Posting this under the heading it deserves: Anaesthesia and elective surgery: the aspiration question Everything below is what sits behind that.
A narrow question about anaesthesia and elective surgery, deliberately narrow, because the broad version has been asked here four times and produced four long threads and no answer.
One question, stated units, stated method, and what I have already ruled out.
On the opening post — agreed on the reasoning, with one qualification.
A pharmacist can answer most questions in this subcategory in a few minutes with access to a proper interaction database, and that access is the thing a forum does not have.
Genuinely open to being wrong about this one.
Two claims get bundled together under anaesthesia and elective surgery and they need separating. The descriptive one — this is what was observed — is usually well supported. The causal one — this is why — usually is not.
Almost every disagreement in threads like this one dissolves once you say which of the two you are making.
A request rather than an answer: could whoever has the primary source for anaesthesia and elective surgery post it? I have seen the claim three times this month and each version had lost a qualifier.
Worth separating two things that post #2 runs together.
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.
If that is already documented somewhere, ignore me and link it.
Post #4 is right about the mechanism and I think understates the practical bit.
The useful distinction on anaesthesia and elective surgery is between what was measured and what was inferred from it. Both end up in the same sentence and only one of them has error bars.
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.
Anaesthesia and elective surgery is one of those subjects where the general answer and the answer for a specific case diverge, and the thread will go in circles until someone says which one is being asked for.
Something worth flagging about anaesthesia and elective surgery: the strongest-sounding claims in this thread are the ones with no source attached, which is the usual pattern and not a coincidence.
The most defensible general position in this subcategory: identify the plausible mechanism, check whether it has been studied, and where it has not, say that rather than filling the gap.
I have seen it go both ways, which is why I hedge.
Answering the question post #9 raises rather than the one it answers.
The documentation on anaesthesia and elective surgery is better than this thread and I say that as someone who has posted in the thread.
Reading back through, this was answered upthread and I missed it. My fault.
I had written a reply contradicting post #18 and deleted it. Here is what survived.
SGLT2 inhibitors: frequently co-administered and relevant to renal and cardiovascular discussion, not to interactions. There is no pharmacokinetic interaction of concern.
Confirming post #18 from a second method, which matters more than confirming it from a second person.
Worth stating the null on anaesthesia and elective surgery before we explain it: the observation may be nothing. That possibility deserves a sentence and usually does not get one.
Small methodological point on anaesthesia and elective surgery: repeating a measurement is cheap and resolves most of what is being argued about here at no cost to anyone.
On post #20 — agreed on the reasoning, with one qualification.
Where a published interaction study exists it usually reports an area-under-curve ratio, and that number is far more informative than a yes-or-no answer.
Small point, but it is the one that usually catches people.
Post #22 is right about the mechanism and I think understates the practical bit.
Having read the whole anaesthesia and elective surgery thread before replying: the question in the first post has not actually been answered yet, and three of us have answered a nearby one instead.
Insulin and sulfonylureas are the interaction that the labelling in this class flags most explicitly, because the risk is additive glucose lowering. That is a prescribing question and not a forum question.
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.
Trying to state the anaesthesia and elective surgery position in a way that someone who disagrees would recognise as fair, because I do not think the version in this thread passes that test.
Post #26 answers the question as asked. The question underneath it is different.
Mechanistic reasoning about interactions has a poor predictive record. It is a good way to generate a question and a bad way to answer one.
It is worth stating the boring hypothesis before the interesting one.
That matches what I have seen, for whatever a single anecdote is worth.
The arithmetic in post #26 is right; the assumption feeding it is the part to check.
Distinguishing three things in the anaesthesia and elective surgery discussion that keep getting used interchangeably: the observation, the proposed mechanism, and the recommendation that gets attached to both.
SGLT2 inhibitors: frequently co-administered and relevant to renal and cardiovascular discussion, not to interactions. There is no pharmacokinetic interaction of concern.