#316 Safer C-Section Pain Control Revisited, PART 1

#319 Four New Studies That Change Daily Anesthesia Safety Decisions

Ketamine for emergency intubation has a reputation for hemodynamic stability, but does the best evidence back that up when your patient is truly sick? Today, we walk through four fresh research summaries that sharpen day-to-day anesthesia patient safety decisions, from airway management in shock and sepsis to the way teams and technology shape outcomes in the OR. First, we break down a large randomized controlled trial comparing ketamine versus etomidate for tracheal intubation in critically ill adults across U.S. emergency departments and ICUs. Mortality is similar, but ketamine shows more peri-intubation cardiovascular collapse, including hypotension and increased vasopressor use, especially in sicker patients. Our practical focus is how to choose an induction agent based on hemodynamic risk and how to prepare for peri-intubation instability. Next, we head into the cardiac OR to explore why surgeon-anesthesiologist dyad familiarity may be a systems-level patient safety strategy. A large retrospective study links more consistent pairings with lower operative mortality and better perioperative outcomes, raising real questions about scheduling, teamwork, and communication under pressure. We also review evidence on BIS-guided closed-loop anesthesia systems that improve anesthetic depth control by reducing excessively deep anesthesia without increasing light anesthesia, and we close with perioperative brain health, highlighting why routine preoperative cognitive screening is still uncommon and what resources could finally make it standard practice. Subscribe to the Anesthesia Patient Safety Podcast, share this with a colleague, and leave a review so more clinicians can find the latest evidence-focused perioperative safety insights. For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/319-four-new-studies-that-change-daily-anesthesia-safety-decisions/ [https://www.apsf.org/podcast/319-four-new-studies-that-change-daily-anesthesia-safety-decisions/] © 2026, The Anesthesia Patient Safety Foundation

#318 Air Embolism Alert

Air embolism is one of those complications that feels impossible right up until it happens fast, quietly, and with life-altering consequences. We walk through the FDA’s 2025 Early Alert on the Watchman access system for left atrial appendage occlusion (LAAO) procedures and connect the dots between device exchange steps, transseptal puncture, and the anesthetic choice that can put patients at risk. We talk about why the shift toward sedation and spontaneous ventilation in structural heart procedures can increase risk when an access system is open or imperfectly sealed. Negative intrathoracic pressure may create a suction gradient that favors air entry into the left atrium, where even small volumes can lead to coronary air embolism or cerebral air embolism. We also review what the FDA reported, including known cases of serious injury and death, and why registry rates may underestimate true events. From there, we translate guidance into practical anesthesia patient safety moves you can use in the interventional cardiology suite: when to consider controlled positive pressure ventilation and PEEP, what to watch during sheath manipulation, and how to set clear roles for sheath control, flushing, and line management. We cover prevention details like keeping components below the level of the heart, slow flushing to maintain a continuous fluid column, and performing exchanges under saline or water baths. We also outline an immediate response plan: recognize quickly, support hemodynamics, consider Trendelenburg positioning, aspirate air if indicated, and activate perfusion support early when available. If this topic touches your practice, share this with your cardiology and anesthesia team, then subscribe, leave a review, and send the episode to a colleague who does transseptal cases. What does your team do to prevent air entrainment during exchanges? For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/318-air-embolism-alert/ [https://www.apsf.org/podcast/318-air-embolism-alert/] © 2026, The Anesthesia Patient Safety Foundation

#317 Setting Expectations For Safer Cesarean Anesthesia with Dr. Ruthi Landau Revisited, PART 2

