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 general anesthesia for cesarean delivery among Black and Hispanic patients. Drawing on ASA recommendations, we outline practical actions that reduce harm: accurate documentation of race, ethnicity, and language; disparities dashboards; education on bias and structural racism; shared decision making; and proactive epidural management to improve conversion to surgical anesthesia without general anesthesia.

Then we turn to implementation science—the missing link between guidelines and reliable practice. We map a simple decision pathway from efficacy to effectiveness to context and strategy, and we share the real levers that move systems: targeted education, inter‑institutional collaboration, policy mechanisms like bundles, and the business case that earns C‑suite commitment. When leaders see the return on investment in safety, liability reduction, and community trust, sustained resources follow.

Finally, we explore technology as an equity engine. AI‑guided ultrasound can extend expertise in low‑resource settings. Predictive analytics may flag fetal heart rate decelerations before they turn critical. And we confront the accuracy gaps in pulse oximetry tied to skin pigmentation and low perfusion, especially during the neonatal transition. With vendor accountability, rigorous validation across diverse populations, smarter sensor selection and placement, and frontline education, monitoring can serve every patient equally.

If this conversation resonates, help us spread the word. Subscribe on Spotify or YouTube, share this episode with a colleague, and leave a review so more clinicians can join the effort to make labor and delivery the safest unit in the hospital. Your feedback and stories shape where we go next.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/278-transforming-maternal-care-through-equity-science-and-tech/

© 2025, The Anesthesia Patient Safety Foundation

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 transfusion strategies, and how placenta accreta spectrum demands regionalized teams and rehearsed playbooks.

The conversation then turns to venous thromboembolism, still a leading cause of maternal mortality. Risk climbs five- to six-fold and peaks postpartum, so we stress reassessment at prenatal intake, during any antepartum admission, at delivery, and before discharge. We compare heparin and low molecular weight heparin in real-world settings, highlight extremely low neuraxial hematoma risk when following ASRA guidance, and share concrete workflow tactics: pre-delivery anesthesia consults, unit-wide alerting, anticoagulant hold triggers, and pre-procedure huddles that keep patients safe while preserving neuraxial options.

Threaded through each segment is a practical theme: faster recognition, standardized bundles, and tight communication save mothers’ lives. If you’re building a safer unit, start with tools that measure what matters, empower nurses to escalate, and remove delays between suspicion and action. Subscribe, share with your team, and leave a review with one change you’ll make this week—what will you implement first?

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/277-transforming-maternal-care-faster-sepsis-recognition-smarter-hemorrhage-response-and-safer-vte-prevention/

© 2025, The Anesthesia Patient Safety Foundation

Maternal safety changes when we stop relying on heroics and start building systems. We open the door to the 2025 APSF Stolting Conference series with a fast, practical tour of what truly reduces morbidity and mortality: collaboration across anesthesia, obstetrics, cardiology, and nursing; open‑source AIM bundles; early warning tools; and standards that compress time-to-treatment when minutes matter. Along the way, we confront the three deadly D’s—denial, delay, dismissal—and replace them with teamwork, tools, timeliness, and trust.

We dig into the history that got us here, from case reports and confidential inquiries to robust maternal mortality review committees and rapid-cycle data that power real change. Then, we zero in on the leading cause of pregnancy-related death—cardiovascular disease—and why risk spikes in the postpartum period. A vivid case of peripartum cardiomyopathy shows how quickly decompensation unfolds and why anesthesia must be in the room early: shaping plans, managing hemodynamics, placing monitors, coordinating with cardiology and OB, and, when needed, activating ECMO. We highlight actionable steps like antenatal anesthesia consults for high‑risk patients, postpartum telemetry monitoring, and pregnancy heart teams that make escalation the rule, not the exception.

Progress is real for hemorrhage and hypertension, but disparities remain stark for Black, Hispanic, and Asian Pacific Islander patients. We talk about implicit bias, access, and respectful care, and we share multilingual urgent maternal warning signs so patients and clinicians recognize danger sooner. The ASA’s recommendations give a clear roadmap for anesthesiologist leadership—on review committees, quality teams, simulation programs, and implementation of SOAP and ACOG frameworks—so that safety becomes predictable.

If this conversation sparks ideas for your unit, we’d love to hear them. Subscribe, share with a colleague who works on labor and delivery, and leave a review telling us the one system change you’ll champion this month.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/276-maternal-care-transformed/

© 2025, The Anesthesia Patient Safety Foundation

A patient rolls into the OR with a tracheostomy—do you maintain the current tube, intubate orally, or go through the stoma? We break down the decision tree that keeps patients safe, from assessing tract maturity and surgical needs to choosing cuffed vs uncuffed strategies and planning for positive pressure ventilation. Then we shift to a critical safety pivot: total laryngectomy. When the trachea is sutured to the skin, the mouth and nose no longer connect to the lungs, and attempts at oral intubation can be deadly. We explain how to recognize the anatomy fast, oxygenate at the neck, and advance through a stepwise algorithm that reduces risk in time‑sensitive emergencies.

