#313 Individualized Multimodal Analgesia

#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

#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