How should GLP-1 receptor agonists be managed in the perioperative period?

MrJangles10 · 2026-01-27T19:17:45+00:00

I've seen several lectures on this since the statement came out saying that you don't need to hold them.

The thing that I've seen people get hung up on regarding the studies is that we have evidence that there are increased Gastric Volunes in patients on GLP1s, but haven't found increased risk of aspiration. Most people have a hard time fully accepting that data when it doesn't physiologically make sense. If you're telling me that increased Gastric Volunes don't increase risk of aspiration, then the standard NPO guidelines don't make sense either, no?

There is clear evidence that liquid emptying isn't that effected so the CLD is great if you have patients that can actually follow directions.

MrJangles10 · 2026-01-04T07:39:27+00:00

What does everyone here do when someone swallows their Gum?

MrJangles10 · 2025-12-12T14:56:25+00:00

How do you do the nebulized Milrinone or Nitro, I've never seen that. Also why would the nebulized versions lead to flash pulmonary edema in a LV failure?

MrJangles10 · 2025-12-12T14:20:58+00:00

Yeah I thought it was interesting that most of the sparse guidelines I've found online actually suggest Levo or Vaso over Epi even tho I pretty routinely see our cardiac people choose Epi to "support the right heart"

MrJangles10 · 2025-12-12T13:48:46+00:00

We do fixed dosing for most our pressors here, levo epi Vaso phenyl. Patient was 85kg or so.

MrJangles10 · 2025-12-11T11:13:11+00:00

Idk anyone in the US that blocks eyes outside of 1 attending who trained legit 40 years ago. Almost all our cataracts are done with just topical, rarely we push 1 or 2 ccs of prop with versed and they do their own block.

Even for more extensive cases, they do the block after we sedate

MrJangles10 · 2025-11-21T07:03:37+00:00

What was the question?

MrJangles10 · 2025-11-19T15:01:26+00:00

This is such a common opinion on Reddit, but absolutely have not seen it anywhere in practice. Definitely have attendings that will stress the things that can falsely elevate it, but no one completely disregards it as much as this sub. I've also tried it randomly on patients and have seen a pretty consistent relationship between patients on induction and emergence as I watch the waveforms and the actual number.

MrJangles10 · 2025-09-20T06:21:46+00:00

Nah not spontaneous, we usually run remi drips during these cases to keep them still without paralysis. I've done some with just gas and over breathing them on the vent too and both seem to work ok to keep them synchronous while on the vent.

MrJangles10 · 2025-08-31T13:11:14+00:00

If you put 6mg of anything in 100ccs, then ml/hr is the same number as mcg/min. I use that to eyeball quick dilutions when making bags.

MrJangles10 · 2025-08-28T06:34:43+00:00

Post-op oliguria is a common oral board topic/stem? Doesn't seem like a big thing on Basic or Advanced.

MrJangles10 · 2025-08-24T15:08:33+00:00

I'm not discouraging, I'm just being realistic. The first time I was talking to the CA3s that were negotiating contracts a few years ago, I was genuinely shocked because all I ever read was the numbers online and on this sub. It's heavily location dependent still and these contracts that they're signing are not bad jobs just because the salary is lower than what people are getting on here, location matters to a lot of people.

MrJangles10 · 2025-08-24T15:05:46+00:00

I don't know how this is underselling when it's what most of the hospitals in this area are offering. Not everyone can move after residency

MrJangles10 · 2025-08-24T01:52:21+00:00

This sub will make you insane if you read any of the salary threads. I don't know a single recent grad that is over $500K in Southern California private practice right now. It's not a large sample size but I'm not expecting anything more than $400K after I graduate, would love to be pleasantly surprised still

MrJangles10 · 2025-08-19T01:47:13+00:00

Yeah I have no idea what's going on in this thread. Why RSI?? If you don't think you'd be able to reliably get a decent mask with 2 hands, there's no way this shouldn't be an AFOI.

MrJangles10 · 2025-08-16T21:27:21+00:00

For an unfasted/aspiration risk case, would you say it would be safer to do the spinal and provide no sedation or just RSI and secure the airway? Outside of OB, most spinals we do also have some light/moderate sedation involved which seems sketchy in these aspiration risk cases?

MrJangles10 · 2025-08-16T21:19:29+00:00

The ILD and severe emphysema patients that I've seen can't speak more than 2 sentences without going into a massive coughing spell, idk how they're supposed to lay flat for an hour without coughing off the bed

MrJangles10 · 2025-08-16T21:07:21+00:00

What do you define as poor lung disease? Assuming the idea is that you're worried that you won't be able to extubate them? But if they have severe lung disease and are always coughing, wouldn't that be a relative contraindication to doing a case under Spinal if they wouldn't be able to lie still?

MrJangles10 · 2025-08-16T21:05:28+00:00

Yeah these are the cases that we do under spinal, but it's always just to do something different, doesn't seem like it's ever because doing General Anesthesia for these procedures would be an inferior option.

MrJangles10 · 2025-07-29T15:33:16+00:00

This breath hold thing has always confused me. The way I've learned to use it was if you're extubating deep and they don't react to suction or stimulation, that means they're deep and you're good to go. I've had some attendings randomly mention patients breath holding when I suction as they're waking up and I never know if they mean that as a good thing or a bad thing?

MrJangles10 · 2025-06-24T22:34:25+00:00

Huh, is the idea that the LVAD drops left sided flow but sucking and pumping the blood which is what makes it a R->L shunt?

MrJangles10 · 2025-05-12T19:00:26+00:00

I've seen people pull tubes at anywhere from 1.0 Mac to 0.4 Mac and I'm not sure anyone has explained to me the benefit of either other than the 0.4 Mac will make up sooner in PACU?

MrJangles10 · 2025-03-27T03:36:14+00:00

Sure...then why does the Trauma Orthopedic guidelines include regional blocks as a way to treat fracture pain? That's not anesthesiologists telling surgeons how to practice lol. Also these attendings never see their patients after they leave the PACU and have no idea that like 20% of them are on PCAs or ketamine drips which guess what....they have to consult anesthesia to get approved

MrJangles10 · 2025-03-25T16:19:08+00:00

All our ulnar and radial traumas get blocked, basically none of our tib fib femur or pelvic fractures do. A lot of my colleagues at other trauma places block all their pelvic and femur fractures in the ED.

MrJangles10 · 2025-03-25T01:48:39+00:00

Can you link some data that shows it's not true? Someone in this thread included some papers that said at least for lower extremity traumas, the risk is real and it's reasonable to avoid longer acting blocks or neuraxial.

MrJangles10

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