Drawing on practical pearls and human‑factors design, we highlight why bedside signs and EMR alerts matter, how standardized language improves handoffs, and where airway exchange catheters, bougies, and wire‑reinforced tubes fit into safe practice. You’ll hear clear guidance on cuff placement relative to the stoma, avoiding mainstem intubation, using waveform capnography for continuous confirmation, and preventing false passages in fresh tracheostomies. We also review eye‑opening data on attempted oral intubations after laryngectomy, underscoring the need for staff education, patient engagement, and systems that make the right move the easy one.

If you manage airways in perioperative or emergency settings, this conversation strengthens your mental models and your muscle memory. Tune in for concise, actionable steps, download the signage and algorithms from the show notes, and share the episode with your team. If this helped sharpen your airway plan, subscribe, leave a review, and tell us your go‑to approach for trach and laryngectomy cases.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/275-tracheostomy-and-laryngectomy-patient-safety/

© 2025, The Anesthesia Patient Safety Foundation

Tracheostomy complications occur at an alarming rate, affecting nearly half of all patients during their initial hospitalization. When these emergencies strike, having a systematic approach can make the difference between life and death.

We dive deep into the critical steps for managing a malfunctioning tracheostomy, beginning with immediate actions like cuff deflation and rapid information gathering about the tracheostomy's history. You'll learn how to systematically troubleshoot ventilation problems, from checking for simple obstructions to determining if the tracheostomy has become dangerously displaced into subcutaneous tissues.

The episode walks through the crucial decision points when standard ventilation fails: Should you attempt oral intubation or go through the stoma? We break down the specific factors that should guide this high-stakes decision, including patient anatomy, tracheostomy maturity, and clinician experience. You'll discover practical techniques for both approaches, including helpful adjuncts like bougies and bronchoscopes that can increase your chances of success.

Perhaps most valuable are the ready-to-use tools shared in this episode - standardized bedside signs and emergency algorithms that can be implemented in your practice immediately. These resources ensure that critical information follows patients throughout their hospital stay and provides a clear pathway for any provider responding to a tracheostomy emergency.

Whether you're an experienced anesthesia professional or still in training, this episode provides essential knowledge for some of the most challenging airway emergencies you'll face. Subscribe now and download our next episode, where we'll continue this vital discussion on emergency tracheostomy management.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/274-critical-decision-points-in-emergency-tracheostomy-management/

© 2025, The Anesthesia Patient Safety Foundation

When our smallest patients need anesthesia care, their immature systems present unique challenges that demand specialized knowledge and vigilance. The risk of postoperative apnea in former preterm infants has long been recognized, but the evidence guiding management continues to evolve.

Join Dr. Alli Bechtel and pediatric anesthesiologist, Dr. Eva Lu-Boettcher as they explore the physiological vulnerabilities that make premature infants susceptible to respiratory complications after anesthesia. The conversation delves into the complex interplay between immature respiratory control centers and anesthetic agents, highlighting how premature infants respond differently to hypoxia and hypercapnia compared to their full-term counterparts.

Drawing from landmark studies and current literature, this episode offers clear, evidence-based recommendations for postoperative monitoring based on post-conceptual age and risk factors. You'll learn about the inverse relationship between post-conceptual age and apnea risk, the critical timing of apnea events, and practical guidelines for determining which patients require extended monitoring. The detailed discussion of monitoring protocols provides a roadmap for keeping vulnerable infants safe during the high-risk postoperative period.

What makes this episode particularly valuable is its practical approach to clinical decision-making. Whether you're determining if a 50-week post-conceptual age infant can be discharged after six hours of monitoring or establishing protocols for term infants who receive opioids, you'll find actionable guidance supported by the latest evidence. As Dr. Lu-Boettcher notes, ongoing meta-analyses and micro-analyses promise to further refine these recommendations in the near future, highlighting the dynamic nature of patient safety practices in pediatric anesthesia.

Curious about how your institution's protocols compare to current best practices? Wondering when it's truly safe to discharge a former preterm infant after anesthesia? Listen now to enhance your understanding of this critical aspect of pediatric anesthesia safety and help ensure that no child is harmed under your care.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/273-breathless-moments-when-premature-babies-need-extra-vigilance/

© 2025, The Anesthesia Patient Safety Foundation

Could your CO2 sensor be putting patients at risk? This eye-opening Rapid Response to Questions from our Readers episode explores a serious patient safety concern that every anesthesia professional needs to understand.

