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 constraints further complicate matters. What happens when cardiac arrest occurs while a patient is positioned prone, lateral, or in steep Trendelenburg? Traditional compressions become impossible, and emerging research suggests prone CPR might actually be superior in some scenarios. Moreover, the advanced monitoring capabilities in the OR – arterial lines, central venous pressure readings, and echocardiography – provide critical data not incorporated into standard protocols.

The American Society of Anesthesiologists has responded with their Perioperative Resuscitation and Life Support Certificate program, addressing these gaps through specialized training that combines ACLS principles with OR-specific knowledge.  Ready to enhance your skills beyond basic ACLS? Explore the ASA's certificate program to earn patient safety CME credits while gaining life-saving expertise tailored to the unique challenges of the operating room. Your specialized knowledge could make all the difference when seconds count.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/264-rethinking-resuscitation-in-the-operating-room-beyond-acls/

© 2025, The Anesthesia Patient Safety Foundation

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 may go undetected. The consequences can be devastating – kidney injury, heart damage, stroke, and even death. For pregnant women undergoing cesarean sections, the risks extend to their babies, with maternal hypotension potentially causing fetal acidosis and neurological compromise.

With the United States maintaining the highest maternal mortality rate among wealthy nations and evidence showing that more than half of pregnancy-related deaths are potentially avoidable, this episode makes a powerful case for updating our standards. The technology exists, the evidence supports it, and the benefits are clear – it's time for healthcare providers, policymakers, and industry leaders to collaborate in making continuous blood pressure monitoring the new standard of care.

Ready to become a champion for continuous blood pressure monitoring at your institution? Visit APSF.org to learn more about this lifesaving technology and join the movement to ensure no one is harmed by anesthesia care.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/263-blood-pressure-blind-spots/

© 2025, The Anesthesia Patient Safety Foundation

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 targeted preparation technique.

Next, we explore a comprehensive meta-analysis of how intravenous antihypertensive medications affect cerebral blood flow. Good news: most medications maintain cerebral autoregulation even when reducing blood pressure. However, nitroprusside and nitroglycerin stand out as exceptions, potentially reducing cerebral perfusion even at appropriate doses. This critical information helps anesthesia professionals make more informed medication choices based on each patient's specific needs.

Finally, we investigate emerging research on GLP-1 receptor agonist medications (increasingly popular for diabetes, weight loss, and cardiovascular disease) and their potential link to vision problems. Several studies suggest these medications may increase the risk of non-arteritic ischemic optic neuropathy—a leading cause of vision loss. While the absolute risk remains small and no direct connection to postoperative vision loss has been established, additional research is needed going forward.

Each of these studies provides valuable insight into how we can continue improving anesthesia safety. Share this episode with your colleagues and join us next time as we work toward ensuring no one is harmed by anesthesia care.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/262-medical-literature-deep-dive-from-infant-intubation-to-glp-1-agonist-risks-and-more/

© 2025, The Anesthesia Patient Safety Foundation

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 for adverse outcomes. The discussion illuminates how anesthesiologists can serve as safety champions by implementing rigorous standards and protocols.

The conversation then pivots to a surprisingly common yet overlooked danger in pediatric anesthesia: the administration of oxymetazoline. What seems like a routine medication becomes hazardous when delivery systems designed for upright, conscious patients are used on supine, anesthetized children. Through practical demonstrations and creative problem-solving, we uncover how simple modifications to delivery methods—specifically using atomizers with precisely filled syringes—can prevent potentially dangerous overdoses and create standardized, position-independent dosing.

Both topics underscore a central theme: anesthesia safety demands thoughtful adaptation of standards to fit unique circumstances. Whether dealing with international variations in practice or the specialized needs of pediatric patients, the commitment to "no one shall be harmed by anesthesia care" requires constant vigilance and innovation. We'd love to hear your experiences with similar challenges—have you encountered safety variations in different practice settings, or developed creative solutions to common problems? Visit APSF.org to explore our resources and join the conversation about advancing anesthesia patient safety worldwide.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/261-patient-safety-challenges-from-global-cosmetic-tourism-to-pediatric-medication-dosing/

© 2025, The Anesthesia Patient Safety Foundation

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 searchable, digestible content they can absorb between cases or during brief study sessions.

What makes these summaries particularly valuable is their breadth and collaborative development. Each summary is peer-reviewed and often created through mentoring relationships between experienced clinicians and trainees, creating educational value beyond the finished product. 

Malinzak offers a clarifying perspective on how quality improvement relates to patient safety: "Patient safety is the goal... That's what we want to accomplish with every single patient. Quality improvement is the process... how we get to the goal." As anesthesiologists face increasingly complex cases and efficiency pressures, this distinction helps practitioners develop systematic approaches to protect vulnerable patients. Looking ahead, she envisions technologies like AI reducing administrative burdens so clinicians can focus entirely on vigilant patient care. Discover these valuable resources by visiting Open Anesthesia's website and filtering for patient safety topics – you never know which summary might teach you something new today.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/260-openanesthesia-and-the-apsf-achieving-safe-and-quality-anesthesia-care-with-education-innovation/

© 2025, The Anesthesia Patient Safety Foundation

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, neurological status and equipment
• Multi-Center Handoff Collaborative tools providing structured approaches to handoffs between care teams
• Recommendations including pre-transport risk assessment, education for all team members, and implementation of standardized checklists
• Importance of system design considerations like uncluttered hallways and team formations that optimize patient observation

The deadline for the October 2025 APSF newsletter is July 1st. Check out the guide for authors at APSF.org for more information.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/259-every-move-matters-why-transport-safety-can-save-your-critical-patients/

© 2025, The Anesthesia Patient Safety Foundation

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 equipment-related. The 2023 I-TOUCH study provides valuable insights, showing cardiac events, respiratory complications, neurologic issues, and equipment problems as the most common challenges during transport. We explore how patient factors (age, illness severity, ventilation requirements) and system factors (transport duration, communication gaps, staff experience) contribute to these risks.

Beyond patient safety, we discuss the often-overlooked physical risks to anesthesia professionals themselves, who report high rates of work-related musculoskeletal injuries from maneuvering heavy transport equipment while managing patient care. The good news? Evidence-based guidelines exist to mitigate these risks. Join us next week as we continue this crucial conversation with practical recommendations from the American College of Critical Care Medicine and the Society of Critical Care Medicine for safer perioperative patient transport.

Have you experienced challenges during patient transport? Share your experiences and learn from colleagues by emailing [email protected] or visiting apsf.org for more resources on perioperative safety.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/258-wheels-of-risk-when-patient-safety-rolls-through-hospital-corridors/

© 2025, The Anesthesia Patient Safety Foundation

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 medications, with significantly worse outcomes when complications occur.

We present a practical algorithm for risk stratification, considering factors like procedure duration, anesthesia type, diabetes control, and comorbidities. You'll learn which patients should hold their medication, which can proceed with caution, and what monitoring strategies to implement when patients haven't properly discontinued their medication before surgery. This guidance is especially valuable for emergency cases where postponement isn't an option.

Whether you're developing institutional protocols or making decisions for individual patients, this episode equips you with the knowledge to navigate the complexities of SGLT2 inhibitor management in the perioperative period. Subscribe to stay informed about the latest in anesthesia patient safety and join our mission to ensure no one is harmed by anesthesia care.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/257-sweet-trouble-perioperative-management-of-sglt2-inhibitors/

© 2025, The Anesthesia Patient Safety Foundation

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