Semaglutide and NPO

[camkiss]

Is anyone using an extended NPO before surgery status for patients on semaglutide? I have two close friends on it and they both report significant delayed gastric emptying and feeling full in the morning, even after eating a small meal early the night before. A GI colleague says he makes his patients liquid only the day before a scope and NPO for 12 hours if they are taking it. I searched today and there do not appear to be any guidelines for this. It’s reported to work mainly by delaying gastric emptying and thus creating a “full” sensation. I have to wonder if 6-8 hours is adequate…

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[coffeebythelake]

Is anyone using an extended NPO before surgery status for patients on semaglutide? I have two close friends on it and they both report significant delayed gastric emptying and feeling full in the morning, even after eating a small meal early the night before. A GI colleague says he makes his patients liquid only the day before a scope and NPO for 12 hours if they are taking it. I searched today and there do not appear to be any guidelines for this. It’s reported to work mainly by delaying gastric emptying and thus creating a “full” sensation. I have to wonder if 6-8 hours is adequate…

The papers I read did not attribute delayed gastric emptying to semaglutide. If you were worried use your judgement about anesthetic management

 

[BLADEMDA]

In this trial, we found that adults with obesity (or overweight with one or more weight-related coexisting conditions) and without diabetes had a mean weight loss of 14.9% from baseline with semaglutide as an adjunct to lifestyle intervention. This loss exceeded that with placebo plus lifestyle intervention by 12.4 percentage points. The 14.9% mean weight loss that we observed in the semaglutide group is substantially greater than the weight loss of 4.0 to 10.9% from baseline with approved antiobesity medications.3,19 Moreover, 86% of participants who received semaglutide, as compared with 32% of those who received placebo, lost 5% or more of baseline body weight, a widely used criterion of clinically meaningful response.2,3,20,21 Weight loss with semaglutide stems from a reduction in energy intake owing to decreased appetite, which is thought to result from direct and indirect effects on the brain.22-25 Weight loss with semaglutide was accompanied by greater improvements than placebo with respect to cardiometabolic risk factors, including reductions in waist circumference, blood pressure, glycated hemoglobin levels, and lipid levels; a greater decrease from baseline in C-reactive protein, a marker of inflammation; and a greater proportion of participants with normoglycemia. Semaglutide also improved physical functioning, as assessed by SF-36 and IWQOL-Lite-CT, a finding that is notable given that overweight and obesity significantly impair health-related quality of life.26 Statistical superiority of semaglutide over placebo was achieved for all end points in the hierarchical testing procedure.

https://www.nejm.org/doi/full/10.1056/NEJMoa2032183

 

[BLADEMDA]

Gastrointestinal side-effects:
The most commonly reported side-effects of GLP-1 RAs are gastrointestinal, such as nausea, vomiting, and diarrhoea.7 In the SUSTAIN trial, 52% of patients reported gastrointestinal side-effects in those receiving semaglutide compared with 35% in the placebo group, resulting in discontinuation of medication in 14% and 8% of patients, respectively.11 Nausea and vomiting are explained by direct central effects of GLP-1 and delayed gastric emptying. Both effects decrease over time with ongoing treatment because of tolerance and tachyphylaxis.8,20e24 After 8 weeks of treatment with liraglutide (a long-acting GLP-1 RA), gastric emptying returned to near baseline values.23 Of note, contrasting effects have been found with shorter acting GLP-1 RAs that retained delayed gastric emptying over time.23 Although associated with reduced oral intake and a beneficial loss of weight in overweight and obese patients, these effects might worry anaesthesiologists given the theoretically increased risk of aspiration. However, although commonly reported by patients, these symptoms are mostly mild, are rarely a reason for discontinuation of therapy, and seem to decrease over time with ongoing treatment.7,25e27 Although gastrointestinal side-effects occurred commonly in the large cardiovascular outcome trials, most were reported in the first weeks after initiation and they only led to discontinuation of treatment in 1e3% of cases.10,11 On the ICU, GLP-1 was also found to decrease gastric motility, although its effect was minimal when gastric emptying was already delayed.28 In patients with diabetes mellitus, gastroparesis is a known complication that requires attention and appropriate action by anaesthesiologists. Postoperatively, gastrointestinal upset remains a common concern. Despite the fact that surprisingly few perioperative studies recorded this outcome,29 it is reassuring that GLP-1 RAs do not appear to further increase the risk of postoperative nausea and vomiting.30e32 We performed two randomised trials studying preoperative liraglutide administration, including more than 400 patients. In both trials, the liraglutide intervention group did not report higher rates of nausea or vomiting compared with the non-GLP-1 groups, neither before nor after surgery

DEFINE_ME

 

[BLADEMDA]

The effect of semaglutide on gastric emptying has been assessed by the paracetamol absorption technique during a standardised meal [13, 29, 30]. The results indicate that there is a minor delay of gastric emptying during the early postprandial phase for subjects when treated with semaglutide, compared with placebo, but there is no overall effect on gastric emptying over a 5-h postprandial period [13].

