The use of glucagon-like peptide-1 receptor agonist (GLP-1 RA) is on the rise, as it has been approved for managing both weight management and hyperglycemia in type 2 diabetes patients. However, concerns persist about their safety during surgery, particularly regarding the risk of aspiration. A recent study published in JAMA Surgery by researchers at the University of Texas Health Science Center at Houston highlighted unexpected risks associated with GLP-1 RAs in patients undergoing elective procedures, raising concerns about their safety during surgical management.
The study evaluated the connection between the use of GLP-1 RA medications and the prevalence of increased residual gastric content (RGC), a major risk factor for aspiration under anesthesia, using gastric ultrasonography. It was based on previous internal quality reviews of anecdotal cases of aspiration under anesthesia among patients taking GLP-1 RAs for weight loss. Despite following preoperative fasting protocols, over half of the patients receiving GLP-1 RAs had significant gastric contents on gastric ultrasound before their scheduled procedure, indicating a higher risk of aspiration compared to patients not on GLP-1 RAs. This association was notably stronger, highlighting a potential correlation between these medications and an increased risk of aspiration under anesthesia. One of the mechanisms of GLP-1 RA medications, crucial for weight loss and glycemic control, is the slowing of gastric emptying, leading to increased residual gastric volumes identified as a ‘full stomach’ on gastric ultrasound.
The cross-sectional study conducted at a university-affiliated hospital from June 6 to July 12, 2023, evaluated 124 participants undergoing elective procedures. Sen et.al highlighted the importance of understanding the implications for patient safety. The research involved subspecialized anesthesiologists with expertise in point-of-care ultrasound, enabling them to assess stomach contents at the bedside. Results indicated that 56% of patients using GLP-1 RAs had increased residual gastric content, compared to 19% of those not receiving the medication. The prevalence of increased residual gastric content with the use of GLP-1 RAs was found to be 30.5%, raising concerns about the potential risks associated with these medications in the context of anesthesia.
Sen et al. also highlighted the significance of the study outcomes, emphasizing the need for updated guidelines and further research to reduce anesthesia-related risks in patients on GLP-1 RAs. The study underscores the importance of effective communication between patients and healthcare providers, particularly regarding medication use, to ensure the safety of patients undergoing elective procedures. As the medical community works to enhance its understanding of these risks, patients are encouraged to openly communicate their use of GLP-1 RAs before surgery, facilitating informed decision-making and improved patient outcomes.
The researchers found that the use of a GLP-1 RA was independently associated with increased RGC on preprocedural gastric ultrasonography. These findings indicate that the preprocedural fasting duration recommended by current guidelines may be insufficient for patients in this group who are at increased risk of aspiration under anesthesia. Further investigation and potential adjustments to preoperative fasting protocols may be warranted to enhance patient safety in this context.
Reference
Sen S, Potnuru PP, Hernandez N, Goehl C, Praestholm C, