from knowing to doing. Subscribe, leave a review, and tell us which safeguard you’ll champion next.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/289-forty-years-of-anesthesia-medication-safety-what-works-and-whats-next/

© 2026, The Anesthesia Patient Safety Foundation

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 translate it into real steps: standardized concentrations for high-alert medications, removal of concentrated lethal agents from the OR, barcode-based identification before draw-up or administration, and smart infusion pumps with user-friendly drug libraries. You’ll hear how prefilled syringes, automated dispensing, and clinical pharmacist integration reduce prep errors and free up attention when it matters most.

The story moves forward with the 2018 focus on drug safety profiles and the stubborn challenge of shortages. We explore actionable ideas: building a standing shortage committee, communicating substitutions fast, simplifying carts and labels when suppliers change, and embracing multimodal analgesia. 

By the end, you’ll have a clear map of what to implement now—printed labels, prefilled syringes, smart-pump integration with your anesthesia record—and what to champion next across your institution. Subscribe and share with a colleague who leads in the OR. Then tell us: which safety step will you push across the finish line this year?

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/288-forty-years-of-perioperative-medication-safety-progress/

© 2026, The Anesthesia Patient Safety Foundation

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 volatiles in longer cases, hydrate well, and spare opioids with multimodal analgesia. Then we scale prophylaxis to risk: dexamethasone at induction, 5-HT3 antagonists at the end, transdermal scopolamine for select patients, and low-dose Droperidol where appropriate. When prophylaxis fails, we explain why repeating ondansetron rarely helps and how switching classes boosts rescue success. Along the way, we map the safety terrain for D2 antagonists—QT prolongation, extrapyramidal risks, anticholinergic effects—so you can individualize care for elderly patients, those on antipsychotics, or anyone with potential drug interactions.

We also dig into what’s new: contemporary analyses of Droperidol at antiemetic doses, and growing evidence that Amisulpride pairs well with Ondansetron or Dexamethasone to improve outcomes. Pediatric pearls include TIVA, fluids, and a two-drug prophylaxis backbone for longer or higher-risk cases. The result is a practical, stepwise approach you can apply tomorrow—reduce risk, layer mechanisms, and rescue smartly—to cut PACU delays, avoid unplanned admissions, and deliver a recovery that feels as good as the surgical fix.

If this deep dive helps your practice, follow, share with your team, and leave a quick review to help others find the show. Tell us your go-to PONV bundle and whether your site stocks Amisulpride.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/287-a-new-era-for-ponv-safety-guidelines-and-smarter-rescue/

© 2025, The Anesthesia Patient Safety Foundation

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 airway. Ultrasound enhanced by AI promises needle guidance, better vascular access, and more consistent regional anesthesia. Gastric ultrasound could reshape fasting practices, reducing hypotension, nausea, and anxiety while safeguarding against aspiration. Alongside these tools, processed EEG helps tailor volatile agents and propofol to the developing brain, pushing practice from population averages to precision dosing.

We also look ahead to artificial intelligence as a connective layer across perioperative care. Think risk stratification in the EHR, early-warning analytics for intraoperative instability, and smarter OR management that reduces cancellations and costs. With expert insights from pediatric anesthesiologist, Dr. Elizabeth Malinzak, we name the real barriers—training, cost, bias, regulation—and stake a claim for proactive safety science over reactive fixes. The goal is equitable, high-quality anesthesia care for every child, in every setting.

If this conversation resonates, follow the show, share it with a colleague, and leave a quick review. Your support helps spread practical tools and ideas that keep our smallest patients safe.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/286-pediatric-anesthesia-safety-past-gains-next-frontiers/

© 2025, The Anesthesia Patient Safety Foundation

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 anesthesia, and how inconsistent state rules leave dangerous blind spots. Dr. Agarwal explains the pillars of safer dental sedation: careful patient selection, a separate and qualified anesthesia provider for deep sedation or general anesthesia, and the ability to rescue from the next deeper level, including effective bag-mask ventilation and the timely use of reversal agents. We also explore the role of capnography, reliable oxygen supply, and scenario-based drills that make rapid response second nature.

Safety grows when systems learn. That’s why we spotlight the urgent need for robust data: routine reporting of outcomes and near misses from dental offices using a simple, standardized tool. Pair that with harmonized terminology aligned to ASA levels, simulation training, and clear emergency protocols, and dentistry can match the reliability gains anesthesia has achieved in hospitals. For parents and patients, we offer direct, practical questions to ask before consenting to sedation—who monitors, what training they have, what equipment is on hand, and whether sedation is truly necessary.

If this conversation gave you new tools or changed your perspective, help us spread the word. Subscribe, share with a colleague or a parent who needs it, and leave a review so more people can find evidence-based guidance on dental anesthesia safety.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/285-safer-smiles/

© 2025, The Anesthesia Patient Safety Foundation

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 experience.

