#313 Individualized Multimodal Analgesia

#313 Individualized Multimodal Analgesia

“Opioid-sparing” sounds like an automatic win until you look closely at what replaces the opioids. We take on one of the toughest questions in modern anesthesiology: how do we reduce opioid-related harm without trading it for medication interactions, kidney injury, bleeding risk, rebound pain, or poorly controlled postoperative pain? We break down what individualized multimodal analgesia really means in day-to-day anesthesia practice. That starts before the first dose is ordered, with a preoperative assessment that weighs comorbidities, baseline renal function, hydration status, and potential drug-drug interactions. We also dig into the medication safety side of multimodal protocols, including why CYP2D6 matters for common oral opioids like hydrocodone, oxycodone, and tramadol, and how CYP2D6 inhibitors such as certain antidepressants can change opioid effectiveness and even extend opioid use after discharge. Regional anesthesia remains a cornerstone, but we stay honest about the pitfalls: incomplete coverage, visceral pain that sneaks through, and the timing mismatch that can trigger rebound pain 12 to 24 hours after a single-shot block, sometimes when the patient is already home. We also discuss when continuous peripheral nerve blocks may better match the duration of perioperative stress and inflammation, plus the practical barriers that determine whether advanced regional techniques are feasible. If you care about opioid-sparing anesthesia, patient safety, and better postoperative recovery, listen and share this with a colleague. Subscribe to the podcast, leave a review, and tell us: what’s one change you’ll make to your multimodal analgesia plan after hearing this? For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/313-individualized-multimodal-analgesia/ [https://www.apsf.org/podcast/313-individualized-multimodal-analgesia/] © 2026, The Anesthesia Patient Safety Foundation

#312 Hantavirus Readiness For Anesthesia Teams

A virus can feel “far away” right up until it lands in a preop bay with a fever, abdominal pain, and a story that only makes sense weeks later. We walk through what anesthesia, perioperative, and critical care teams need to know about hantavirus, why the incubation period (often 7 to 42 days) complicates detection, and how the Andes virus changes the conversation because it is the only hantavirus known to spread person to person. We start with the basics that matter at the bedside: common transmission pathways like inhalation of aerosolized particles from rodent droppings, the two major clinical syndromes (hantavirus cardiopulmonary syndrome and hemorrhagic fever with renal syndrome), and the pathophysiology that drives non cardiogenic pulmonary edema, shock, thrombocytopenia, and organ failure. We also cover diagnosis (PCR and antibody testing), reporting to public health, and why supportive care remains the foundation, including when ECMO may be considered as a bridge to recovery. Then, we bring it into the perioperative space with clear, practical infection control guidance for operating rooms and procedural areas. We talk elective case delays after known exposure, emergency surgery planning with bleeding risk, negative pressure isolation rooms, and PPE choices like N95 or PAPR for clinicians. We also share concrete anesthesia circuit precautions recommended by occupational health experts, including HEPA filtration placement, safer gas sampling scavenging, and how to handle circuit disconnections to reduce room contamination. If you want a focused, evidence aware checklist for hantavirus preparedness in anesthesia care, hit play, share this with a colleague, and subscribe so you do not miss the next safety update. After listening, leave a review and tell us: what is the single biggest gap in your OR infection control plan right now? For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/312-hantavirus-readiness-for-anesthesia-teams/ [https://www.apsf.org/podcast/312-hantavirus-readiness-for-anesthesia-teams/] © 2026, The Anesthesia Patient Safety Foundation

