Anesthesia Patient Safety Podcast

#248 Beyond the Mask: An OpenAnesthesia Collaboration on Perioperative Drug Safety

• Anesthesia Patient Safety Foundation • Episode 248

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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

Marjorie Striegler:

You're listening to the Anesthesia Patient Safety Podcast, the official podcast of the Anesthesia Patient Safety Foundation. We're bringing you the very best from the APSF newsletter and website, as well as the latest information in perioperative patient safety. Thanks for joining us.

Alli Bechtel:

Hello and welcome back to the Anesthesia Patient Safety Podcast. My name is Allie Bechtel and I'm your host. Thank you for joining us for another show. We have a new podcast series that we are launching today. This is an exciting collaboration with Open Anesthesia and the Anesthesia Patient Safety Foundation. For this series, we will be talking with Open Anesthesia Summaries authors about important topics in perioperative patient care and patient safety. This is a great way to expand your knowledge on these high-yield and practical topics. Our topics today are perioperative drug safety and perioperative allergies and anaphylaxis. This falls under the APSF patient safety priority of medication safety. Stay tuned for my conversation with open anesthesia author, juan Lee, who wrote the summary and is a guest on our show today.

Alli Bechtel:

Before we dive further into the episode, we'd like to recognize BD, a major corporate supporter of APSF. Bd has generously provided unrestricted support to further our vision that no one shall be harmed by anesthesia care. Thank you, bd. We wouldn't be able to do all that we do without you To follow along with us. You can head over to openanesthesiaorg and click on the summaries heading. Our featured summaries today are perioperative drug safety and perioperative allergy and anaphylaxis. Our featured APSF patient safety priority is medication safety. Head over to APSForg and click on the APSF priorities heading. Then click on medication safety. This priority includes drug effects, labeling issues, shortages, technology issues and processes for avoiding and detecting errors.

Alli Bechtel:

Let's take a moment to review the 2022 APSF Medication Safety Patient Safety Priority Group recommendations. Here we go. Number one the APSF should optimize the use of pre-filled syringes and pre-prepared infusions to reduce the chance for dilution or labeling errors and potentially minimize waste. Number two the APSF should implement point-of-care electronic medication scanning for medication checks and clinical decision support prior to medication administration, with auditory or spoken and displayed medication name alerts and other critical information. Number three the APSF should work with regulatory bodies and manufacturers to standardize medication vials and distinguish medications by class with color-coded labels to reduce errors.

Alli Bechtel:

4. The APSF should recommend the use of standard concentrations of medications across patient care areas, including the emergency department, icu and perioperative environments. Number five the APSF should develop online resources highlighting best medication safety practices, including toolbox checklists, white papers and more tailored for anesthesia professionals who practice in facilities with fewer resources than large health systems or academic institutions, such as surgery centers, office-based settings and community hospitals. There is a lot of excellent work being done by the APSF to help improve medication safety. This is such an important topic. Today we are excited to be partnering with Open Anesthesia to share their comprehensive, high-quality educational content. And now let's meet the author as we review these important topics in anesthesia patient safety. Hello and welcome to the show. Could you please introduce yourself and tell us a little bit about yourself?

Juan Li:

Sure, my name is Zhuan. I'm right now a cardiac thoracic Beth Israel Deaconess Medical fellow at Medical Center, Harvard Medical School. So I'm currently in fellowship now, but I was attending anesthesiologist for three years before I'm a cardiac thoracic fellow and before that I was a resident here in the Beth Israel Deaconess hospital Medical Center for residency, and I graduated medical school in China, Beijing, from Peking Union Medical College in 2016.

Alli Bechtel:

Now, before we get into the open anesthesia summary, can you share with us some of the key takeaways?

Juan Li:

Okay, sure, so this drug safety. We focused on a couple of key points. First of all, we talked about perioperative anaphylaxis, which is common in peri-out of settings, and we secondly focused on the newer medication drugs and also safety concerns about the new medications coming to market, and then we talked about the practice and safety culture in the perioperative settings. Lastly, we put a couple of recommendations for improving medical safety for perioperative medicine.

Alli Bechtel:

Now let's get a little bit more information about perioperative drug safety. Can you provide a brief overview and some background information for us?

Juan Li:

Oh sure, so perioperative drug safety is a very critical area in healthcare, focused on preventing adverse events during anesthesia and surgery. Historically, medication errors in the operating room were common due to complex environments, lack of standards and absence of pharmacy support. So anesthesiologists often managed medications without computerized decision support, leading to errors from medical calculations, distractions, non-standardized drug preparations. So over time, efforts have been made to improve safety through standardization of drug concentrations and equipment. Technology and especially APSF foundations, played a significant role in promoting these changes, I think, and also, additionally, post-market surveillance and initiatives like the FDA's Sentinel Initiative have also enhanced the detection of safety issues with neurodrugs. And despite these advancements, vigilance and continuous improvement remain essential to minimize risk and ensure patient safety.

Alli Bechtel:

What are some of the important considerations that we need to be on the lookout for with different anesthetic agents? Can you describe some of the current anesthetic safety issues?

