#293 Reimagining Anesthesia With AI, Wearables, And Safety Culture

What if the anesthesia workstation could see trouble coming and stop it before it starts? We explore how anesthesia moves from reactive to predictive by blending AI, medical-grade wearables, and closed loop systems with a strong safety culture. The story of Alex—a 75-year-old who developed postoperative delirium and fell—anchors the stakes and shows how early signals, if recognized and acted on, can change a life.

We break down practical uses of machine learning in the perioperative space: forecasting hypotension minutes ahead, integrating multimodal physiologic data for real-time decision support, and taming alarm fatigue with smarter, context-aware alerts. From operating room monitors to infusion pumps, interoperability turns scattered data into timely action. 

Automation takes the next step with closed loop control. Imagine EEG-guided dosing that keeps hypnosis within target ranges, fluid and vasopressor titration that stabilizes hemodynamics, and a supervisory controller that coordinates these loops so clinicians can focus on communication, situational awareness, and patient advocacy. Through it all, safety culture remains the foundation: psychological safety, shared learning, and consistent prioritization of safety over short-term operational pressures. Technology should amplify the human connection, not replace it.

You’ll leave with a clear view of what to pilot now—AI decision support in high-yield scenarios, targeted wearable programs for high-risk pathways, and structured training that embeds safety into daily practice. If this vision sparks ideas or questions, reach out and join the conversation. Subscribe, share with a colleague who cares about perioperative safety, 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/293-reimagining-anesthesia-with-ai-wearables-and-safety-culture/

© 2026, The Anesthesia Patient Safety Foundation

Transcript

Sponsor Thanks And Article Setup

Why The Future Piece Was Written

SPEAKER_01 0:10

Hello, and welcome back to the Anesthesia Patient Safety Podcast. My name is Allie Bechtel, and I'm an anesthesiologist and your host for today. Thank you for joining us for another show. Henry Ford once said, if I had asked people what they wanted, they would have said faster horses. Don't worry, we won't be talking about horses or cars on the show today, but we can apply this quote to anesthesia patient safety as well. The future of anesthesia patient safety will require that we move beyond what we have always done and embrace innovative models of health care that align with the needs of our patients. For the APSF to accomplish our mission, that no one shall be harmed by anesthesia care, we will need to reimagine anesthesia care beyond the current cognitive implementation and financial barriers to deliver predictive, personalized, and safer care. The future that we envision will deliver improved outcomes for patients and a sustainable experience for all perioperative team members filled with vitality and purpose. Are you excited about this future of perioperative anesthesia patient safety? Before we dive further into the episode today, we'd like to recognize Frazinius Kabi, a major corporate supporter of APSF. Frazini Ascabi has generously provided unrestricted support to further our vision that no one shall be harmed by anesthesia care. Thank you, Frazinius Kabi. We wouldn't be able to do all that we do without you. We are returning to the October 2025 APSF newsletter again today. Our featured article is The Future of Anesthesia: Embracing Innovation for Safer, Personalized Perioperative Care by Daniel Cole and colleagues. To follow along with us, head over to apSF.org and click on the newsletter heading. The fourth one down is Newsletter Archives, and from here, scroll down to the October 2025 newsletter and our featured article today. I will include a link in the show notes as well. To help kick off the show today, we are going to hear from one of the authors who also has a big role in the APSF. Let's take a listen now.

SPEAKER_00 2:46

Hi, my name is Dan Cole. I'm an anesthesiologist at UCLA and president of the Anesthesia Patient Safety Foundation.

SPEAKER_01 2:55

I asked Dan why he wrote this article. This is what he had to say.

SPEAKER_00 3:01

I wrote the article to highlight an exciting future for clinicians, one where we can reshape the arc of patient outcomes by embracing emerging technology.