We break down practical steps that clinicians can apply today. Learn the difference between systemic and neuraxial opioids for breastfeeding safety, when to use ultrasound-guided TAP or QL blocks after general anesthesia, and how micro-boluses of IV dexmedetomidine can blunt visceral sensations, anxiety, and shivering. Dr. Landau also shares the latest from ASA statements and SOAP guidance, including dose-dependent monitoring strategies that make neuraxial opioids feasible even in resource-constrained settings.

The conversation moves beyond pharmacology to focus on outcomes that matter to families: fewer leftovers at home, less persistent opioid use, and birth memories grounded in trust instead of fear. We talk debriefs, trauma-informed care, and patient-reported experience measures, plus new research on sensation profiles and intrathecal adjuvants like dexmedetomidine and clonidine. If you’re building an opioid-sparing cesarean pathway—or refining the one you have—this is a clear, evidence-informed playbook.

If this resonates with you, follow the show, share it with your OB and nursing teams, and leave a review with one change you plan to make next shift. Your feedback helps more clinicians find these strategies and keeps more parents safe and comfortable.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/284-safer-c-section-pain-control-with-ruth-landau-md/

© 2025, The Anesthesia Patient Safety Foundation

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 of tracheal compression, SVC obstruction, pericardial effusion, and standardized tumor volume in children. From there, we outline sedation-first strategies using ketamine, dexmedetomidine, and carefully titrated remifentanil to preserve spontaneous ventilation and avoid precipitous loss of tone. For patients who truly need general anesthesia, we share an OR playbook: lower-extremity access when SVC flow is threatened, semi-upright preoxygenation, slow induction while maintaining spontaneous ventilation, awake intubation options, and selective use of short-acting agents to test tolerance of positive pressure.

Ventilation choices can make or break the case. We explain why long expiratory times and low respiratory rates reduce air trapping and auto-PEEP, and how fiberoptic bronchoscopy can guide tube position, predict extubation risk, and inform postoperative support. Rescue pathways are explicit: repositioning and CPAP, mechanical stenting with an endotracheal tube or rigid bronchoscope, rapid escalation to airway stents, and ECMO when distal collapse or cardiovascular compromise persists. We also spell out who needs ICU monitoring after surgery and why the safest path often means doing less.

If this topic raises your heart rate, you’re not alone. Tune in to sharpen your plan, align your team, and build a safer pathway from preop to postop for both adults and kids. Subscribe, share with your OR team, and leave a review with your best tip for managing high-risk mediastinal masses.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/283-how-to-plan-induce-and-recover-patients-with-anterior-mediastinal-mass-without-triggering-collapse/

© 2025, The Anesthesia Patient Safety Foundation

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 qualitative study surfaces predictable threats like unfamiliar systems and weak team integration, while primary care data shows prescribing differences without higher adverse events. In anesthesia, large safety studies are scarce, so leaders must rely on smart design: targeted orientation, standardized room setups, and shared mental models that don’t depend on who’s on the schedule. We also talk dollars and sense, highlighting a simulation-based break-even estimate for when full-time hiring outperforms locum coverage, and how to weigh cost without compromising safety.

From the main OR to higher-risk non-operating room anesthesia sites, we outline concrete steps that work across settings. Limit initial deployment to oriented locations, add locum staff to all communication channels from day one, and use checklists, cognitive aids, and universal timeouts to reduce variability. Establish clear role definitions and escalation trees posted in every anesthetizing location, and fold temporary clinicians into audits, feedback loops, and ongoing education. The aim is simple: compress the ramp-up, eliminate guesswork, and make the safe action the easy action—even when teams change daily.

If you care about perioperative safety, access, and team resilience, this conversation gives you a playbook to act now. Subscribe, share with a colleague who onboards locums, and email your best orientation tip so we can feature it on a future show.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/282-building-safer-anesthesia-teams-in-a-locum-driven-world/

© 2025, The Anesthesia Patient Safety Foundation

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-resource settings while many colleagues abroad still rely on vigilant listening and teamwork to compensate for missing monitors and essential medicines. Dr. McQueen explains the workforce crisis—too few trained providers, concerns with credentialing, limited continuing education—and why the fix starts with lifting current teams, not replacing them. We discuss how ministries of health, medical schools, and national anesthesia societies can drive lasting change by investing in local training pipelines, fair compensation, and clear standards that elevate both physician and non-physician providers.

From the WHO Surgical Safety Checklist to Lifebox-style initiatives, we look at how checklists adapted to local constraints can improve outcomes when paired with reliable oxygen, pulse oximetry, and capnography. We also dive into the power of perioperative mortality reviews which can turn scarce data into quality improvement that sticks. Dr. McQueen makes a compelling case for bilateral partnerships that build capability, confidence, and leadership so anesthesiologists can advocate for what their patients need most.

If you care about global health equity, safer surgery, and the systems that truly protect patients, this conversation brings clarity and momentum. Listen, share with a colleague, and subscribe so you don’t miss future episodes—and leave a review to help others find the show.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/281-safer-anesthesia-everywhere/

© 2025, The Anesthesia Patient Safety Foundation