Effect of Semaglutide on the Pharmacokinetics of Metformin, Warfarin, Atorvastatin and Digoxin in Healthy Subjects - Clinical Pharmacokinetics

Background and Objective Semaglutide is a glucagon-like peptide-1 analogue in development for the once-weekly treatment of type 2 diabetes mellitus. Its effect on the rate and extent of absorption of concomitant oral medications (metformin, warfarin, atorvastatin and digoxin) was evaluated in...

link.springer.com

 

[BLADEMDA]

In conclusion, in adults with obesity, once‐weekly s.c. semaglutide 2.4 mg suppressed appetite, improved control of eating, reduced the frequency and strength of food cravings, lowered ad libitum energy intake and was associated with clinically meaningful reductions in body weight versus placebo at week 20, with no evidence of delayed gastric emptying as measured indirectly through paracetamol absorption.

The effect of semaglutide 2.4 mg once weekly on energy intake, appetite, control of eating, and gastric emptying in adults with obesity

To investigate the effects of once‐weekly subcutaneous (s.c.) semaglutide 2.4 mg on gastric emptying, appetite, and energy intake in adults with obesity.A double‐blind, parallel‐group trial was conducted in 72 adults with obesity, ...

www.ncbi.nlm.nih.gov

 

[UBCmed09]

This thread has not aged particularly well

Given the recent spate of case reports describing residual gastric contents in context of fasted patients on semaglutide and the recent ASA consensus document etc, I'm curious what approach centers are taking to the perioperative mgmt of GLP-1 receptor agonists like semaglutide. Here at our regional hospital in Canada we are asking patients, when possible, to hold semaglutide for 3 weeks. This is equivalent to 3 half-lives so still not optimal but at least should correlate to ~88% elimination.

Most of those we see on Ozempic are on it for weight loss rather than diabetes management but we are still determining how we will deal with diabetics on this medication if we would like them to ideally stop their semaglutide for 3 weeks...Our community endocrinologist is insanely busy and can't realistically see all these patients in adequate time. I'm having a hard time finding what impact discontinuation of semaglutide has on post-prandial and random glucose in diabetics.

Anyways, very much a prominent discussion in the anesthesia community here in Canada at the moment.

 

[UBCmed09]

This thread has not aged particularly well

Given the recent spate of case reports describing residual gastric contents in context of fasted patients on semaglutide and the recent ASA consensus document etc, I'm curious what approach centers are taking to the perioperative mgmt of GLP-1 receptor agonists like semaglutide. Here at our regional hospital in Canada we are asking patients, when possible, to hold semaglutide for 3 weeks. This is equivalent to 3 half-lives so still not optimal but at least should correlate to ~88% elimination.

Most of those we see on Ozempic are on it for weight loss rather than diabetes management but we are still determining how we will deal with diabetics on this medication if we would like them to ideally stop their semaglutide for 3 weeks...Our community endocrinologist is insanely busy and can't realistically see all these patients in adequate time. I'm having a hard time finding what impact discontinuation of semaglutide has on post-prandial and random glucose in diabetics.

Anyways, very much a prominent discussion in the anesthesia community here in Canada at the moment.

I now see there is some ongoing discussion that didn't pop up in my quick search so will try to catch myself up on those!

 

[DocVapor]

Had a case last week.

41 y/o Male for Laparoscopic Umbilical Hernia repair. Well-controlled DM2 (A1C ~7 for the past 3 years or so) on Rybelsus - last dose was ~32 hours before induction. Did an RSI - passed OG after. Got ~600 ml of brown emulsified grossness out of the stomach.

Now how much of that is due to pre-existing gastroparesis vs the Rybelsus, who really knows. But keep in mind that max dose Rybelsus is far weaker than the lowest dose injectable.

 

[coffeebythelake]

Had a case last week.

