Sugammadex safety considerations span across patient populations with renal impairment, pediatric patients, and pregnant or breastfeeding individuals, requiring nuanced clinical decision-making based on current evidence and ongoing research.

• Sugammadex reversal of moderate blockade is safe and faster than using neostigmine/cisatracurium for patients with renal impairment
• Quantitative neuromuscular monitoring is essential to ensure adequate reversal (TOF >90%)
• FDA approval exists for children 2+ years with the same dosing parameters as adults
• Infants <2 years require special consideration due to immature neuromuscular systems and distinct physiology
• Recurarization cases exist but are rare, primarily in very young patients
• Pregnancy considerations include theoretical concerns about progesterone binding
• Breastfeeding compatibility varies based on lactation stage, with early postpartum period requiring more caution
• Continued research needed to establish definitive guidelines, especially for neonates, infants, and lactating patients

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/250-sugammadex-in-special-populations-what-every-anesthesia-professional-needs-to-know/

© 2025, The Anesthesia Patient Safety Foundation

Discover the critical safety considerations when using Sugammadex, the seemingly "magical" neuromuscular blockade reversal agent that's fundamentally changed anesthesia practice. We delve deep into the science behind this medication and examine its use in three challenging patient populations: those with renal failure, pregnant patients, and pediatric patients.

For patients with kidney dysfunction, we explore the fascinating pharmacokinetics of Sugammadex and how its primarily renal excretion creates potential complications. With a normal half-life of approximately two hours extending to a 19 hours in severe renal impairment, understanding the risk of recurarization becomes essential. Despite these challenges, recent research suggests Sugammadex may still offer advantages over traditional reversal agents in these patients.

Pregnant patients present another complex scenario. Does Sugammadex bind to progesterone? What might this mean for maintaining pregnancy? We examine the current Society for Obstetric Anesthesia and Perinatology guidelines alongside emerging research that offers glimpses of hope for safe use. From animal studies to limited human case reports, we unpack what we know and the significant questions that remain unanswered.

The conversation extends to breastfeeding considerations and emergency scenarios where the risk-benefit analysis shifts dramatically. Through expert insights and references to the latest studies, we provide practical knowledge for anesthesia professionals navigating these challenging clinical situations. This episode serves as a crucial reminder that despite advances in pharmacology, patient safety still demands individualized care, vigilant monitoring, and thoughtful application of evolving evidence.

Want to further enhance your patient safety skills? Check out the Manual External Defibrillation course available at no cost through the ASA learning management system. Join us next week as we continue our discussion with a focus on pediatric patients and Sugammadex use.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/249-sugammadex-safety-special-populations-special-concerns/

© 2025, The Anesthesia Patient Safety Foundation

Medication safety remains a cornerstone of anesthesia practice with complex environments and high-stakes decisions requiring vigilant attention to prevent errors. This collaboration between APSF and OpenAnesthesia spotlights critical aspects of perioperative drug safety with practical insights from Dr. Juan Li, a cardiothoracic anesthesia fellow at Beth Israel Deaconess Medical Center.

• Perioperative anaphylaxis requires immediate recognition of cardiovascular, respiratory, and cutaneous manifestations
• Neuromuscular blocking agents and antibiotics represent common triggers for anaphylactic reactions
• Preoperative assessment must include thorough allergy history, medication reconciliation, and identification of drug-drug interactions
• Standardized drug concentrations, preparation methods, and equipment minimize medication errors
• Technology integration through barcode readers and computerized decision support enhances safety
• Pharmacy support with pre-mixed solutions and pre-filled syringes reduces preparation errors
• Post-operative monitoring remains critical for catching delayed medication reactions
• Safety culture should emphasize root cause analysis rather than punishment for medication errors
• Implementation of standard protocols is essential for managing new medications with limited safety data

Visit APSF.org and Openanesthesia.org for detailed information and resources on medication safety in anesthesia practice.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/248-beyond-the-mask-an-openanesthesia-collaboration-on-perioperative-drug-safety/

© 2025, The Anesthesia Patient Safety Foundation

Climate change has arrived in the operating room, and pediatric anesthesiologists are taking action. Dr. Eva Lu-Boettcher, pediatric anesthesiologist and Director of Anesthesia Quality and Safety at the University of Wisconsin Children's Hospital, shares her journey toward sustainable anesthesia after witnessing firsthand the effects of climate change—including her Wisconsin community experiencing the world's worst air quality from wildfires.

