Still holding Ozempic before every case? You're a year behind.

Five things worth knowing before today's first case.

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This Week's Top Story

Still holding Ozempic before every case? You're a year behind.

Half the ORs we walk into still run the old reflex. If the patient is on a GLP-1, the move was simple—hold it before every case. When Ozempic and the rest took off, that was the rule, and the ASA said as much in 2023, stop the weekly shot a week out, the daily ones day-of. Easy rule to follow.

It's apparently not the rule anymore. The 2024 multisociety guidance, from the ASA, the GI societies, and bariatric surgery, walked it back. For a low-risk patient having elective surgery, you don't have to stop the drug at all. You manage the risk instead, twenty-four hours of clear liquids, treat them like a full stomach, and reach for the gastric ultrasound on the ones who worry you.

But why the patient is on it changes the math, and this is where it gets less tidy than the guidance sounds. A diabetic on a GLP-1 for glycemic control requires different considerations than someone on a high dose purely for weight loss. Hold the diabetic's drug to dodge aspiration and you send their sugars climbing, so for them, continuing and managing the stomach usually wins. The weight-loss-only patient is the murkier one. You're not risking their glucose by holding it, and they're often the ones on the bigger, still-escalating doses whose stomachs are most likely to still be full. So does the continue-it rule really apply to them the same way? The guidance doesn't answer that cleanly, and we won't pretend to either. It's a judgment call for you to make.

And the guidance is still catching up to itself. The ASA helped write the 2024 continue guidance, but AANA hasn't adopted it, and its own recommendation stays more cautious; on an elective case, consider holding the drug and using gastric ultrasound to check the stomach if you're unsure. The UK and Australia land close to continue, while Europe hasn't issued its own rule at all. None of it is fully settled, so different guidelines can point you in slightly different directions on the same patient. That isn't a fight over who's right, it's a field still working it out, which leaves more of the call with you than any single protocol does.

The evidence is still messy, the meta-analyses don't agree, and most of the real aspirations happened during sedation, not intubation. But the direction is clear, individualize each anesthetic considering the entire picture. So if your group's protocol still says hold every GLP-1, full stop, it's worth pulling up and taking another look, the thinking behind it has moved.

Our take is at the bottom of this issue ↓

⏱ Act This Week

UnitedHealthcare just updated its commercial anesthesia policy. If you bill any UHC commercial work, pull the new policy this week and read it against how you're coding, because reimbursement changes usually show up as denials before anyone sends you a memo. Five minutes now beats a clawback in ninety days.

This Month's Number

That's the going locum rate on a current CRNA posting in Los Angeles. Coastal metros and hard-to-staff rural sites sit at the top of the market right now, so if your rate has been flat, that gap is your leverage at the next contract conversation.

Board Watch

Here's the quiet one nobody teaches you in school. In this field, the thing that protects your license usually isn't the perfect anesthetic, it's the note. The pre-op you actually documented, the risk conversation you charted, the reason you made the call you made. When something goes sideways, the record is the difference between a defensible decision and your word against theirs. Chart like someone will read it back to you a year from now, because sometimes they will. And if you ever feel yourself tempted to clean up a note after the fact, that instinct is the one that ends careers, not the original event.

Scope, Moving

The scope map is moving, mostly your way. Ohio's HB52 is now law and swaps blanket physician supervision for a collaborative model, and the physician on the record no longer has to be an anesthesiologist. Arizona's HB2447 bars insurers from paying nurse anesthetists less than physicians for the same work. Rhode Island cleared S3184 and H7740, clarifying who can run deep sedation and general anesthesia, and Delaware's HB435 is advancing. The one cutting the other way is New York's S00357, which would require CRNAs to collaborate with a physician, worth watching closely if you practice there.

Drug Shortage Flash

The FDA shortage list shifted this week. New or still tight: ropivacaine, sufentanil, lorazepam, and etomidate injection. The one to flag is desflurane, it's listed as being discontinued, not just short, so if it's still in your workflow, start planning the switch now rather than the morning you reach for it. Hydromorphone and ketorolac have eased back to available. Statuses move week to week, so confirm at the source before you reroute a case.

Coming to Your OR

Meet ciprofol. The FDA just approved it, sold as cipepofol under the brand CYPSEDO, the first China-originated IV anesthetic to reach the US market, and it's a propofol cousin that runs about four to six times more potent. The name is a menace though, ciprofol, cipepofol, one slipped letter from Cipro the antibiotic, so somewhere a pharmacy tech is already sweating an order. Expect it to start showing up as a propofol alternative, keep the spelling straight and respect the potency.

This one is moving fast, and that's the honest headline. A few years ago, holding every GLP-1 before surgery was the careful, reasonable call, and honestly it's still a defensible one. The guidance has shifted since, the societies haven't fully lined up behind a single approach, and the evidence is still coming in. So if your read on this feels unsettled, that's because the field is too.

Where it lands for us is practical. The goal was always the same, keep the patient from aspirating, and there's now more than one reasonable way to get there; a clear-liquid diet, a gastric ultrasound, a full-stomach plan, or holding the drug when that is what's best for the patient. The useful move this week is to pull your group's protocol and see where it sits, since the thinking here is newer than most protocols are. Take the patients one at a time, document why you made the call, and keep watching this one, because it's going to keep changing.

If you're thinking it, we're talking about it.

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Legislative data, LegiScan & OpenStates (CC BY 4.0). Drug shortage data, ASHP / openFDA. Federal regulatory data, FederalRegister.gov (public domain). Compensation, Marit Health (market feed), BLS, AANA.