We dive into two troubling cases where patients under general anesthesia developed respiratory acidosis despite normal-appearing monitoring parameters. The culprit? A semi-quantitative CO2 sensor being used in an operating room setting where it was never designed to function safely. Through detailed case analysis, we uncover how the Nihon Kohden cap-ONE TG920P CO2 analyzer—which operates on the assumption that inspired air contains zero CO2—failed to detect dangerous rebreathing when CO2 absorbers became exhausted.

What makes this situation particularly concerning is that these semi-quantitative sensors display waveforms similar to their quantitative counterparts, creating a false sense of security. Dr. Amrutha Bindu Nagella shares her firsthand experience discovering the problem and her recommendations for preventing future incidents. We also hear Nihon Kohden's response, including their commitment to improving device labeling and safety warnings.

This episode highlights a critical knowledge gap that exists when technology moves between different clinical environments without proper understanding of its limitations. Whether you're an anesthesiologist, CRNA, anesthesia technician, or hospital administrator making purchasing decisions, this information could prevent a potentially dangerous situation in your operating room. Subscribe to the Anesthesia Patient Safety Podcast for more essential safety updates that keep your patients protected during anesthesia care.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/272-behind-the-waveform-critical-safety-implications-of-co2-sensor-selection/

© 2025, The Anesthesia Patient Safety Foundation

Patient engagement stands as the cornerstone of perioperative safety, bringing together the knowledge of medical professionals with the lived experiences of those receiving care. Through powerful personal testimonies and expert insights, we explore how this critical partnership transforms surgical outcomes.

Vonda Vaden Bates shares her heartbreaking journey that began with her husband's successful brain surgery but ended tragically with a fatal pulmonary embolism. Despite their active engagement with the healthcare team, a crucial knowledge gap existed - they didn't recognize the symptoms of a developing blood clot. This experience crystalized what Vonda calls "the intersection of engagement with education," highlighting why simply asking questions isn't enough when patients don't know which questions are most crucial.

The episode explores the comprehensive Patient Guide to Anesthesia and Surgery developed by the APSF, covering everything from understanding anesthesia types to post-surgical pain management strategies. This resource aims not just to inform but to empower patients to actively participate in their care journey, potentially taking preventative steps long before the morning of surgery.

Dr. Della Lin, an anesthesiologist and APSF board member, offers a profound perspective that reshapes how we think about the patient-provider relationship: "Patients are not the visitors to hospitals; we are visitors in their lives." This fundamental shift moves healthcare away from doing things to or for patients toward genuinely co-designing care with them. The APSF resources undergo rigorous review by both clinicians and patients, ensuring they address real questions using accessible language and helpful visuals. We encourage anesthesia professionals to not only share these materials but to study them as tools for better understanding patient perspectives. Have you incorporated these resources into your practice? Share your story at [email protected] and help us continue building bridges between medical expertise and patient experience.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/271-empowering-patients-the-key-to-safer-anesthesia/

© 2025, The Anesthesia Patient Safety Foundation

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 anesthesia?" and "Are there long-term side effects?"—questions that anesthesia professionals hear regularly but that patients struggle to find answers to online.

Since its October 2023 launch, the Patient Guide has become one of APSF's most visited resources, attracting over 10,000 visitors monthly. This success demonstrates the critical need for patient-centered information that bridges the gap between medical expertise and patient understanding. As Van Pelt powerfully states, "Our goal is to create a culture where patients' voices are not just heard, but actively sought out and valued as essential components of safe care." Discover how this resource is changing the conversation around anesthesia safety and why patient engagement isn't just beneficial—it's essential for optimal outcomes. Visit APSF.org today to explore the Patient Guide and share this valuable resource with your patients and colleagues.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/270-from-fears-to-facts-empowering-patients-before-surgery/

© 2025, The Anesthesia Patient Safety Foundation

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 break down a comprehensive management algorithm, from the counterintuitive first step of leaving the infiltrated catheter in place to attempt medication aspiration, through systemic absorption enhancement techniques using hyaluronidase and nitroglycerin paste. The episode covers detailed reversal strategies based on monitoring capabilities, explaining how to prevent recurarization and safely manage these patients postoperatively.

Beyond immediate management, we look toward a future where infiltration detection technologies and standardized guidelines are integrated into residency training and crisis checklists. This episode provides the missing guidance that anesthesia professionals need to navigate this surprisingly common complication with confidence.

Have you experienced neuromuscular blocker infiltration in your practice? What strategies have worked for you? Share your thoughts or questions at [email protected] and join us in building a safer future where no one is harmed by anesthesia care.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/269-infiltrated-iv-crisis-managing-complications-and-keeping-patients-safe/

© 2025, The Anesthesia Patient Safety Foundation