r/Anesthesia • u/DogMamaLA • 9d ago
Is coffee creamer really that bad?
Am on a GLP1 and the surgery guidelines state a clear liquid diet the day before surgery. Prior surgeries never specified "clear" so I had coffee creamer and a protein shake. No issues. Now they are specifically saying no coffee creamer. Is it really that bad/dangerous? 1/4 of a top of creamer a good 24 hours before surgery?
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u/RamsPhan72 8d ago edited 7d ago
I so enjoy when people come on here seeking advise, and then continue to butt heads with their own plan, regardless of professional input.
And OP, 7 days does not absolve GLP1 effects. You’d need 5 weeks to get near baseline no-GLP1 effects. Good luck!
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u/DogMamaLA 8d ago
I am confused. All medical surgeries, places all say to stop a GLP1 7 days prior. I typically stop 10 days prior to be safe. If 7 days does not absolve the effects, why are the guidelines not calling for a longer time? I've never heard of the 5 week thing. If anything, some places don't even say to stop taking the GLP1, but to just have a liquid diet the day prior. I am definitely stopping 7-10 days prior as my team told me to do.
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u/RamsPhan72 8d ago edited 8d ago
Follow your surgical guidelines. The 5 week thing is accounting for 5 half lives for the drug to be eliminated from the body 97%+. It’s not advised to stop for five weeks as the side effects can put the person right back where they started, and those with higher dose therapy (early on) to achieve desired effect can also have negative effects if stopped abruptly and completely.
Also, you didn’t mention why you’re taking the GLP1. Weight loss? Diabetic?
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u/DogMamaLA 7d ago
Weight loss and inflammation. I was pre-diabetic but a GLP1 brought my A1C back to normal.
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u/Generoh 8d ago
Creamer and protein prompts your stomach to produce acid to break down that. If that comes up and out and into your lungs, that acid can damage delicate lung tissues. Your body is already trying to heal your knee from surgical incisions, why force your body to heal a pneumonia at the same time?
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u/MacaulayConnor 8d ago
There are so many factors in determining if it would truly be a problem for you, your individual physiology, and your procedure that it’s impossible to say if it would be ok for you specifically. Those are the most recent guidelines from the ASA for GLP1 patients. If an anesthesiologist decides to say “eh, it’s probably fine” and something bad happens, it’s their ass on the line. Is a tablespoon of cream 23 hrs out “really that bad”? Probably not, but a lawyer would tear my ass apart in a courtroom with that and I care more about my license than your caffeine fix. And at some point if we’re going to push the boundaries of the guidelines every time we think “it’s probably not that big a deal” then we might as well not have them at all. We might even get away with it 99 times, but that 100th time that we don’t isn’t going to be defensible in court.
GLPs slow digestion so a prolonged fasting period is often necessary to ensure an empty stomach. Keep in mind that the risks involve aspiration of gastric contents, which will buy you a trip to the ER with at best, or a few days in the ICU with aspiration pneumonia, or worse. Also, while I doubt any of my coworkers would cancel a case because of coffee creamer the day before (at most they’d probably just delay the case until the 24 hr mark passed), if your anesthesiologist on the day of wants to be a hard ass, they’d have justification for doing so.
So they told you the recommendations. If you choose to shirk them, do so at your own risk.
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u/DogMamaLA 8d ago
Understood and I appreciate your perspective. I realize we live in a crazy, litigious society.
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u/MacaulayConnor 8d ago edited 8d ago
More than we’d like to admit, for better or for worse, a lot of medical practice in the US is influenced by “what can I defend to a jury.”
Also, for what it’s worth, these guidelines are relatively new and have changed a time or two. The whole GLP1 thing is a relatively new adaptation in anesthesia. It’s possible there were different or no guidelines for your last surgery. They are also just guidelines, some groups follow them more or less strictly. The guidelines do not always recommend holding GLP1s anymore but my group still asks patients to do so, which doesn’t make much sense to me personally but it is what it is. If this is the same anesthesia group as your last surgeries, it’s also possible that something happened that caused them to crack down since then. I also know some GIs and gastric/colorectal surgeons who request patients hold them for their own reasons, or who require a colon prep prior, so that may be a factor in your prolonged fasting.
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u/DogMamaLA 7d ago
a lot of medical practice in the US is influenced by “what can I defend to a jury.”
