A new perioperative cardiac guideline, and whether GLP-1s really need holding

The edition in brief

Today's anaesthesiology edition opens on the reference change every preoperative service relies on: the 2026 multisociety guideline on perioperative cardiovascular management for noncardiac surgery replaces the 2014 version and consolidates new evidence on evaluation, drug therapy, monitoring and devices. A prospective study of 5,302 videolaryngoscopic intubations across 44 hospitals showed that a good glottic view does not guarantee easy tube delivery — even with an excellent view, 6.3% of first attempts were difficult or failed — arguing for documentation that separates what was seen from what was done. A randomised trial in 220 labouring women found warming epidural local anaesthetic to body temperature halved intrapartum fever, though the reduction fell short of the trial's preset threshold. A clinic pearl reaffirms readiness for local-anaesthetic systemic toxicity. The practice-changer is a topical one: a large observational analysis found preoperative GLP-1 receptor agonist use was not associated with increased aspiration risk, and was linked to lower short-term mortality than metformin or DPP-4 inhibitors — reassuring, but observational and needing prospective confirmation before relaxing current fasting guidance.