#311 From Cable Chaos To One Step Airway Access

Twenty-two steps to reach an airway is not a quirky workflow problem, it’s a patient safety problem. We’re turning our attention to a neuro-interventional radiology (Neuro IR) suite where cables, monitors, and a poorly positioned anesthesia machine created a cramped, high-friction non-operating room anesthesia (NORA) environment. Joined by John Edwards, CRNA, we unpack how a real-world quality improvement project at the University of Kentucky Medical Center turned staff frustration into an evidence-based anesthesia workspace redesign. We start with what triggered the change: frontline clinicians describing barriers to optimal patient care, unsafe ergonomics, and a layout that made simple tasks unnecessarily hard. From there, we connect the dots to broader NORA safety expectations, including the American Society of Anesthesiologists guidance on having sufficient space, equipment access, and the ability to reach the patient quickly. Them, the team brings anesthesia staff, interventional radiology personnel, and facilities managers together to redesign the room with minimal disruption. You’ll hear the practical interventions that made the difference, like cable management using existing ceiling infrastructure, switching to a more compact anesthesia machine, and repositioning equipment to restore clear access to the patient. The results are striking: smoother movement, less clutter, improved morale, and a dramatic reduction in the distance to the airway. If you work in any NORA location, this is a blueprint for safer anesthesia workflows. Subscribe for more NORA safety and patient safety insights, share this with a colleague who works off-site, and leave a review to help more clinicians find the show. For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/311-from-cable-chaos-to-one-step-airway-access/ [https://www.apsf.org/podcast/311-from-cable-chaos-to-one-step-airway-access/] © 2026, The Anesthesia Patient Safety Foundation

#310 Moisture Matters In Anesthesia Circuits

Condensation in an anesthesia circuit looks harmless until it starts skewing flow sensor readings or creating the kind of warm, wet environment where microbes can thrive. We pick up the story after the investigation into moisture and mold concerns in GE operating room ventilators, then move straight into the questions clinicians asked most: which filters matter, how low-flow anesthesia changes the moisture equation, and what “moisture mitigation” actually means at the bedside. We walk through APSF guidance on filtration, including why a high-quality filter between the expiratory limb and the anesthesia machine is a key defense for keeping respiratory pathogens out of the workstation. We also talk about what HME filters do well for airway humidity and reducing moisture entering the machine, where their limits are (especially moisture generated by CO2 absorption), and why sidestream gas sampling lines deserve more attention in infection prevention and anesthesia machine protection. Then we share GE Healthcare’s response, including what’s universal across modern anesthesia breathing systems, what features support moisture management, and when optional condensers may help depending on clinical usage patterns. If this topic affects your OR workflow, subscribe, share the episode with a colleague, and leave a review so more anesthesia professionals can find these moisture management and patient safety insights. For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/310-moisture-matters-in-anesthesia-circuits/ [https://www.apsf.org/podcast/310-moisture-matters-in-anesthesia-circuits/] © 2026, The Anesthesia Patient Safety Foundation

#309 Mold Risk In Anesthesia Workstations

Black particles in a breathing system are the kind of finding that makes every anesthesia professional stop and look twice. We’re sharing what a large health system uncovered after concerns for mold and moisture accumulation surfaced inside certain GE Healthcare anesthesia workstations used in operating rooms, especially during longer cases and in humid conditions. What started with a routine inspection quickly scaled into a broad audit of OR ventilators, a review of internal moisture points, and an urgent push for real-world mitigation. We walk through what the investigation found, what cultures grew, and the question everyone asks first: what is the risk to patients? We discuss why the available evidence suggests the infectious risk is likely minimal when high-quality heat and moisture exchange (HME) filtration and breathing circuit filters are used correctly, and why the team still pulled affected machines from service for sterilization per manufacturer instructions. Patient safety isn’t only about infection, though, and we also cover how excess condensate can affect flow sensors and tidal volume accuracy. Then we get concrete about prevention. We break down where moisture comes from inside an anesthesia ventilator, how low-flow anesthesia and rebreathing can increase water production in the circuit, and why simply turning up fresh gas flow isn’t the right fix when cost and environmental impact matter. You’ll hear the day-to-day moisture mitigation strategies that were implemented, including education, routine moisture and mold checks, overnight handling of circuits and sensors, and why add-on condenser drainage may be necessary for older compatible models. If you want a practical checklist mindset for anesthesia workstation maintenance, OR ventilator safety, and moisture management, this is for you. Subscribe, share with your colleagues, and leave a review so more teams can spot problems early and keep patients safe. For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/309-mold-risk-in-anesthesia-workstations/ [https://www.apsf.org/podcast/309-mold-risk-in-anesthesia-workstations/] © 2026, The Anesthesia Patient Safety Foundation