41 y/o Male for Laparoscopic Umbilical Hernia repair. Well-controlled DM2 (A1C ~7 for the past 3 years or so) on Rybelsus - last dose was ~32 hours before induction. Did an RSI - passed OG after. Got ~600 ml of brown emulsified grossness out of the stomach.

Now how much of that is due to pre-existing gastroparesis vs the Rybelsus, who really knows. But keep in mind that max dose Rybelsus is far weaker than the lowest dose injectable.

The guideline for rybelsus (daily oral) would be stop on day before surgery.

 

[jwk]

We're asking any patient on Ozempic et al to hold for a week. If that's not possible, they get an RSI. I've done several EGDs that were immediately aborted when food was found in the stomach when the EGD scope was passed. I'm a believer.

 

[PainDrain]

Had a case two weeks ago. 21 yo for a gen surgery case and taking Ozempic for weight loss. She held it for one week prior to surgery. After induction we sucked out 500mls of nastiness from her stomach. I am going to RSI and tube all these patients even if they have stopped their medication in the appropriate timeframe.

 

[dchz]

Thanks for the anecdotes... I think this is the first time I've changed my practice so much due to anecdotal evidence. But the risk/reward trade off is so great that I have advised patients differently.

 

[UscGhost]

We're asking any patient on Ozempic et al to hold for a week. If that's not possible, they get an RSI. I've done several EGDs that were immediately aborted when food was found in the stomach when the EGD scope was passed. I'm a believer.

Question.

I had a couple EGDs recently. One patient had stomach pain, scope immediately found a pyloric mass with obstruction and 1500 ml of fluid in the stomach. My rationale was to keep patient sedated long enough for the GI doc to suction it out before we finish the procedure. My feeling was they most of the risk was with initial scope placement and subsequent risk of aspiration upon awakening would be reduced with suctioning. As opposed to immediate abort.

I had another case, on ozempic, had retained food in the stomach 12 hrs npo. We finished the egd for similar reasons.

Is the general consensus to immediately abort?

 

[UBCmed09]

Had a case two weeks ago. 21 yo for a gen surgery case and taking Ozempic for weight loss. She held it for one week prior to surgery. After induction we sucked out 500mls of nastiness from her stomach. I am going to RSI and tube all these patients even if they have stopped their medication in the appropriate timeframe.

You might consider pre-op gastric US as an adjunct to help you assess risk in these patients. I've begun doing these for semaglutide patients who have not been off their med for at least 3 weeks and have found them fairly quick and easy. The finding of an empty stomach (bullseye appearance) is particularly easy to identify.

In addition, some of the minimal literature available suggests that the presence of GI symptoms (specifically nausea, vomiting, bloating or abdominal pain) dramatically increases the likelihood of there being residual gastric contents. Consequently, I screen all my patients on semaglutide or tirzepatide for these symptoms.

 

[coffeebythelake]

Question.

I had a couple EGDs recently. One patient had stomach pain, scope immediately found a pyloric mass with obstruction and 1500 ml of fluid in the stomach. My rationale was to keep patient sedated long enough for the GI doc to suction it out before we finish the procedure. My feeling was they most of the risk was with initial scope placement and subsequent risk of aspiration upon awakening would be reduced with suctioning. As opposed to immediate abort.

I had another case, on ozempic, had retained food in the stomach 12 hrs npo. We finished the egd for similar reasons.

Is the general consensus to immediately abort?

Can u actually suction the stuff out? If yes then do it as much as possible.

 

[coffeebythelake]

You might consider pre-op gastric US as an adjunct to help you assess risk in these patients. I've begun doing these for semaglutide patients who have not been off their med for at least 3 weeks and have found them fairly quick and easy. The finding of an empty stomach (bullseye appearance) is particularly easy to identify.

In addition, some of the minimal literature available suggests that the presence of GI symptoms (specifically nausea, vomiting, bloating or abdominal pain) dramatically increases the likelihood of there being residual gastric contents. Consequently, I screen all my patients on semaglutide or tirzepatide for these symptoms.

Do you have a good guide or resource for doing gastric ultrasound?

 

[MirrorTodd]

Currently taking ozempic myself. I'll post up an n=1 mini study.

 

[HalO'Thane]

Do you have a good guide or resource for doing gastric ultrasound?

