For most of my career, when I have seen something unusual (like a sneeze under a general anesthetic – I’ve seen it twice now), the only people to discuss it with are your partners. And unless you are in an academic environment, that is usually as far as it goes. Today, thanks to the internet, you can share your experiences with a much wider audience, with immediate impact.
Does the crowdsourcing of anecdote allow for “faster” recognition that there may be a problem with a new drug or surgical technique? Or does a social media platform simply amplify an issue to give an appearance of importance when it may have no factual basis?
“Does the crowdsourcing of anecdote allow for ‘faster’ recognition that there may be a problem with a new drug or surgical technique? Or does a social media platform simply amplify an issue to give an appearance of importance when it may have no factual basis?”
The answer might be either, depending on the situation, and some level of discernment is required on the part of the individual user. A better question is: Where does the value of personal experience and anecdotes start and stop in this new modern age?
ASA Community, our member-exclusive online discussion platform, offers the perfect opportunity for case study (community.asahq.org/home). Member conversation is robust, with more than 500 new threads and 5,000 replies posted in 2023 alone. ASA Community can reach large numbers of members every week, with conversations on the topics and issues that confront us all in our daily practice, which was the primary driver for the creation of this platform. While the information and advice shared are not necessarily peer-reviewed, it has been my observation that those who visit ASA Community do a good job of policing each other for accuracy and validity and pointing out when there is a divergence between scientific evidence and individual experience.
Below is one recent example of how ASA members have benefited from community discussion, often with direct application to their own practices.
“Oh, oh, oh, Ozempic!”
In a thread started in May 2022, a member had noted the increasing use of GLP-1 agonist drugs for the treatment of obesity (outside its use in type 2 diabetes) and wondered if we should be recommending cessation of this drug prior to surgery. While there were case reports starting in 2021 concerning medication-induced gastroparesis, the jury was still out on the impact of this drug in our presurgical populations. But things were just beginning. By January 2023, a case report in the Canadian Journal of Anesthesia was published, and in April, one community poster shared news on the forum about an upcoming paper to be published in August concerning the use of GLP-1s and their associated positive risks during GI endoscopy. It seemed that the anecdote being shared around the community water cooler was going to be supported with its first study.
Once the discussion was raised on ASA Community about GLP-1 medications and surgery, personal reports of retained food and aspiration/emesis began rolling in. Members recounted their experiences working with patients taking these drugs and shared their institutions’ provisional policies on NPO wait times. In fact, there were more discussions on this topic between 2022-23 than any other topic on ASA Community, and terms like “Ozempic,” “GLP-1,” and “semaglutides” were among the top search queries of 2023.
In June 2023, ASA released consensus-based guidance about why there was concern, and at a minimum how long to hold the drug prior to surgery. Clearly, this is an issue that everyone wanted to read about and not just share through the posts! The published guidance on GLP-1 medications marked only the second time in memory that ASA has stepped forward in the name of patient safety ahead of the studies to publish some sort of warning and guidance to the general membership. The first was the guidance on when to have elective surgery after COVID-19 seropositivity – unsurprisingly, a buzzy topic on ASA Community at the time as well.
The power of “peer-to-peer”
Medicine, like all areas of online information-sharing, can fall victim to distortion and disinformation. We must always be vigilant in our sources and maintain our caution regarding the importance one places on anecdote. But information-sharing has incredible potential to speed up a process that can normally take a long time. Having 50,000-plus anesthesiologists on speed dial can be an incredible source of early warning information.
Peer-to-peer conversation can provide a valuable indication of the need for further inquiry – the proverbial canary in the coal mine, but on a much larger scale. It helps us hone in on the right questions to ask as a specialty. So, the next time you encounter a particular challenge in your practice, please consider tapping the collective knowledge of your fellow members in ASA Community. You may not be the only one!
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