People spend weeks vetting their surgeon, yet rarely give a second thought to their anesthesiologist. That is completely backwards. Your anesthesiologist manages your airway, guards your vitals, and handles your pain throughout the entire procedure. True safety doesn't come from their mere presence — it’s built on their preparation before the first incision.
Key Takeaways
- Anesthesia safety is built before the operating room. Pre-operative preparation is where complications are caught and prevented, not just managed.
- NPO compliance, medication reconciliation, and the pre-operative assessment are the three protocols that matter most before any surgical procedure.
- Patients on GLP-1 medications like Ozempic must stop taking them one full week before elective surgery — a guideline that far too many patients are never told about.
- A complete medication list, including supplements, is one of the most useful things a patient can bring to a pre-op appointment.
Here is something most people do not know going into surgery: the decisions that determine whether your procedure goes smoothly are largely made before you ever lie down on the operating table. Not in the room where the surgery happens — in the appointments, assessments, and conversations that precede it.
Dr. Andrew Hummel, a board-certified anesthesiologist with more than a decade of clinical experience, is direct about this. The safest surgery, in his view, is the one where nothing surprises the anesthesiologist. Eliminating surprises is almost entirely a function of preparation — prep that begins well before anyone asks you to count backward from ten.
His approach is perioperative, meaning his involvement with a patient does not start at induction and does not end at extubation. It spans the full surgical day. As he puts it: "The entire surgical day is my domain. That continuity of care is what defines how I practice, and it's what I believe separates a truly perioperative anesthesiologist from one who simply manages the room."
That continuity starts with three protocols. Each one is clinically established, and also misunderstood or overlooked by patients who simply were not told why it matters.
The NPO Rule — and the Update Most Patients Have Never Heard
NPO is a Latin abbreviation: nil per os, nothing by mouth. Before general anesthesia, your body's normal protective reflexes are suppressed. Your airway is unprotected. If your stomach contains food or liquid during that window, it can travel into your lungs — a complication called pulmonary aspiration. It is one of the more preventable catastrophic outcomes in anesthesiology, and the NPO rule exists entirely because of it.
What has changed is what the rule actually says. A lot of patients are still operating on the old guidance of “nothing after midnight”. But current guidelines from the American Society of Anesthesiologists are more nuanced — clear liquids, meaning water, black coffee, and plain tea, are generally permitted up to two hours before surgery. A glass of water at 5 a.m. before a 9 a.m. procedure is generally fine. However, protein shake or a full meal at 6 a.m. before a 7 a.m. case is not, and treating it as equivalent to a glass of water is a mistake with real consequences.
There is also a newer concern that is becoming increasingly urgent. GLP-1 drugs like Ozempic, Wegovy, and Mounjaro are everywhere now for weight loss and diabetes management. But here’s the catch: they drastically delay stomach emptying. Food sits in the digestive tract far longer than usual, meaning a patient can religiously follow pre-surgery fasting rules and still end up heading into the operating room on a full stomach. Under general anesthesia, that is a serious aspiration risk.
Dr. Hummel's protocol is unambiguous: hold GLP-1 medications for one full week before elective surgery. This is not an abundance of caution. It is the current clinical standard. Patients on these medications are frequently not told about it by anyone before they arrive.
Medication Reconciliation — Including the Things You Did Not Think to Mention
Before any procedure, every medication a patient takes needs to be reviewed. Most chronic medications continue the morning of surgery with a small sip of water. Others require careful, individualized decisions based on the drug's half-life and the procedure's bleeding risk.
| Medication Category | Typical Approach |
|---|---|
| Blood pressure medication | Usually continued the morning of surgery |
| Thyroid hormones | Usually continued the morning of surgery |
| Anticoagulants (blood thinners) | Hold timing depends on drug and procedure risk |
| Diabetes medications | Individualized — drug type matters significantly |
| Cardiac medications | Case-by-case, often coordinated with cardiology |
| Supplements (fish oil, garlic, ginkgo, vitamin E) | Often need to be stopped — increase bleeding risk |
Table 1: How Common Medications Are Managed Before Surgery
That last row is where things get missed. Supplements are not inert. Fish oil, garlic, vitamin E, and ginkgo biloba all have real pharmacological effects, and all of them increase bleeding risk in the operating room. Patients almost never mention them in pre-op appointments — not because they are hiding anything, but because it genuinely does not occur to them that a supplement they bought at a pharmacy could matter in a surgical context.
Bringing a complete and honest medication list to a pre-operative appointment, containing everything, prescribed and otherwise, is one of the simplest and most direct contributions a patient can make to their own safety. It takes a few minutes to prepare and gives the anesthesiologist the full picture needed to plan around any potential complications before they become actual ones.
The Pre-Operative Assessment — Which Is Not Paperwork
The third protocol is the one that patients most consistently underestimate. The pre-operative assessment feels, from the outside, like a box-ticking exercise. On the clinical side, it is where most of the real decision-making actually happens.
This is where Dr. Andrew Hummel, anesthesiologist, evaluates your airway anatomy, determines your overall anesthetic risk classification, and identifies anything about your medical history that could change how your case needs to be managed. What gets caught at this stage, rather than on the day of surgery, is the difference between a smooth procedure and a complicated one.
In his career, Dr. Hummel has identified the following during pre-operative assessments:
- Undiagnosed obstructive sleep apnea that would have significantly complicated airway management
- Unsuspected cardiac abnormalities that changed the anesthetic plan entirely
- Medication interactions with direct implications for intraoperative safety
- Prior difficult intubation history that had not been documented anywhere in the patient's record
None of those patients knew there was anything to flag. They were not withholding information — the information simply had not surfaced before someone looked specifically for it. That is what the pre-operative assessment is for.
If you have a history of complications under anesthesia, a cardiac device, a family history of malignant hyperthermia, or a difficult intubation in a prior procedure, your anesthesiologist needs to know before the day you arrive. Not while the surgical team is waiting and you are already in the pre-op bay — before.
The moment you close your eyes in the operating room is not where anesthesia safety begins. For Dr. Andrew Hummel, anesthesiologist, it is where weeks of preparation either holds or gets tested.
Your Safety Begins Long Before You Sleep
Your safety in the operating room isn't determined by luck. It is achieved through careful preparation long before you drift off. By following NPO guidelines, disclosing every supplement, and speaking openly during pre-op assessments, you empower your anesthesiologist. Trust the process. Thorough planning turns potential risks into quiet, routine successes.