Ever wondered what happens when neuromuscular blocking agents infiltrate into surrounding tissue instead of flowing smoothly through an IV? The consequences can be serious and potentially life-threatening for patients recovering from anesthesia.

We dive deep into a complication that affects nearly 14% of the 150 million peripheral IV catheter insertions performed annually in the United States. While most healthcare providers have experienced IV infiltrations, few understand the unique dangers posed when paralytics like rocuronium leak into surrounding tissues. This scenario creates unpredictable pharmacokinetics with delayed absorption that can lead to secondary recurarization – muscle weakness and respiratory compromise that may occur hours after a patient appears to have fully recovered.

Experts Dr. Andrea Vannucci and Dr. Karolina Brook share their insights and clinical experience on this important patient safety topic. They outline a comprehensive management approach including immediate interventions (attempting medication aspiration, establishing alternative IV access), treating the infiltration site (with nitroglycerin paste and hyaluronidase), and preventing recurarization through careful medication dosing and extended monitoring. Most critically, they recommend monitoring extubated patients for a minimum of four hours following infiltration of neuromuscular blocking agents – a practice not universally followed but essential for patient safety.

Whether you're an anesthesiologist, CRNA, resident, or any perioperative clinician, this episode provides crucial information to help you recognize, manage, and prevent complications from this common but potentially dangerous event. Subscribe to the Anesthesia Patient Safety Podcast for more evidence-based strategies to protect your patients from harm.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/268-beyond-the-vein-the-dangers-of-infiltrated-muscle-relaxants/

© 2025, The Anesthesia Patient Safety Foundation

Navigating the fine line between effective pain control and minimizing harm from opioid medications remains one of anesthesiology's greatest challenges. This episode dives deep into the evolving landscape of perioperative pain management, examining how clinicians can achieve the delicate balance required for optimal patient outcomes.

Dr. Paul Guillod joins us to share his perspective as both an anesthesiologist and pain management specialist, highlighting how opioid-sparing techniques create opportunities for interdisciplinary collaboration and improved surgical recovery. We examine the substantial risks of traditional opioid-based approaches: respiratory depression, delayed bowel function, delirium, and paradoxically, opioid-induced hyperalgesia.

The episode showcases promising research on multimodal analgesia strategies that target multiple pain pathways simultaneously. By combining regional anesthesia techniques with medications like NSAIDs, acetaminophen, ketamine, dexmedetomidine, and newer options like suzetrigine, clinicians can dramatically reduce opioid requirements while maintaining effective pain control. Real-world implementation of these approaches through Enhanced Recovery After Surgery (ERAS) protocols has yielded impressive results: 50% reductions in in-hospital opioid use, shortened hospital stays, and improved pain scores across multiple surgical specialties.

Whether you're a clinician seeking to improve your pain management approach or simply interested in understanding how anesthesia care is evolving to address the opioid crisis, this episode offers valuable insights into creating safer, more effective perioperative experiences. Subscribe to the Anesthesia Patient Safety Podcast and join us in our commitment that no one shall be harmed by anesthesia care.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/267-beyond-opioids-revolutionizing-perioperative-pain-control/

© 2025, The Anesthesia Patient Safety Foundation

Perioperative stroke represents a rare but potentially devastating complication of anesthesia care. While occurring in less than 1% of non-cardiac surgical patients, this complication fundamentally threatens not just patient outcomes but their very identity. As Dr. Jacob Nadler poignantly notes in our podcast, "By maintaining brain health, we're preserving the essence of who our patients are—their memories, their personality, their ability to connect with friends and family."

The most significant recent development in this field comes from the 2024 joint guidelines that have dramatically shortened the recommended waiting period following stroke before elective surgery. What was once a nine-month wait has been reduced to just three months based on compelling evidence from a cohort study of 5.8 million patients showing risk stabilization after 90 days. This change has profound implications for surgical planning and patient care timelines.

Anesthesia professionals must be vigilant about key risk factors including advanced age, previous stroke history, renal dysfunction, and anemia. The podcast explores critical medication management considerations, particularly regarding anticoagulation protocols, alongside specific intraoperative targets for blood pressure and hemoglobin levels. For suspected perioperative stroke, rapid multidisciplinary intervention with emergent brain imaging, possible thrombolytics, and mechanical thrombectomy may be indicated.

For every anesthesia professional, this episode provides essential insights to help fulfill our commitment that no one shall be harmed by anesthesia care. Subscribe on Spotify or YouTube and share with colleagues to spread this vital safety information.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/266-protecting-the-brain-perioperative-stroke-prevention/

© 2025, The Anesthesia Patient Safety Foundation