Pulmonary aspiration of gastric contents in two patients taking semaglutide for weight loss

Semaglutide is a new weight loss treatment that has received substantial media attention in recent years. Anaesthetists must be aware of a potentially dangerous side effect of the drug: decreased gastric emptying. This is caused by effects on gastric smooth muscle, mediated by the vagal afferent nerves. This is especially relevant in the peri-operative setting where pulmonary aspiration of gastric contents is a recognised complication. Here, we report two cases of peri-operative regurgitation of gastric contents in patients taking semaglutide. A patient taking semaglutide may have a full stomach despite compliance with routine pre-operative fasting guidelines. We consider how to manage patients receiving glucagon-like peptide-1 agonist therapy in the peri-operative period, including identifying those at high risk of regurgitation. Precautions such as rapid sequence induction and tracheal intubation can be used, but gastric ultrasound may also be useful in the pre-operative environment to help identify patients at high risk of aspiration.

Observing many researchers using the same data and hypothesis reveals a hidden universe of uncertainty

This study explores how researchers' analytical choices affect the reliability of scientific findings. Most discussions of reliability problems in science focus on systematic biases. We broaden the lens to emphasize the idiosyncrasy of conscious and unconscious decisions that researchers make during data analysis. We coordinated 161 researchers in 73 research teams and observed their research decisions as they used the same data to independently test the same prominent social science hypothesis: that greater immigration reduces support for social policies among the public. In this typical case of social science research, research teams reported both widely diverging numerical findings and substantive conclusions despite identical start conditions. Researchers' expertise, prior beliefs, and expectations barely predict the wide variation in research outcomes. More than 95% of the total variance in numerical results remains unexplained even after qualitative coding of all identifiable decisions in each team's workflow. This reveals a universe of uncertainty that remains hidden when considering a single study in isolation. The idiosyncratic nature of how researchers' results and conclusions varied is a previously underappreciated explanation for why many scientific hypotheses remain contested. These results call for greater epistemic humility and clarity in reporting scientific findings.