Latest Ozempic Guidelines

[masterPain]

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I know this is a much debated topic and the guidelines have changed multiple times. Can someone kindly give me the latest? TIA

 

[aneftp]

There are no real general rules with ozempic. Just use your own best judgment.

If patient shows up and Iike general case. And you aren’t sure. Just rsi them.

The Mac cases are more the iffy choices.

 

[Radar26]

Follow your hospital’s policy. If that is gray, like ours, then for MAC case- I would tube them for the MAC case if they: recently started the drug (last 4 months), are on an escalating dose, have N/V symptoms, or what they recently ate.

I find it extremely rare to passively vomit during induction and quick intubation (as long as thy don’t cough or get stimulated when passing the tube). More often I hear about aspirations during MACs where the pt gets stimulated all a sudden…

 

[Gern Blansten]

The term “shared decision making” is key. I would explain risks to patient and allow them and their proceduralist to all be involved so that there is consensus and no surprises. Helps the communication flow better. But generally, as stated in above posts.

 

[NumTacos]

Agree with all of the above. Unless it is spelled out very precisely in your hospital policy, I tube most of these players.

 

[abolt18]

Our hospital policy says liquid diet x 24h if on GLP-1 for elective surgery. Patients doesn't follow that, they get the "X" and come back another day, hopefully following directions.

 

[Radar26]

Our hospital policy says liquid diet x 24h if on GLP-1 for elective surgery. Patients doesn't follow that, they get the "X" and come back another day, hopefully following directions.

I like that in theory- only issue is what liquids do they consume (yogurt, ice cream, fatty soups) and does that empty out of the stomach any faster?

Is it the consistency or the contents of what they ate that matters?

 

[PlayToWin]

Best policy at the moment is probably hold glp1 for 7 days and/or clear liquid for 24 hours. If mac and symptomatic for aspiration risk , then you’re in a bind. Maybe gastric ultrasound if you’re comfortable.

 

[aneftp]

Historically going back 35 years (1990 for those of you guys in practice at the time) . What were the phen phen anesthesia guidelines back at that time. (Not current anesthesia guidelines)

That’s what the ozempic guidelines feel like. We really don’t know.

 

[abolt18]

I like that in theory- only issue is what liquids do they consume (yogurt, ice cream, fatty soups) and does that empty out of the stomach any faster?

Is it the consistency or the contents of what they ate that matters?

ASA recommendation specifically says liquid diet x 24h and NPO x 8 hr like normal. Does not specify further than that.

 

[BLADEMDA]

FYI, I have had obese patients with DM who were off GLP1 meds for 1-2 weeks still have over 150 ml in residual gastric contents. One "aspirated" about 15 ml under GA with a proseal LMA. He still went home after 2 hours of observation in the PACU. I intubate more often and with a lower threshold on these types of patients regardless of any protocol in place.

 

[Mman]

One "aspirated" about 15 ml under GA with a proseal LMA.

how on earth did you verify and quantify a volume of "aspiration" with an LMA?

 

[Arch Guillotti]

FYI, I have had obese patients with DM who were off GLP1 meds for 1-2 weeks still have over 150 ml in residual gastric contents. One "aspirated" about 15 ml under GA with a proseal LMA. He still went home after 2 hours of observation in the PACU. I intubate more often and with a lower threshold on these types of patients regardless of any protocol in place.

Doesn't seem to be much of a point here.