Juan Li:

Yes, I think, regarding first part, anaphylaxis, we should definitely focus on the life-threatening conditions caused by the most common drugs we encounter for the anaphylaxis, like neuromuscular blocking agents, antibiotics, and so we should monitor, like an aneel, cardiovascular, cardiovascular collapse, bronchospasm or a organ involvement immediately during the care of the patient. And once we notice anaphylaxis we should discontinue the medication right away. And in the following days of care of the patient we probably will think about doing serum tryptase levels test and focusing on the physiology changes, obviously cardiovascular, we will notify any hypotension, bradycardia during the anesthesia, respiratory chains, bronchospasm, hypoxemia, gi like a rash, angioedema. A patient has nauseous vomiting for the pre-med and also for other metabolic electrolytes. Imbalances like hypokalemia, hyperkalemia and also some delayed drug effects like a delayed onset of anaphylaxis in the PACU settings. We should also focus on those physiology changes above mentioned.

Alli Bechtel:

This is great. What are some additional safety considerations that anesthesia professionals should be on the lookout when it comes to using medications in the perioperative area?

Juan Li:

Yeah, sure. So I think we should focus on preoperative assessment. First, we should review the allergy history of the patient, the drug list, also the medication reconciliation, including identify the drug-drug reactions, with the patient asking the full history of the over-the-counter drug medications, pay attention to drug interactions. And secondly, we should also do some anaphylaxis precautions for high-risk drugs. We should be prepared for any anaphylaxis even though the patient has no exposure before and we should keep vigilant for the whole process to recognize the signs and symptoms earlier and take protocol management to deal with these situations, like anaphylaxis, shock conditions.

Juan Li:

And also regarding to newer medications, there are very limited data to how to monitor this. Like the new medications coming to market, like Sugamidex or other medication, we have to be very careful about the rare side effects and also we should focus on education and training about the situation that we cannot use of these medications. And lastly, I think we should put standardization and best practice into consideration, because all those new medications, we should implement protocol management to deal with the drug safety concerns. Deal with the drug safety concerns and also I think the communication and safety culture should be put on the list as well. Adopt a just culture approach to investigate medication errors. Focus on root cause analysis rather than punishment.

Alli Bechtel:

So there are some serious complications associated with medication errors. It is important for anesthesia professionals to remain vigilant during cases where they are providing anesthetic care. Can you review some of the best practices for medication administration?

Juan Li:

Yeah, sure, I think we have a couple of things we can focus on. I think, first of all, we should do standardized process, implement standardized drug concentrations, preparation methods and equipment to minimize errors. And secondly, we should implement technology integration, like utilize barcode readers, automatic drug delivery systems and computerized decision support tools to enhance medication safety. And lastly, I think we need our pharmacy support as well, to leverage specialized satellite pharmacists to provide pre-mixed solutions and pre-filled syringes, reducing the risk of errors during drug preparation.

Alli Bechtel:

Is there anything else that we haven't talked about when it comes to perioperative drug safety or anaphylaxis, that you'd like to share with us today?

Juan Li:

I think I probably missed something like is important as well, which is post-operative monitoring, because most of the time we focus on pre-op, intra-op, but post-op is also one of the parts. We should be very careful Because there are some medications that have delayed reactions. We should educate our nurses, pacu teams about reactions like monitoring and how to deal with drug effects. And there are also medications that have some residual effects, effects like neuromuscular blocking agents, which has happened not that uncommon in the PACU settings and I think this is the part we should also continue to monitor, even we finish our anesthesia care in the OR.

Alli Bechtel:

That's right. Anesthesia professionals need to be perioperative physicians and have an important role for patient safety in the preoperative, interoperative and postoperative physicians and have an important role for patient safety in the preoperative, interoperative and postoperative space. Well, this was a really great review. Can you tell us what's next for you in terms of any upcoming research or projects finishing your fellowship?

Juan Li:

Yeah, yeah, it's a. It's a good topic for my next steps. I'm planning to stick around at the Massachusetts area, so I'm going to stay at the Bessiesville Dignity Medical Center and the community hospital at BI Leahy System. I really enjoy working in the cardiothoracic anesthesia part, so I definitely will be dividing deeper into that area and my main focus is going to be boosting perioperative patient safety for anesthesia. I've got a couple of exciting plans, like a non-chain QI projects to enhance safety of transesophageal echocardiography and also expand the use of point of care for ultrasound and make sure our transfusion practices are as safe as possible. These are a couple of QI projects and it's all about making things better for our patients and the team.

Alli Bechtel:

Oh, that's great. Well, hopefully you will share some of those projects and findings with us with the Anesthesia Patient Safety Foundation going forward. Thank you, thank you, ali. Well, thank you so much for contributing to the show today. We are looking forward to continuing this collaboration between the Open Anesthesia Summaries and the Anesthesia Patient Safety Podcast.

Juan Li:

Thank you very much. Thank you for inviting me today.

Alli Bechtel:

Thank you so much to Juan for joining us on the show today. We are looking forward to continuing this series and sharing more open anesthesia summaries with you. If you have any questions or comments from today's show, please email us at podcast at APSForg. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit APSForg for detailed information and check out the show notes for links to all the topics we discussed today. If you like listening to our show and we hope that you do please take a minute to give us a five-star rating wherever you listen to your podcasts and share this podcast with your colleagues or anyone you know who is interested in anesthesia patient safety. This is a great way to expand our listeners and help make anesthesia safer all around the world. Thank you for listening and sharing. Until next time, stay vigilant so that no one shall be harmed by anesthesia care.