I always find the ASRA resources to be the most high yield by providing the most useful clinical information in the most concise manner:

POCUS Spotlight: Gastric Ultrasound

 

[nimbus]

Currently taking ozempic myself. I'll post up an n=1 mini study.

Images from your EGD?

FWIW my brother in law lost 60lbs in 1 year on Ozempic.

 

[Ronin786]

I don't get the utility of gastric ultrasound. If you can prove somebody has a full stomach, why are you still going ahead with elective cases but using RSI? If anything you're making your medicolegal responsibility higher even if you proceed with RSI.

RSI isn't a get out of jail card for aspiration, even if it might decrease the risk. Proponents of gastric ultrasound can never explain why it's not a good enough tool to cancel a case yet it's supposed to be good enough to change management. And the truth of the matter is, not everybody with a "full stomach" on gastric ultrasound is going to aspirate on induction.

If anything it's a waste of time and might provide false reassurance particularly in the hands of folks who are less than skilled in its use. Or in the myriad of obese patients who you can rarely get a good window.

 

[narcotics999]

Images from your EGD?

FWIW my brother in law lost 60lbs in 1 year on Ozempic.

Gain how much after stopping?

 

[nimbus]

Gain how much after stopping?

He’s not planning to stop.

 

[dchz]

I don't get the utility of gastric ultrasound. If you can prove somebody has a full stomach, why are you still going ahead with elective cases but using RSI? If anything you're making your medicolegal responsibility higher even if you proceed with RSI.

You're assuming all cases are either elective or emergent. But a whole world of cases exist in the gray area. And having reliable datapoints can help make decisions.

If anything it's a waste of time and might provide false reassurance particularly in the hands of folks who are less than skilled in its use.

This is flawed logic: specificity and sensitivity of a gastric ultrasound is high. operator error should not disprove a diagnostic method.

E.g. If you suck at TEEs, it doesn't mean TEEs are not a good diagnostic tool. It just means you should get better at doing TEEs.

Or in the myriad of obese patients who you can rarely get a good window.

This isn't the heart on a TTE. There are no rib "window"s to get through. Stomach and liver are anterior structures that are right next to the probe???

 

[Ronin786]

You're assuming all cases are either elective or emergent. But a whole world of cases exist in the gray area. And having reliable datapoints can help make decisions.


This is flawed logic: specificity and sensitivity of a gastric ultrasound is high. operator error should not disprove a diagnostic method.

E.g. If you suck at TEEs, it doesn't mean TEEs are not a good diagnostic tool. It just means you should get better at doing TEEs.


This isn't the heart on a TTE. There are no rib "window"s to get through. Stomach and liver are anterior structures that are right next to the probe???

Operator error is definitely a drawback to any diagnostic method, heck that's been the debate over PAC for years and years and entirely the reason why they've disappeared from routine clinical practice!

And yes, gastric ultrasound is more difficult on obese patients, Just like liver and GB imaging are more difficult without any "window". Go try it and see.

You failed to answer any of the questions posed other than saying "datapoints help your decision". Datapoints that have no clear clinical significance actually do not help your decision making and in-fact may make it more difficult. Sensitivity and specificity of gastric ultrasound is great for detecting full stomachs, but the majority of patients that require gastric ultrasound are likely to fall in the grade 0/1/2, which has no clear correlation to aspiration risk.

 

[dchz]

Or in the myriad of obese patients who you can rarely get a good window.

My point is there is no "window". And it seems you agree.

And yes, gastric ultrasound is more difficult on obese patients, Just like liver and GB imaging are more difficult without any "window". Go try it and see.

See, this is where I feel like you're making phantom arguments. When did I say they are not more difficult on obese patients?? I do agree they are more difficult on obese patients. My argument is there is no "window" like there is on TTE. And the stomach and liver are anterior structures.

Plenty of procedures are more difficult on obese patients. But when was the last time you decided not to do a diagnostic cath because he or she is obese? Do trauma surgeons skip the FAST exams because the pt is obese?

You failed to answer any of the questions posed other than saying "datapoints help your decision". Datapoints that have no clear clinical significance actually do not help your decision making and in-fact may make it more difficult. Sensitivity and specificity of gastric ultrasound is great for detecting full stomachs, but the majority of patients that require gastric ultrasound are likely to fall in the grade 0/1/2, which has no clear correlation to aspiration risk.

I failed to answer your questions because you never posed any questions. So yes, I failed to answer questions not posed.

