Anesthesia Patient Safety Podcast

#284 Safer C-Section Pain Control with Ruth Landau, MD

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/ [https://www.apsf.org/podcast/284-safer-c-section-pain-control-with-ruth-landau-md/] © 2025, The Anesthesia Patient Safety Foundation

#283 How To Plan, Induce, And Recover Patients With Anterior Mediastinal Masses Without Triggering Collapse

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/ [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

#282 Building Safer Anesthesia Teams In A Locum-Driven World

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/ [https://www.apsf.org/podcast/282-building-safer-anesthesia-teams-in-a-locum-driven-world/] © 2025, The Anesthesia Patient Safety Foundation

#281 Safer Anesthesia, Everywhere

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/ [https://www.apsf.org/podcast/281-safer-anesthesia-everywhere/] © 2025, The Anesthesia Patient Safety Foundation

#280 Speak Up To Save Lives

What if the biggest risks in maternal care are not just clinical, but cultural? We dig into the hard truth that speaking up can feel risky, pain during cesarean is often underestimated, and rare obstetric crises can overwhelm memory. From there, we chart a path toward safer births with practical tools that any team can use: psychological safety to unlock communication, structured pre‑briefs and rapid debriefs, and cognitive aids that turn chaos into coordinated action. We walk through the lived reality of intraoperative pain—why negative skin tests don’t guarantee visceral coverage, how fear of general anesthesia can delay needed care, and the downstream consequences for bonding, breastfeeding, and mental health. You’ll hear clear, patient‑centered steps: standard sensory assessment, explicit pain check‑ins, decisive treatment or conversion when indicated, and honest conversations that validate experience. The message is simple and urgent: pain is preventable harm, and timely action saves more than minutes—it protects families. Readiness matters beyond big hospitals. Rural teams face OB unit closures, low volumes, and limited resources. Mobile simulation and statewide programs show how to keep skills sharp for postpartum hemorrhage, eclampsia, and high‑risk transfers. We also highlight the Four Ps for anesthesia professionals—presence, preemption, proficiency, and platform—to embed safety into daily practice, from risk screening to standardized pathways. Finally, we extend the safety net into the community with sepsis bundles and accessible education so patients and their support networks recognize warning signs and act fast. Along the way, we touch on pediatric safety and emerging evidence that EEG‑guided anesthesia can reduce emergence delirium. If transforming maternal care speaks to you, join us. Subscribe, share this episode with a colleague, and leave a review with one change your team will make this month. Your insight could be the spark another unit needs to save a life. For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/280-speak-up-to-save-lives/ [https://www.apsf.org/podcast/280-speak-up-to-save-lives/] © 2025, The Anesthesia Patient Safety Foundation