Anaesthesia and elective surgery: the aspiration question posts 31–60
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
Anyone asking an interaction question should list everything, including the things they consider irrelevant. The irrelevant one is the answer more often than chance would suggest.
Written from notes rather than memory, which is why the numbers are specific.
Post #31 answers the question as asked. The question underneath it is different.
The bit of anaesthesia and elective surgery that nobody enjoys is that the answer changes depending on what you are trying to decide with it. Say what the decision is and the thread will converge.
Everything in post #35 holds. The case it does not cover is the one I have.
Anaesthesia and elective surgery: I would want to see the raw numbers rather than the summary before agreeing. Summaries lose exactly the information that would settle this.
Narrowing post #35, because the general version has more than one answer.
The reason anaesthesia and elective surgery is hard to answer is that the obvious measurement and the relevant quantity are not the same thing, and substituting one for the other is silent.
Nothing to add, except that this is the answer I would give if asked.
Narrowing post #40, because the general version has more than one answer.
Renal or hepatic impairment changes the calculus for a lot of combinations and is the context most often missing from an interaction question here.
That reframing is the whole thing. The facts I already had.
The arithmetic in post #43 is right; the assumption feeding it is the part to check.
A supplement is a drug for interaction purposes, and the fact that it is sold without a prescription tells you nothing about whether it interacts. The paperwork is usually worse rather than better.
The arithmetic on anaesthesia and elective surgery is the easy part and it is where the errors are, which is an uncomfortable combination. Show your working and someone will catch it.
Post #46 put the caveat in the right place and I want to underline it.
Where the anaesthesia and elective surgery discussion usually stalls is that nobody wants to say "I do not know" and everyone is willing to say "it varies". Those are the same sentence with different clothes on.
Anticoagulant questions come up regularly and are the clearest case for professional advice rather than discussion, because the consequence of being wrong is not gradual.
That has held every time I have looked, which is not the same as always.
Two sentences on anaesthesia and elective surgery and then I will stop, because the rest is speculation and the thread is better without mine.
What is documented is narrow. What is inferred from it is broad. The gap between them is where every argument here lives.
Nothing here is medical advice and an interaction question is one where the cost of a wrong forum answer is genuinely high. Ask the prescriber or the pharmacist.
I would put moderate confidence on the mainstream reading of anaesthesia and elective surgery and no more. That is not scepticism for its own sake; it is where the sourcing actually stops.
I had written a reply contradicting post #49 and deleted it. Here is what survived.
Nobody has said the unglamorous part of anaesthesia and elective surgery yet, so: most of the variation is explained by things that are boring to write about and easy to check.
SGLT2 inhibitors: frequently co-administered and relevant to renal and cardiovascular discussion, not to interactions. There is no pharmacokinetic interaction of concern.
Small correction to my own earlier position on anaesthesia and elective surgery. I had the units the wrong way round, which changes the conclusion by an order of magnitude and therefore changes it entirely.
Narrowing post #57, because the general version has more than one answer.
The reason anaesthesia and elective surgery keeps being re-asked is that the answer is conditional and people quote it without the condition. It is not that the answer is unknown.