Many patients walk into labor and delivery picturing a birth day, not an operating room, and that mismatch is where preventable suffering can start. We sit down with Dr. Ruthi Landau to get practical about cesarean delivery anesthesia, with a focus on patient safety, respectful communication, and what to do when a patient says, “This isn’t comfortable.” We dig into why setting expectations during neuraxial consent matters, and why active management of labor epidurals is not optional when an urgent intrapartum C-section may be around the corner. We also unpack what the literature keeps showing: epidural top-ups for intrapartum cesarean delivery are a common pathway to intraoperative discomfort. From re-dosing to adjuvants to real-time reassurance, we talk through concrete ways to prevent pain from being brushed off as “normal.” The conversation goes beyond the OR. A traumatic cesarean experience can shape the next pregnancy, fuel avoidance, and contribute to childbirth-related PTSD. We discuss trauma-informed care, offering debriefs, connecting patients to maternal mental health services, and using patient-reported experience measures to learn where systems fail. On the technical side, we cover pain management for general anesthesia cases, when to keep using an existing epidural, how neuraxial opioids fit with SOAP consensus monitoring guidance, and what a solid multimodal plan looks like when there is no neuraxial option including TAP or QL blocks, acetaminophen, NSAIDs, and opioid stewardship. Subscribe for more obstetric anesthesia and anesthesia patient safety conversations, share this with an anesthesia or OB colleague, and leave a review to help others find the show. What change are you most ready to make in your C-section anesthesia practice? For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/317-setting-expectations-for-safer-cesarean-anesthesia-with-dr-ruthi-landau-revisited-part-2/ [https://www.apsf.org/podcast/317-setting-expectations-for-safer-cesarean-anesthesia-with-dr-ruthi-landau-revisited-part-2/] © 2026, The Anesthesia Patient Safety Foundation

#316 Safer C-Section Pain Control Revisited, PART 1

If you’ve ever heard “it’s just pressure” during a C-section and felt your gut twist, you’re not alone, and it may be a patient safety issue hiding in plain sight. We sit down with Dr. Ruthi Landau, the Virginia Apgar Professor of Anesthesiology and Director of Obstetric Anesthesiology at Columbia University, to get practical about what patients actually feel during cesarean delivery anesthesia and what we can do when those sensations become uncomfortable. We talk through why labeling sensations as pressure versus pain misses the point, and why the better clinical question is simple: “Is it uncomfortable?” From there, we unpack a safer communication loop that invites patients to speak up and gives them real choices for relief, whether that means dosing through an epidural, using IV medication, or escalating plans when neuraxial techniques are not working.  We also dig into opioid-sparing strategies for C-section pain management, including multimodal non-opioid analgesia, the risks of cookie-cutter discharge prescriptions, and how shared decision-making can reduce leftover opioids at home. Finally, Dr. Landau shares current practice insights on dexmedetomidine for shivering, anxiety, and visceral discomfort, along with the evolving evidence base and dosing approaches being used today. If you care about safer cesarean delivery, obstetric anesthesia best practices, and preventing opioid-related harm, subscribe, share this with a colleague, and leave a review so more clinicians can find the conversation. For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/316-safer-c-section-pain-control-revisited-part-1/ [https://www.apsf.org/podcast/316-safer-c-section-pain-control-revisited-part-1/] © 2026, The Anesthesia Patient Safety Foundation

#315 Pain During Cesarean Delivery

Pain during cesarean delivery is not “just pressure,” and it is not rare. We dig into why inadequate pain control during C-section remains underrecognized even as patient-reported data suggest it may be one of the most common anesthetic complications in obstetric anesthesia, with consequences that can reach far beyond the operating room including PTSD, postpartum depression, disrupted bonding, and lasting distress about birth. We walk through what the research has measured so far (conversion to general anesthesia, neuraxial replacement, and intravenous rescue medications) and what those markers can miss when the team does not recognize pain in real time. Patient stories, including lessons highlighted in The Retrievals podcast, make the safety gap impossible to ignore and help explain how bias, hierarchy, and cultural norms can quietly normalize suffering. We also unpack how language choices, especially the casual overuse of “pressure,” can minimize pain and derail clear assessment. From there, we get practical. We talk about shared decision making, objective ways to identify intraoperative pain, and how teams can escalate care: pause when possible, optimize neuraxial anesthesia, use evidence-based adjuncts, and move to general anesthesia when regional anesthesia is not sufficient. We also cover why systems matter, from reliable block testing to OR readiness for safe obstetric general anesthesia and postoperative follow-up when pain occurs. Subscribe for more anesthesia patient safety conversations, share this with a colleague on L&D, and leave a review so more clinicians can find it. What is one change you want your team to make after listening? For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/315-pain-during-cesarean-delivery/ [https://www.apsf.org/podcast/315-pain-during-cesarean-delivery/] © 2026, The Anesthesia Patient Safety Foundation