Anesthesia Patient Safety Podcast

#291 Managing Anesthesia Risks for Patients with Acute and Chronic Cocaine Use

A cocaine-positive patient rolls into the OR and the monitors look fine—until twenty minutes after induction, when the blood pressure plummets. We unpack that swing from sympathetic surge to sudden crash through two real cases: an emergent trauma laparotomy complicated by asystole and a chronic intranasal user with profound hypotension that only responded to direct-acting vasopressors. From there, we connect the dots to the pharmacology that makes these events predictable and, with the right plan, manageable. We talk candidly about what matters before wheels-in: timing of last use, objective signs of toxicity, and targeted testing. You’ll hear why urine screens can stay positive for weeks, why indirect agents like ephedrine can fail, and how phenylephrine or norepinephrine often become first-line choices. For regional anesthesia, we flag contamination risks and local anesthetic systemic toxicity concerns that call for dose adjustment and intralipid readiness. Chronic cocaine use adds another layer, including left ventricular dysfunction, myocardial infarction and fibrosis, and calcium dysregulation. Hospital policy and equity loom large. Automatic cancellations for cocaine positive patients can worsen pain, delay care, and disproportionately impact patients with limited access. We review current evidence suggesting many asymptomatic, cocaine-positive patients tolerate elective noncardiac surgery under general anesthesia with hemodynamics comparable to controls when vigilant management is in place. The takeaway: build flexible, evidence-informed pathways that prioritize patient safety without reflexive delays, and keep a rescue mindset with careful monitoring and direct vasopressors within reach. If this sparked ideas for your practice, subscribe, share with a colleague, and leave a review so more clinicians can find these insights. For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/291-managing-anesthesia-risks-for-patients-with-acute-and-chronic-cocaine-use/ [https://www.apsf.org/podcast/291-managing-anesthesia-risks-for-patients-with-acute-and-chronic-cocaine-use/] © 2026, The Anesthesia Patient Safety Foundation

#290 From Blind Needles To Ultrasound: The Safety Revolution In Regional Anesthesia

A remarkable safety story runs through regional anesthesia, from the era of blind needle placement to a modern practice guided by real-time ultrasound, lipid rescue, and reliable team checklists. We walk through the key milestones that cut complications, accelerated block onset, and lowered conversion to general anesthesia, while keeping a clear eye on the hazards that remain. Along the way, we explain how a simple seven-point timeout helps prevent wrong-sided blocks and why ultrasound has reshaped dosing, local anesthetic spread confirmation, and failure rates. We also dig into the numbers around local anesthetic systemic toxicity and neurologic injury, translating data into everyday decisions at the bedside. You’ll hear how improved dosing protocols, reduced volumes with ultrasound guidance, and rapid access to lipid therapy drive cardiac toxicity toward zero. We unpack the real contributors to failed blocks—anatomic variation, communication barriers, obesity, surgical factors, and experience—and share practical, high-yield steps for safer performance, from short-bevel needle selection to injection pressure monitoring and clear patient counseling. Looking forward, we explore the next wave of tools transforming the block room: 3D and 4D ultrasound for richer visualization, needle tip tracking for faster and steadier trajectories, and pressure monitoring that warns before harm. We spotlight how AI could assist with ultrasound interpretation, trajectory planning, and complication prediction, while wearables and high-fidelity simulation extend safety beyond the procedure to early detection and better training. If you care about preventing never events, reducing LAST, and building a resilient regional anesthesia workflow, this conversation lays out what works now and what’s coming next. Enjoyed the insights? Subscribe, share with a colleague, and leave a review to help more clinicians advance patient safety. For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/290-from-blind-needles-to-ultrasound-the-safety-revolution-in-regional-anesthesia/ [https://www.apsf.org/podcast/290-from-blind-needles-to-ultrasound-the-safety-revolution-in-regional-anesthesia/] © 2026, The Anesthesia Patient Safety Foundation