I disagree that these datapoints have have no clear clinical significance. Sensitivity and specificity is great for full stomachs. S&S is also great for empty stomachs if one scans the entire 3D structure and rule out false negatives.

Gastric ultrasound has made my decision making easier, not more difficult. An example:

Yesterday I had 2 pts who were both on ozempic depot shots. Both obese (BMI > 30), both had Ozempic shot ~ 4 days prior, both fasted for about 14 hours. They needed bronch biopsies to determine whether or not they have cancer. The procedure is not emergent, but is diagnosing cancer ever truly elective?

First pt has full stomach on gastric ultrasound she decided the risk of delay is less than the risk of aspiration. I gave extended fasting criteria (pause Ozempic, no solids for 24 hours prior to procedure) for next time.

Second pt had an empty stomach on gastric ultrasound. I double checked to rule out false negatives: I sat the PT up and gave 30cc of maalox and watch liquid appear in the stomach. I swept up and down to confirm that the structure that I thought was the stomach was indeed his entire stomach in the upright position. The pt was worried about his cancer diagnosis. The patient, pulmonologist, and I were ok to proceed given the datapoint of empty stomach on gastric ultrasound. I also confirmed the empty stomach with OG suction after intubation.

We have to recognize that sometimes our delays could translate to MONTHS of delayed cancer treatment. I felt very good about what I did to help the pt and I would have done the same for my loved ones.

 

[linkin06]

Another one.

 

[VA Hopeful Dr]

Another one.


View attachment 378781

Not a shock. Also been a lot of off-label prescribing of Mounjaro for weight loss without diabetes already.

I'd be curious what y'all are seeing with this one compared to Ozempic in terms of delayed gastric emptying. Mounjaro has significantly fewer side effects so I'd wonder if the delay isn't as bad.

 

[nimbus]

Affects back end too.

Effect of Glucagon-Like Peptide-1 Receptor Agonists on... : Official journal of the American College of Gastroenterology | ACG

(GLP-1RA) are commonly used medications for diabetes mellitus and obesity that are known to delay gastrointestinal motility. We hypothesized that the use of GLP-1RA would be associated with decreased quality of bowel preparation. METHODS: We performed a retrospective cohort study of patients...

journals.lww.com

“We began observing inadequate bowel preparation in our patients undergoing colonoscopy who were on GLP-1 RAs, which raised questions, especially given the association between these medications and delays in intestinal transit,” study investigator Eric. J. Vargas, MD, of the Mayo Clinic, Rochester, Minn., told this news organization. The team decided to investigate.

The “most surprising finding” was the “notably higher rate of inadequate bowel preparation, which necessitates a repeat colonoscopy within 12 months to ensure adequate screening and surveillance for colorectal cancers,” he said. “Specifically, for every 14 patients treated with GLP-1 RAs, one patient would require a repeat colonoscopy due to suboptimal preparation.”

 

[TheLoneWolf]

Affects back end too.

Effect of Glucagon-Like Peptide-1 Receptor Agonists on... : Official journal of the American College of Gastroenterology | ACG

(GLP-1RA) are commonly used medications for diabetes mellitus and obesity that are known to delay gastrointestinal motility. We hypothesized that the use of GLP-1RA would be associated with decreased quality of bowel preparation. METHODS: We performed a retrospective cohort study of patients...

journals.lww.com

“We began observing inadequate bowel preparation in our patients undergoing colonoscopy who were on GLP-1 RAs, which raised questions, especially given the association between these medications and delays in intestinal transit,” study investigator Eric. J. Vargas, MD, of the Mayo Clinic, Rochester, Minn., told this news organization. The team decided to investigate.

The “most surprising finding” was the “notably higher rate of inadequate bowel preparation, which necessitates a repeat colonoscopy within 12 months to ensure adequate screening and surveillance for colorectal cancers,” he said. “Specifically, for every 14 patients treated with GLP-1 RAs, one patient would require a repeat colonoscopy due to suboptimal preparation.”

It's funny you mention this. The American Gastroenterology Association does not recommend routinely holding GLP drugs for elective endoscopy.

I wonder how they can square this with the ASA guidelines.

I wouldnt do those cases if the meds weren't appropriately held. They can always give their own sedation if they are so desperate to proceed with an elective case.

No data to support stopping GLP-1 agonists prior to elective endoscopy

As patient safety will always be paramount, and in the absence of actionable data, we encourage our members to exercise best practices when performing endoscopy on patients on GLP-1 receptor agonists.

gastro.org

 

[nimbus]

It's funny you mention this. The American Gastroenterology Association does not recommend routinely holding GLP drugs for elective endoscopy.