The healthcare sector contributes a staggering 8% of total U.S. greenhouse gas emissions, with anesthesia practices like high fresh gas flow during pediatric mask inductions representing significant contributors. Dr. Lu-Boettcher reveals how simple adjustments to match fresh gas flow with a patient's minute ventilation can dramatically reduce carbon emissions without compromising safety or induction effectiveness.

What makes Dr. Lu-Boettcher's approach particularly fascinating is her application of behavioral science and "nudge theory" to achieve lasting change. By implementing default ventilator settings, providing comparative feedback to providers, and creating electronic reminders, her team achieved a remarkable 41% increase in compliance with sustainable practices. 

Ready to make your anesthesia practice more sustainable? Listen now to learn practical techniques for greener pediatric anesthesia care that maintains the highest safety standards while protecting our planet. The future of anesthesia must balance excellent patient care with environmental stewardship—and the time to start is now.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/247-nudge-your-way-to-greener-pediatric-anesthesia/

© 2025, The Anesthesia Patient Safety Foundation

Dr. Liz Hansen takes us behind the scenes of a remarkable transformation at Seattle Children's Hospital, where pediatric anesthesiologists have reduced their greenhouse gas emissions by over 90% without compromising patient safety. A lifelong environmentalist and bike commuter, Dr. Hansen was shocked to discover that anesthesia gases contributed to 7% of her hospital's total emissions. This revelation sparked a personal and professional journey to align her clinical practice with her environmental values.

The conversation reveals practical strategies for reducing anesthesia's carbon footprint, from eliminating nitrous oxide to implementing low-flow techniques. Dr. Hansen shares how her team gradually won over colleagues by demonstrating that sustainable practices could maintain or even improve patient outcomes. She offers detailed insights into working with child life specialists, adapting mask induction techniques, and using data tracking to drive continuous improvement.

What makes this story particularly powerful is the ripple effect beyond a single institution. Dr. Hansen co-founded Project SPRUCE (Saving Our Planet by Reducing Carbon Emissions), an international consortium of anesthesia groups collaborating to reduce their environmental impact. Member organizations have already achieved their first-year goal of 50% emissions reduction, with more ambitious targets on the horizon.

For anesthesia professionals concerned about climate change but unsure how to make a difference, this episode offers hope and concrete action steps. Remember, "the antidote to despair is action." Download the Yale Gassing Greener app, try a nitrous-free induction on your next cooperative patient, or advocate for addressing gas leaks in your facility's central supply system. Your individual choices matter, especially when they inspire others to follow your lead.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/246-ditching-nitrous-oxide-the-bike-commuters-guide-to-safe-and-sustainable-anesthesia/

© 2025, The Anesthesia Patient Safety Foundation

In our latest episode, we dive headfirst into the growing issue of medical misinformation and its alarming effect on anesthesia patient safety. As patients increasingly turn to social media for health information, the risks of encountering inaccurate content have soared, posing challenges for healthcare professionals.

Join us as we explore a recent article by George Tewfik and Raymond Malapero from the February 2025 APSF Newsletter, focusing on how misinformation can threaten patient safety, especially during critical procedures. We'll outline the detrimental consequences of misinformation, breaking them down into three distinct categories: fear and anxiety, delay of treatment, and avoidance of treatment altogether. Understanding the psychological and physiological impacts of misinformation is crucial for anesthesia professionals and helps to frame how we can best support our patients.

You’ll also learn actionable strategies for addressing these issues directly with patients. Empathy and compassionate communication are vital tools in combatting misinformation and fostering trust between healthcare providers and patients. By guiding patients towards reputable resources and encouraging open dialogue about their concerns, we can mitigate the effects of fear and anxiety, ultimately enhancing safety in anesthesia care.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/245-unmasking-medical-misinformation/

© 2025, The Anesthesia Patient Safety Foundation

Join us as we dive into the critical topic of medical misinformation and its alarming impact on patient safety, particularly in the field of anesthesia. In this compelling episode, we unpack how misconceptions shape patient trust and communication with healthcare providers. Our conversation features insightful commentary from Dr. George Tewfik, who highlights real-world examples of how misinformation spreads and influences patient decisions. 