Reactive Care Case: Alex’s Outcome

AI And Predictive Analytics In The OR

Wearables And The Digital Twin

Closed Loop Systems And Automation

Building A Strong Safety Culture

Rewriting Alex’s Story With Tech

Final Reflections And Listener Actions

SPEAKER_01 3:15

Thank you so much to Dan for helping to introduce this topic. Now it's time to get into the article. Here are the highlights that we are going to be discussing further on the show today. Perioperative care models must move away from being reactive towards being predictive, personalized, and proactive. And there is a call to action to embrace AI, wearable sensors, closed loop systems, and safety culture to improve outcomes, reduce complications, reduce clinician burden, and help improve alignment with patient care needs. Let's look at these considerations a little closer, starting with a possible case presentation. Our patient is Alex, a 75-year-old man now retired who underwent surgery for colon cancer. His past medical history includes hypertension and diabetes. He was living independently with no cognitive impairment. During his surgery, there were multiple periods of modest hypotension. On the night after surgery, Alex demonstrated signs of postoperative delirium and fell while getting out of his bed. The delirium worsened, which prolonged the hospital stay. Alex was discharged to long-term care and never returned to independent living. This story demonstrates a reactive care model. Early signs of clinical deterioration were missed, leading to adverse effects and long-term consequences. There is a better way with emerging technology so that we can predict risk, intervene proactively, and actually change outcomes. First up, we're going to talk about artificial intelligence. We have seen the massive growth of digital health records and computational power, which is driving machine learning, personalized medicine, and predictive analytics. Machine learning involves algorithms that detect patterns to be able to predict complications, identify appropriate therapies, and allow for early intervention. For example, if machine learning can predict hypotension ahead of time and alert the anesthesia professional, the anesthesia professional can then take the appropriate actions so that the hypotension doesn't occur at all. There is a lot of data in the perioperative environment from electronic medical records to our infusion pumps to our monitoring devices. Going forward, we will likely see a focus on real-time signal processing, integration of multimodal physiologic data, and closed loop interoperability between monitoring platforms and delivery systems. This allows for real-time decision support and earlier interventions with personalized therapy to prevent clinical deterioration before it happens. AI-enabled alarm management is another exciting area that may help to reduce alarm fatigue by suppressing non-actionable alerts, enhance safety, and mitigate the clinical burden. There is an opportunity here to use responsible AI as a powerful complement to human connection. The authors remind us of the words of Karim Lakhani, Harvard Business Professor AI won't replace humans, but humans with AI will replace humans without AI. Next up, let's talk about wearables. You may be using a consumer grade wearable right now on your wrist, and you are not alone. These wearable devices have been widely adopted for personal health goals and monitoring. In healthcare, medical-grade wearables have not been widely adopted yet due to performance requirements, regulatory thresholds, cost, and concerns about the impact on strained caregivers. Can you think of situations where having personalized continuous data would greatly enhance patient care and safety in the perioperative period? The authors provide examples including preoperative monitoring and using the data to inform prehabilitation strategies, continuous postoperative monitoring rather than our current strategy of intermittent checks, and after discharge at home where there is currently a lack of any monitoring. There is an important step here. We can't just give our patients smartwatches during their pre-operative clinic visit. The wearable technology must be integrated with AI systems that are capable of transforming continuous streams of raw physiologic data into meaningful, actionable insights. That is where the magic happens. One idea is to develop a digital twin, that is, a real-time, data-driven virtual model of a patient's biologic and physiologic status. Then, with the wearable sensor linked to an AI program, the dynamic model would allow for earlier and more precise and personalized interventions. This is one way that we move from a reactive, one-size-fits-all healthcare approach to proactive, personalized, and predictive healthcare. Let's take a look at an example from the postoperative period. We equip a posto-perative patient, a biosensor that transmits multiple physiologic parameters to a centralized AI-supported monitoring platform. Then, the AI system identifies early signs of respiratory depression and triggers an alert to clinicians who are able to provide timely clinical intervention before a critical event occurs. This emerging technology would be an important step to help keep patients safe throughout the perioperative period. One more area of emerging technology that we are going to look at today includes closed loop systems. We are looking to the future where workstations use closed loop systems as extenders of care by automating simple repetitive tasks. So, what is a closed loop system? It uses data from an input, which is then fed to a controller, which then adjusts the output appropriately. For example, electroencephalogram data, EEG data, is the input that may be fed into a computer algorithm, the controller, and then the propofol dose may be adjusted appropriately, that's the output, to help keep the patient within the optimal zone and reduce variation. This has the benefits for the patient of more time in the optimal zone and decreased risk for complications, as well as benefits for the clinician by offloading repetitive tasks and freeing up time for situational awareness and total patient care. The authors describe the ideal system that would integrate several closed loop systems into a master controller as opposed to three independent systems controlling hypnosis, fluid therapy, and hemodynamic management. This may be the anesthesia system of the future while allowing the anesthesia professional to focus on patient care and safety. Technology is not the only way to improve anesthesia patient safety in the future. Safety culture is a necessity as well. Safety culture reflects the sum of what an organization is and does in the pursuit of safety. Safety culture may be different across organizations while still maintaining a culture of safety. The authors remind us of the quote by Maya Angelou People may forget what you said, but they will never forget how you made them feel. This message reminds us of the essential role of culture, high-functioning teams, and the healing power of human connection. The human touch fosters trust, improves outcomes, and reaffirms the purpose of our work. Healthcare systems face a challenging environment, and it is often that in the immediate operational needs of the organization are put ahead of safety culture. You might argue that this is sensible and just the way it has to be to run an organization. But this way of thinking is short-sighted and the long-term costs are significant. The authors tell us that when we fail to embed safety culture into every moment of care, we compromise the mission of healthcare and erode public trust. There is a call to action for healthcare systems to invest in systems, training, and technologies with safety as the foundation. Does your healthcare system have a safety culture? In your anesthesia department meetings, when you talk about first case on time starts or turnover times or order sets or new equipment or medication stocking, is patient safety part of the conversation and embedded into every moment of care? We need all healthcare professionals to be safety champions as part of a safety culture going forward. Let's put our current reactive system in a box. The future of perioperative safety exists outside the boundaries of this box. To get there, we need to harness the emerging technologies that we talked about today within a culture of safety. Not only will we see improved patient safety in this future system, but there are additional benefits for clinicians with reduced cognitive load, enhanced professional fulfillment, and a renewed ability to attract the brightest minds to our specialty. Remember our story about Alex? If we choose to lead with vision, courage, and purpose, we can rewrite the story of Alex. Before we wrap up for today, I also asked Dan what he hopes to see going forward. Here is his response.

SPEAKER_00 13:39

Emerging technologies such as artificial intelligence, decision support, wearable technologies, and closed loop systems are catalysts for a new model of care. These technologies promote and transform health care from a reactive system to one that is predictive, personalized, and proactive. Advancing both safety culture and high-value care for every patient.

Newsletter Submission Details And Closing

SPEAKER_01 14:14

Thank you so much to Dan for contributing to the show today. Did this episode spark some excitement for the future of anesthesia patient safety? We hope so. If you have any questions or comments from today's show, please email us at podcast at apSF.org. 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 apSF.org for detailed information and check out the show notes for links to all the topics we discussed today. Do you have a great idea related to patient safety? We hope that you will consider submitting to the APSF newsletter. The newsletter has a circulation of approximately 700,000 readers and is translated into nine languages. The next deadline is March 1st, 2026. That's right around the corner. Check out the guide for authors on the APSF website, and I will include the link in the show notes for more information. You could be the next APSF newsletter author, and we might be featuring your article on a future podcast. So what are you waiting for? Submit your patient safety article today. Until next time, stay vigilant so that no one shall be harmed by anesthesia care.