I wonder how they can square this with the ASA guidelines.

I wouldnt do those cases if the meds weren't appropriately held. They can always give their own sedation if they are so desperate to proceed with an elective case.

No data to support stopping GLP-1 agonists prior to elective endoscopy

As patient safety will always be paramount, and in the absence of actionable data, we encourage our members to exercise best practices when performing endoscopy on patients on GLP-1 receptor agonists.

gastro.org

A cynic would say they can do even more scopes.

 

[Simba1711]

In my experience, the gi doctors have been the most aggressive performing procedures. They’ll scope anyone. On paper , they should have a solid clinical knowledge background since they had to do 3 years of internal medicine but they forget it as soon they become a gi attending. It’s painful cancelling their cases because they don’t act rational and ignore clinical guidelines.

 

[Dr. Rude]

It's funny you mention this. The American Gastroenterology Association does not recommend routinely holding GLP drugs for elective endoscopy.

I wonder how they can square this with the ASA guidelines…

No data to support stopping GLP-1 agonists prior to elective endoscopy

As patient safety will always be paramount, and in the absence of actionable data, we encourage our members to exercise best practices when performing endoscopy on patients on GLP-1 receptor agonists.

gastro.org

Each specialty society has their own guidelines and position statements. This is not the only specialty whose practice conflicts with ASA guidelines. E.g., what ER docs do for sedation and no status, preop preparation by the cardiology society.

 

[TheLoneWolf]

Each specialty society has their own guidelines and position statements. This is not the only specialty whose practice conflicts with ASA guidelines. E.g., what ER docs do for sedation and no status, preop preparation by the cardiology society.

Agreed, best practice dictates that one hold to their same speciality guidelines/ recommendations.

ED routinely sedates non fasted patients for minor procedures. I'm not involved. Just because they can do it...and have ED literature to back it...doesn't mean I can. Anesthesiologist who cant even follow NPO guidelines is...something else

 

[coffeebythelake]

In my experience, the gi doctors have been the most aggressive performing procedures. They’ll scope anyone. On paper , they should have a solid clinical knowledge background since they had to do 3 years of internal medicine but they forget it as soon they become a gi attending. It’s painful cancelling their cases because they don’t act rational and ignore clinical guidelines.

You know why
$$$$$$$$$$$

 

[TheLoneWolf]

You know why
$$$$$$$$$$$

Yep

At least I'm not literally getting pooped on to make a livin

 

[GaseousClay]

Had a case two weeks ago. 21 yo for a gen surgery case and taking Ozempic for weight loss. She held it for one week prior to surgery. After induction we sucked out 500mls of nastiness from her stomach. I am going to RSI and tube all these patients even if they have stopped their medication in the appropriate timeframe.

the question is would you delay a purely elective case if they did not hold it appropriately? even if asymptomatic.

 

[Beeftenderloin]

the question is would you delay a purely elective case if they did not hold it appropriately? even if asymptomatic.

This is the policy in my system. Hold parameters for the GLP agonists that are in line with the latest ASA guidelines are part of our PAT call script. Surgeons/procedutalists were all made aware that cases can and will be cancelled for this. Has happened several times.

 

[DocMcCoy]

the question is would you delay a purely elective case if they did not hold it appropriately? even if asymptomatic.

Purely elective, cancel given published guidelines.

 

[coffeebythelake]

Purely elective, cancel given published guidelines.

Actually published guidelines do not say cancel. That is an option. But the ASA has not made such a hardline statement.

 

[DocMcCoy]

Actually published guidelines do not say cancel. That is an option. But the ASA has not made such a hardline statement.

View attachment 380030

Good clarification. Ultrasound an empty stomach and I guess you could proceed.

Though I would cancel any elective “full stomach”. Interesting wording they used there.

 

[coffeebythelake]

Good clarification. Ultrasound an empty stomach and I guess you could proceed.

Though I would cancel any elective “full stomach”. Interesting wording they used there.

Well I think the issue with glp drugs is that there is very little data out there. We know it slows gastric emptying. We know there have been anecdotal reports of aspiration events. We think this drug induced gastroparesis effect decreases over time. We just don't know enough of the actual specifics. The ASA recs are based on very little except for opinions from experts. Thry made it very clear.