Anesthesia Patient Safety Podcast

• #253 When Electrocautery Meets Implanted Devices: What Every Anesthesia Professional Needs to Know

  The safe management of non-cardiac implantable electrical devices during surgery requires careful planning and knowledge of device-specific considerations. We continue our discussion from last week with actionable recommendations for each stage of perioperative care.• Electrocautery poses significant risks including device reprogramming, thermal burns, and damage to neural tissue• Turn off devices or set to safe surgery mode before using electrocautery • Bipolar cautery is safer than monopolar; if monopolar is needed, use lowest power setting• Place grounding pads to minimize current through the device generator• Somatosensory evoked potentials (SSEPs) are relatively safe while motor evoked potentials (MEPs) should be avoided• Newer devices may be MRI conditional but require specific protocols including device interrogation• Regional anesthesia should use ultrasound guidance rather than nerve stimulation techniques• Neuraxial anesthesia is not contraindicated for spinal cord stimulator patients but must be placed below insertion level• ECT can be performed with device turned off and careful electrode placement• Devices should be turned back on before emergence from anesthesia• Postoperative evaluation should include checking for thermal injuries and neurologic changesThanks for joining us for our 253rd episode! Wow, 250 and counting! Go tell a friend or colleague about our show as we work toward 500 episodes. If you enjoy the Anesthesia Patient Safety Podcast, please give us a five-star rating, subscribe, and share with colleagues.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/253-when-electrocautery-meets-implanted-devices-what-every-anesthesia-professional-needs-to-know/© 2025, The Anesthesia Patient Safety Foundation

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• #252 Managing Neurologic Stimulators: A Critical Guide for Safe Anesthesia

  The podcast explores comprehensive recommendations for managing patients with non-cardiac implantable electrical devices during surgical procedures, emphasizing preoperative assessment, device interaction prevention, and safety protocols.• Types of devices include vagal nerve stimulators, deep brain stimulators, and spinal cord stimulators• Preoperative evaluation is crucial for identifying devices and contacting managing clinicians• Algorithm provided for assessing potential interactions with electrocautery, MRI, and neuromonitoring • Diathermy is absolutely contraindicated in patients with non-cardiac implantable devices• Critical information needed includes device type, manufacturer, lead locations, and latest interrogation results• Recent urgent safety alert issued about medication vial coring risks with specific interim recommendationsIf you have any questions or comments, please email us at [email protected]. Visit apsf.org for detailed information and check out the show notes for links to all topics discussed.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/252-managing-neurologic-stimulators-a-critical-guide-for-safe-anesthesia/© 2025, The Anesthesia Patient Safety Foundation

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• #251 Surgical Fires: The 30% Oxygen Rule

  Surgical fires are devastating yet entirely preventable events that continue to occur in operating rooms around the world. This eye-opening episode features biomedical engineer Mark Bruley and anesthesiologist Dr. Jeffrey Feldman, who share decades of expertise investigating and preventing these catastrophic incidents.The conversation reveals why the seemingly simple recommendation to limit open oxygen delivery to 30% is so critical for patient safety. Through forensic investigations and laboratory testing, we learn how oxygen-enriched environments transform common surgical materials into dangerously flammable substances. The experts describe the "two-fold risk" created when oxygen concentrations exceed safe limits: materials ignite more easily and flames spread exponentially faster, putting patients at serious risk of harm.The experts outline clear, evidence-based approaches to prevent surgical fires, including the use of oxygen blenders for precise control and securing the airway when higher oxygen concentrations are clinically necessary. They share encouraging data showing significant reductions in surgical fire incidents over the past decade, while emphasizing that complete elimination is both possible and necessary.Whether you're an anesthesia professional, surgeon, or perioperative nurse, this episode provides essential knowledge to protect your patients from this preventable complication. Visit the APSF website for comprehensive resources, including videos and algorithms, to implement surgical fire prevention protocols at your institution. By understanding and applying these recommendations, we can work together to ensure no patient is ever harmed by a surgical fire again.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/251-surgical-fires-the-30-oxygen-rule/© 2025, The Anesthesia Patient Safety Foundation

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• #250 Sugammadex in Special Populations: What Every Anesthesia Professional Needs to Know

  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 patientsFor 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

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• #249 Sugammadex Safety: Special Populations, Special Concerns

  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

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