The rapid rise of social media as a primary information source has created a fertile ground for myths and misconceptions to thrive, leading to heightened anxiety among patients about anesthetic procedures.  Misinformation, such as exaggerated risks linked to medications like propofol and fentanyl, can cause unnecessary fear and even affect the consent process. 

As we walk through patient anxieties and barriers, we provide practical strategies for healthcare professionals to combat misinformation effectively. Emphasizing the need for transparent and empathetic communication, we aim to empower listeners with the tools to engage their patients constructively.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/244-battling-myths-and-misinformation-ensuring-patient-safety-in-anesthesia/

© 2025, The Anesthesia Patient Safety Foundation

This episode delves into key findings in the literature, focusing on the nuances of neuromuscular blockade in pediatric patients and novel advancements in intubation techniques to enhance patient safety. We explore significant insights from recent studies that highlight age-related differences in recovery times from neuromuscular blockade and practical recommendations. We also discuss a novel flexible stylet for intubation and the implications of intravenous catheter design during emergency needle decompression.

Highlights include:

• Exploring age-based variability in neuromuscular recovery 
• Understanding the effects of volatile anesthetics on younger patients 
• Emphasizing the importance of quantitative monitoring in pediatrics 
• Introducing a new flexible intubation aid to enhance airway management 
• Discussing a case report on emergency needle thoracostomy 
• Practical recommendations for training to improve response in emergency situations

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/243-unlocking-insights-for-safer-anesthesia-key-findings-from-the-literature-and-a-case-report/

© 2025, The Anesthesia Patient Safety Foundation

Feeling overwhelmed about staying up to date with the anesthesia literature? We hope you will check out the APSF's In The Literature section. This resource brings you straightforward summaries of recent high-impact articles related to anesthesia patient safety. This episode highlights crucial updates in the literature concerning diabetes management, the impact of fatigue on anesthesia professionals, research about GLP-1 receptor agonists, and the use of methadone for next-day discharge surgery. These insights aim to enhance patient safety and improve the overall quality of anesthesia care.

• Updates on blood glucose management guidelines for diabetic patients 
• Findings on the relationship between fatigue and patient safety 
• The risks of aspiration in patients taking GLP-1 receptor agonists 
• Insights on using methadone for pain control in outpatient surgeries 
• Discussion on the implications of recent research for clinical practice

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/242-enhancing-anesthesia-patient-safety-literature-reviews-guidelines-and-recommendations/

© 2025, The Anesthesia Patient Safety Foundation

This episode discusses the implementation of ISO 80369-6 neuraxial connectors in Japan, analyzing the challenges faced and the implications for patient safety. The conversation highlights the importance of clinician involvement and the need for clear communication and trials during the transition to new medical standards.

• Overview of ISO 80369-6 and its significance in anesthesia care
• Challenges faced in Japan during the implementation of new connectors
• Historical context of the LOR connector and its risks
• Importance of clinician involvement in product testing and standard formulation
• Call for vigilance and advocacy among anesthesia professionals for patient safety when creating new medical devices and setting new standards

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/241-the-impact-of-iso-80369-6-neuraxial-connectors-patient-safety-challenges-and-opportunities/

© 2025, The Anesthesia Patient Safety Foundation

The episode explores the challenges and lessons learned from Japan's recent implementation of ISO 80369-6 standards in anesthesia practices, highlighting the critical importance of clinician involvement in developing safety protocols. We discuss the historical context, issues with communication, and various complications arising from the transition to new safety standards.

• Importance of ISO standards in enhancing patient safety
• Role of clinician input in developing safety protocols
• Japan's experience with the implementation of ISO 80369-6
• Historical context of neuraxial connection standards
• Issues arising from lack of communication during transitions
• Challenges faced by healthcare professionals adjusting to new standards
• Support structures needed for effective standards implementation
• Lessons learned for global anesthesia practices regarding ISO standards

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/240-enhancing-international-anesthesia-patient-safety-insights-on-iso-standards/

© 2025, The Anesthesia Patient Safety Foundation