00:00Firstly, just to get the jargon out of the way, I know the risk we're talking about here
00:06is pulmonary aspiration.
00:07Can you just explain what that risk is?
00:11So pulmonary aspiration is a rare complication of anaesthesia and surgery where the contents
00:16of a patient's stomach comes up their esophagus and into their airway or into their trachea.
00:22And it can do two things.
00:23One is it can completely block the trachea or it can lead to acid, particularly acid
00:28injury to the lungs, leading to a longer term and potentially fatal lung condition, which
00:33may require intensive care and other management.
00:36So we've known about this for a long time.
00:38It isn't a brand new thing.
00:40And when patients have emergency surgery, we often take specific measures, especially
00:45a synethes, to reduce the risk of aspiration.
00:49But the problem with these drugs is that the way they work reduces the emptying of the stomach.
00:54So we believe further increases the risk of aspiration, even when people have had a long
00:59fasting time.
01:01And this is true.
01:02Is it even when people stop taking the drugs in the lead up to surgery for a number of weeks,
01:08say?
01:09Well, this is one of the things we don't really know.
01:11We are very confident that there is reduced or slowed emptying of the stomach on these drugs.
01:18But the question is, how long do we stop them for?
01:21The other thing and why we've changed our recommendations, if you'd asked me 18 months ago, I would have
01:26said stop the drugs.
01:27But now the consensus amongst ourselves as an ethers, but also amongst experts in diabetes
01:33and obesity medicine, is that it's better for the patients to stay on the drugs, because
01:38if we have delay of surgery, that may be a problem, that they have to stop and then start
01:43again for many weeks.
01:44But their diabetes control is poor and they may lose momentum in their weight loss.
01:48So we've decided in working with not only an ethers, but also other groups such as the
01:53diabetes experts, that we'll recommend continuing these drugs.
01:57What we've, the big changes of what we now recommend from the evidence of people who've
02:02had, having, you know, preparation for colonoscopy, is that patients who are on these drugs, continue
02:08their drugs, but have 24 hours of clear fluid diet prior to their surgery, in addition to
02:13the usual fasting period that we recommend for solids.
02:17And we're hoping that this reduces the risk.
02:20Have there been any deaths in Australia from this specific surgical complication that can
02:25be traced back to GPL-1s?
02:28There have been deaths in the past from aspiration for patients not on these drugs.
02:34We don't know, we're not, or the College of Anethers is not aware of patients, you know,
02:40having died from this.
02:41There are reports around the world of some patients having aspiration.
02:46But I think one of the important things is that we as specialists and ethers, part of our
02:51training is to, in fact, manage aspiration.
02:53So if it were to occur, we can dramatically reduce the likelihood of patient harm.
02:58But we'd much rather be preventing aspiration rather than having to manage it.
03:02So obviously to manage it, you need people to disclose it.
03:06And drugs like Azempic are very popular.
03:08But there is a reportance, a reluctance to report.
03:12Why aren't people fessing up to being on these drugs?
03:14Well, I don't know whether to reluctance.
03:16Some will be reluctant.
03:17And I think that group of patients may be those who are on it, you know, just for weight
03:21loss.
03:22They may be getting the drug prescriptions outside their usual GP.
03:26And a bit like some people don't really want to say, oh, yes, I've had cosmetic surgery.
03:30So I think that group.
03:31But I think there's actually many other patients.
03:33So the drugs are taken as injections once a week.
03:36So people may have forgotten they're on them or they may not sort of think of them as medications
03:40because they're injections rather than tablets or they may not because they may know it's
03:44a hormone.
03:45They might think of it as a medication.
03:47So I think there's a number of reasons why people may not mention these drugs because
03:51they, you know, they're asked about the medications.
03:54The important thing for that is us working with our patients and our general practice colleagues
03:59and others to encourage patients to tell us about these drugs, but also for us, particularly
04:04as anesthetists and those doing preoperative questionnaires, to ask specifically about
04:08them.
04:08Are you on any azempic type drugs?
04:11And that's what I now do in my preoperative consultation with patients.
04:14Yeah, that was going to be my final question to you.
04:17I mean, your advice to people who might be on these GPL1s who are preparing for surgery,
04:22they should disclose.
04:23Is there anything else they can do in order to prepare?
04:25The main thing is to follow this guideline of the 24 hours of clear fluids and advice
04:35given around that.
04:36But I just want to really emphasise for those who feel embarrassed saying that they're on
04:41azempic, please tell us.
04:42You know, we're not judgmental.
04:44We really want to know and provide the best possible care for our patients.
04:48David Storey, President of the Australian and New Zealand College of Anesthetists.
04:52Thank you so much for your time.
04:53Thanks, Ruby.
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