Key Takeaways
- With so many suffering from problems related to obesity, patients and providers boast about the benefits of GLP-1 agonists.
- This medicine has been successfully used to treat type 2 diabetes but is now FDA-approved to treat obesity in individuals 12 and older.
- GLP-1 agonists delay gastric emptying, often increasing gastric contents despite following preoperative fasting protocols.
- The American Society of Anesthesiologists provides healthcare professionals with recommendations, promoting patient safety during sedation procedures.
- With increased GLP-1 agonist use, healthcare professionals must be alert to the increased surgical risks of pulmonary aspiration.
Being overweight or obese affects approximately 70% of Americans, causing physical and psychosocial suffering. In 2014, a medication commonly used for type 2 diabetes was approved by the FDA to treat obesity. Since the FDA approval, these medications have become prevalent in treating obesity in adults and adolescents. However, the pharmacokinetics may pose a problem for anesthesiologists and surgeons.
Glucagon-like peptide-1 is a pleiotropic hormone that performs many metabolic functions. Some of these metabolic effects are the following:
For decades, people with type 2 diabetes have benefited from these medications. Now, researchers have found that these same drugs effectively treat obesity. Many health professionals claim these pharmaceuticals are the much-needed breakthrough for the obesity crisis.
Since GLP-1 receptors are located throughout the body (GI tract, pancreas, heart, liver, and brain), GLP-1 agonists impact many organs and bodily functions.
Improved glycemic control: By increasing weight loss results and insulin secretion, people with diabetes who use GLP-1 agonists are seeing improved A1c results.
Cardiovascular benefits: This medication decreases glycated hemoglobin levels, helps manage blood pressure, improves cholesterol levels and produces better heart function and perfusion.
Weight loss benefits: Reducing body fat by 5%-10% significantly lowers people’s risk of developing heart disease and improves overall health.
With the many benefits GLP-1 agonists produce, it is clear why they are growing in popularity. However, GLP-1 agonists contribute to delayed gastric emptying, and surgeons have noticed large amounts of gastric contents despite following fasting protocols.
Common side effects of GLP-1 agonists are nausea, vomiting and diarrhea. These side effects, combined with delayed gastric emptying and anesthesia, place patients at an increased risk of pulmonary aspiration during sedation procedures.
Pulmonary aspiration is a rare result of anesthesia but one of the most devastating outcomes related to airway management during sedation. The most common cause of aspiration during surgery is passive or active vomiting.
Recognizing patients taking these medications is essential because they generally have increased gastric volume content regardless of fasting. Anesthesiologists and surgeons must be aware and prepared with how to proceed safely.
These dynamic drugs decrease the devastating results of diabetes and obesity for adults and adolescents. Mindfulness when planning sedative procedures is vital for patient safety.
Physicians need to look for the following medicines when planning a sedative procedure for patients:
The American Society of Anesthesiologists (ASA) provides recommendations so patients can benefit from diabetic control and weight loss without worrying about sedative procedures. Their guidance promotes safe surgical strategies for patients taking GLP-1 agonists. ASA also calls for more intensive research regarding evidence-based protocols for patients taking GLP-1 agonists and needing anesthesia.
For patients taking GLP-1 agonists daily, ASA recommends omitting the medicine on the day of the surgery. If the patient takes the medication weekly, the recommendation is to hold the weekly dose. ASA recommends consulting an endocrinologist to prevent hyperglycemia during the procedure for patients depending on these drugs for glycemic control.
Considering the possibilities, medical professionals can prepare and promote safety during sedation.
If the patient presents with nausea, vomiting, retching, bloating or abdominal pain, postpone the procedure and discuss the risk of pulmonary aspiration with the patient.
If the patient takes the drug but does not present with GI symptoms, ASA recommends implementing additional preoperative testing and precautions.
An ultrasound helps providers determine gastric content volume. If the stomach is empty, continue with the procedure. However, consider delaying sedation or implementing full stomach precautions if the stomach is full or the volume is inconclusive.
Providers use these precautions for urgent situations. Emergency circumstances with uncertain gastric content volume merit a rapid delivery of anesthesia and gastric decompression. However, even with decompression, anesthesiologists must be on high alert when residual solid contents are present.
If the patient omits the medications and feels good, medical staff can proceed with the procedure as planned. It is important to note that no evidence suggests an ideal fasting period for patients taking GLP-1 agonists. Until research provides adequate evidence, the ASA recommends following established fasting guidelines for sedative procedures.
With the use of GLP-1 agonists for both diabetic control and weight loss management, medical providers must be aware that these patients have a greater risk of aspiration during sedation. With the increased use of GLP-1 agonists for young and old, pulmonary aspiration is a concern for adults and adolescents taking these medications.
“Glucagon-like peptide 1 (GLP-1).” NIH: National Library of Medicine, 20219, Glucagon-like peptide 1 (GLP-1) – PMC.
“Patients Taking Popular Medications for Diabetes and Weight Loss Should Stop Before Elective Surgery, ASA Suggests.” American Society of Anesthesiologists, 2023, Patients Taking Popular Medications for Diabetes and Weight Loss Should Stop Before Elective Surgery, ASA Suggests.
“Are Serious Anesthesia Risks of Semaglutide and Other GLP-1 Agonists Under-Recognized? Case Reports of Retained Solid Gastric Contents in Patients Undergoing Anesthesia.” Anesthesia Patient Safety Foundation, 2023, Are Serious Anesthesia Risks of Semaglutide and Other GLP-1 Agonists Under-Recognized? Case Reports of Retained Solid Gastric Contents in Patients Undergoing Anesthesia.
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