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 podcast@apsf.org. 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

Dr. Liz Hansen takes us behind the scenes of a remarkable transformation at Seattle Children's Hospital, where pediatric anesthesiologists have reduced their greenhouse gas emissions by over 90% without compromising patient safety. A lifelong environmentalist and bike commuter, Dr. Hansen was shocked to discover that anesthesia gases contributed to 7% of her hospital's total emissions. This revelation sparked a personal and professional journey to align her clinical practice with her environmental values.

The conversation reveals practical strategies for reducing anesthesia's carbon footprint, from eliminating nitrous oxide to implementing low-flow techniques. Dr. Hansen shares how her team gradually won over colleagues by demonstrating that sustainable practices could maintain or even improve patient outcomes. She offers detailed insights into working with child life specialists, adapting mask induction techniques, and using data tracking to drive continuous improvement.

What makes this story particularly powerful is the ripple effect beyond a single institution. Dr. Hansen co-founded Project SPRUCE (Saving Our Planet by Reducing Carbon Emissions), an international consortium of anesthesia groups collaborating to reduce their environmental impact. Member organizations have already achieved their first-year goal of 50% emissions reduction, with more ambitious targets on the horizon.

For anesthesia professionals concerned about climate change but unsure how to make a difference, this episode offers hope and concrete action steps. Remember, "the antidote to despair is action." Download the Yale Gassing Greener app, try a nitrous-free induction on your next cooperative patient, or advocate for addressing gas leaks in your facility's central supply system. Your individual choices matter, especially when they inspire others to follow your lead.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/246-ditching-nitrous-oxide-the-bike-commuters-guide-to-safe-and-sustainable-anesthesia/

© 2025, The Anesthesia Patient Safety Foundation

In our latest episode, we dive headfirst into the growing issue of medical misinformation and its alarming effect on anesthesia patient safety. As patients increasingly turn to social media for health information, the risks of encountering inaccurate content have soared, posing challenges for healthcare professionals.

Join us as we explore a recent article by George Tewfik and Raymond Malapero from the February 2025 APSF Newsletter, focusing on how misinformation can threaten patient safety, especially during critical procedures. We'll outline the detrimental consequences of misinformation, breaking them down into three distinct categories: fear and anxiety, delay of treatment, and avoidance of treatment altogether. Understanding the psychological and physiological impacts of misinformation is crucial for anesthesia professionals and helps to frame how we can best support our patients.

You’ll also learn actionable strategies for addressing these issues directly with patients. Empathy and compassionate communication are vital tools in combatting misinformation and fostering trust between healthcare providers and patients. By guiding patients towards reputable resources and encouraging open dialogue about their concerns, we can mitigate the effects of fear and anxiety, ultimately enhancing safety in anesthesia care.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/245-unmasking-medical-misinformation/

© 2025, The Anesthesia Patient Safety Foundation