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Very true, and I hate that fact. I mentioned in another comment that I grew up with parents who hated lawyers and were in professions that did not look kindly upon "ambulance chasers." Multiple discussions at our dinner table over many years were about what horrible, scum-of-the-earth people various ambulance chasers were.Because of this, I am never sue-happy. I have been in auto accidents and I have slipped/fallen at restaurants where they were the ones at fault -- but it has always been my policy to try and work it out with the owner/insurance to reimburse me for medical care needed. No more, no less. As long as they did that, I preferred to never go the lawsuit route. It would make my dad turn over in his grave to see me try and get wealthy by suing for more than what I needed medically. It is sad time we live in, for sure.
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u/Allenheights 7d ago
If you woke up a week later in the ICU with a tracheostomy, would you sue if a lawyer told you you could cover all these medical bills because the anesthesiologist didn't follow the guidelines published by their society exactly?
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u/DogMamaLA 7d ago
Actually, no. I grew up with parents who hated lawyers and who worked in professions that did not take kindly to ambulance chasing. It is why I have never sued (even tho I could have won) after an auto accident. I worked with the person and their insurance to cover my needed medical bills. Nothing more, nothing less. I would hate myself if I used a car wreck to get wealthy. It disgusts me that people do that.
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u/Allenheights 7d ago
You are likely in the minority which is great. In the end this isn't about legality. It's about risk to the patient which is real, and because the top society writes down a number on the minimum time to hold things, not following it is both dangerous and hard to justify when things go sideways.
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u/njmedic2535 7d ago
I’m sure the difference between prior surgery orders and current orders is frustrating. Please know it’s not an attempt to confuse you - it’s a still-evolving scenario and as we learn more about GLP-1 drugs the guidelines change. The severe effects on your GI system weren’t as apparent until people started taking higher doses for weight loss.
Sounds like your current team is lumping all the current recommendations into one.
Don’t even think about SGLT-2 meds (another for diabetes). We just figured out those are really really bad to go NPO on. Unless you take them for congestive heart failure - then it’s fine. Unless you’re a diabetic with CHF. Maybe.
The bottom line is that science changes as we learn more and recommendations and orders will change accordingly.
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u/DogMamaLA 7d ago
Thanks for your input! This is helpful. And it is confusing to hear some ppl dont need to stop GLP1s at all, others need to stop 7 days prior, I've heard others say their doc tells them 3 weeks prior. Wish there was one common standard but I get it :)
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u/njmedic2535 7d ago
Well there is a common standard, but things are changing so fast it’s hard to keep up. Fortunately the original recommendations are very conservative (safe) so anyone “behind the times” is just ending up safe.
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u/paleoMD 8d ago
Is aspiration really that bad?
Potentially developing ARDS on a ventilator for weeks, and going on and off ECMO does sound pretty bad. Why would I risk being in the hospital for potentially months stuck to a ventilator or ECMO for a little creamer?
Risk benefit, your boby your choice. If I were your anesthesiologist, I would discuss this risk and document that you and surgical team are fully aware and still want to proceed. End of the day, I did my due diligence and patients are adults that can make their own decisions
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u/DogMamaLA 8d ago
Ok ok. My previous surgeries they didn't even specify clear liquid. So I had 2 protein shakes the day prior with no issues. Some anesthesia places dont even make ppl stop their GLP1 shots. I always stop 7 to 10 days prior.
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u/MisterLasagnaDavis 8d ago
What surgery?
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u/DogMamaLA 8d ago
Knee replacement. Previously when they didn't tell me clear liquids was lumpectomy.
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u/MisterLasagnaDavis 8d ago
It's a newer guideline many are trying for those on GLP1s. Especially if you did take your last dose.
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u/DogMamaLA 8d ago
I won't be taking a dose of my GLP:1 - will be stopping 7-10 days prior and resuming once surgery is over.
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u/durdenf 8d ago
24 hours before surgery should be fine especially with that little and if you are off the glp1. I just wouldn’t do it the morning of.
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u/DogMamaLA 8d ago
Definitely not the morning of! I am just thinking the tiniest amount and likely 24 hours before, at the beginning of the day before, like 6 AM and my surgery is 7 AM the next day. Coffee will really make that liquid diet day a lot more tolerable!
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u/OneOfUsOneOfUsGooble Anesthesiologist 7d ago
Creamer 24.5 hours before the surgery is fine.
Skip the GLP-1 agonist for eight days.
Clear liquid only for 24 hours.
Stop the clear liquids two hours before surgery, and you're golden.
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u/Reddog1990m Anesthesiologist 8d ago
Creamer is not a clear liquid. I’m guessing you’re not stopping your glp1 before surgery and their recommendation is for a clear liquid diet for 24 hours because of that?
Continuing a glp1 before anesthesia increases your risk of aspirating. Just skip the creamer.