3 Jul 2023 • With the growing popularity of glucagon-like peptide-1 (GLP-1) receptor agonists for the treatment of type 2 diabetes and weight loss, the American Society of Anesthesiologists (ASA) suggests withholding the medication before elective surgery to reduce the risk of complications associated with anesthesia in adults and children.

“While there is currently a lack of scientific data on how GLP-1 receptor agonists affect patients having surgery and interact with anesthesia, we’ve received anecdotal reports that the delay in stomach emptying could be associated with an increased risk of regurgitation and aspiration of food into the airways and lungs during general anesthesia and deep sedation,” said ASA President Michael W. Champeau, M.D., FAAP, FASA. “These complications can be serious, so we are providing guidance on when GLP-1 agonists should be stopped in advance of an elective procedure."

ASA’s Task Force on Preoperative Fasting suggests the following for patients taking GLP-1 agonists for type 2 diabetes or weight loss who are having elective procedures - Day or week prior to the procedure

• Hold GLP-1 agonists on the day of the procedure/surgery for patients who take the medication daily.
• Hold GLP-1 agonists a week prior to the procedure/surgery for patients who take the medication weekly.

Day of the procedure:

• Consider delaying the procedure if the patient is experiencing GI symptoms such as severe nausea/vomiting/retching, abdominal bloating or abdominal pain.
• Continue with the procedure if the patient has no GI symptoms and the GLP-1 agonist medications have been held as advised.
• If the patient has no GI symptoms, but the GLP-1 agonist medications were not held, use precautions based on the assumption the patient has a “full stomach” or consider using ultrasound to evaluate the stomach contents. If the stomach is empty, proceed as usual. If the stomach is full or if the gastric ultrasound is inconclusive or not possible, consider delaying the procedure or proceed using full stomach precautions.

Full stomach precautions also should be used in patients who need urgent or emergency surgery.

Source: ASA | Read full story