#315 Pain During Cesarean Delivery

#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

#314 PACU Corneal Abrasion Protocol

Eye pain in the PACU can feel like an automatic page to ophthalmology, but it doesn’t have to be. We break down postoperative corneal abrasions on the show today.  We share practical, clinician-ready guidance drawn from a multidisciplinary PACU corneal abrasion protocol developed with anesthesiology and ophthalmology expertise. You’ll hear exactly what to ask and look for when a patient reports blurry vision or a gritty sensation, the red flag that changes everything (vision loss), and how fluorescein stain plus a cobalt blue light exam can quickly sort a true corneal defect from keratoconjunctivitis or dry eyes. We also cover straightforward treatment for an uncomplicated corneal abrasion, including erythromycin ointment every four hours until symptoms resolve, along with clear follow-up rules when symptoms persist beyond 24 hours. Then, we dig into the quality improvement and operations side: how tracking cases in the electronic medical record supports reliable follow-up, how the protocol reduces unnecessary ophthalmology consults, and why this approach can improve patient satisfaction while protecting safety. You’ll also hear the real-world impact, including complete symptom resolution in tracked patients and substantial patient cost savings tied to avoided consult charges. Subscribe for more anesthesia patient safety insights, share this episode with a colleague who staffs PACU, 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/314-pacu-corneal-abrasion-protocol/ [https://www.apsf.org/podcast/314-pacu-corneal-abrasion-protocol/] © 2026, The Anesthesia Patient Safety Foundation

#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