#289 Forty Years Of Anesthesia Medication Safety: What Works And What’s Next

A single syringe swap should never decide a patient’s fate. We pull back the curtain on forty years of anesthesia medication safety to show what truly works—then tackle the hard part: getting proven safeguards into every OR, every time. From look-alike vial hazards to standardization that actually sticks, this conversation blends frontline realities with practical steps leaders can implement now. We dig into the high-stakes TXA wrong-drug, wrong-route crisis and explain why eliminating vials and moving to ready-to-administer IV bags is a must. Along the way, we unpack new FDA label warnings, the APSF–ISMP joint recommendations, and the forcing functions that prevent catastrophes, including NRFit for neuraxial routes and barcode verification at the point of care. We also surface quieter threats—vial coring, variable concentrations, and chaotic storages—and show how color-coded, readable labels and organized carts reduce cognitive load when seconds matter. Opioid safety gets equal focus. We connect preoperative risk assessment, multimodal analgesia, and smart postoperative monitoring to reduce opioid-related harm without compromising comfort. Technology has matured too: AI-driven clinical decision support can flag dosing and drug-choice risks in real time, but only if woven into workflows that clinicians trust. Throughout, we return to the implementation gap: success depends on leadership support, supply chain alignment, failure mode analysis, transparent reporting, and peer support that sustains a just culture. If you care about safer anesthesia—standardized labels and concentrations, prefilled syringes, organized storage, barcode checks, and a culture that learns—this is your playbook. Listen, share with your team, and help push your institution from knowing to doing. Subscribe, leave a review, and tell us which safeguard you’ll champion next. For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/289-forty-years-of-anesthesia-medication-safety-what-works-and-whats-next/ [https://www.apsf.org/podcast/289-forty-years-of-anesthesia-medication-safety-what-works-and-whats-next/] © 2026, The Anesthesia Patient Safety Foundation

#288 Forty Years Of Perioperative Medication Safety Progress

Seconds define outcomes in the OR, and medication safety lives in those seconds. We take you inside four decades of work by the Anesthesia Patient Safety Foundation to show how our field shifted from relying on vigilance to building systems that make the right action the easy action. Along the way, guest contributor, Dr. Elizabeth Rebello, shares why standardization, technology, and culture are not buzzwords but lifelines when a single clinician must select, prepare, and administer drugs under pressure. We break down the STPC framework born from the 2010 Stoelting Conference—standardization, technology, pharmacy/pre-filled/pre-mixed, and culture—and translate it into real steps: standardized concentrations for high-alert medications, removal of concentrated lethal agents from the OR, barcode-based identification before draw-up or administration, and smart infusion pumps with user-friendly drug libraries. You’ll hear how prefilled syringes, automated dispensing, and clinical pharmacist integration reduce prep errors and free up attention when it matters most. The story moves forward with the 2018 focus on drug safety profiles and the stubborn challenge of shortages. We explore actionable ideas: building a standing shortage committee, communicating substitutions fast, simplifying carts and labels when suppliers change, and embracing multimodal analgesia.  By the end, you’ll have a clear map of what to implement now—printed labels, prefilled syringes, smart-pump integration with your anesthesia record—and what to champion next across your institution. Subscribe and share with a colleague who leads in the OR. Then tell us: which safety step will you push across the finish line this year? For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/288-forty-years-of-perioperative-medication-safety-progress/ [https://www.apsf.org/podcast/288-forty-years-of-perioperative-medication-safety-progress/] © 2026, The Anesthesia Patient Safety Foundation

#287 A New Era For PONV: Safety, Guidelines, And Smarter Rescue

Nausea shouldn’t be the most memorable part of surgery. We take a clear, evidence-based look at postoperative nausea and vomiting, from identifying who’s at risk to building smarter prophylaxis bundles and choosing the right rescue when prevention falls short. With guest insights from Dr. Connie Chung, we unpack the Fourth Consensus Guidelines, translate them into practical workflows, and explore how Amisulpride—an atypical D2 antagonist—changes the game with an FDA indication for rescue after failed prophylaxis. We start by shrinking baseline risk: consider regional anesthesia when feasible, leverage TIVA with propofol, avoid nitrous and volatiles in longer cases, hydrate well, and spare opioids with multimodal analgesia. Then we scale prophylaxis to risk: dexamethasone at induction, 5-HT3 antagonists at the end, transdermal scopolamine for select patients, and low-dose Droperidol where appropriate. When prophylaxis fails, we explain why repeating ondansetron rarely helps and how switching classes boosts rescue success. Along the way, we map the safety terrain for D2 antagonists—QT prolongation, extrapyramidal risks, anticholinergic effects—so you can individualize care for elderly patients, those on antipsychotics, or anyone with potential drug interactions. We also dig into what’s new: contemporary analyses of Droperidol at antiemetic doses, and growing evidence that Amisulpride pairs well with Ondansetron or Dexamethasone to improve outcomes. Pediatric pearls include TIVA, fluids, and a two-drug prophylaxis backbone for longer or higher-risk cases. The result is a practical, stepwise approach you can apply tomorrow—reduce risk, layer mechanisms, and rescue smartly—to cut PACU delays, avoid unplanned admissions, and deliver a recovery that feels as good as the surgical fix. If this deep dive helps your practice, follow, share with your team, and leave a quick review to help others find the show. Tell us your go-to PONV bundle and whether your site stocks Amisulpride. For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/287-a-new-era-for-ponv-safety-guidelines-and-smarter-rescue/ [https://www.apsf.org/podcast/287-a-new-era-for-ponv-safety-guidelines-and-smarter-rescue/] © 2025, The Anesthesia Patient Safety Foundation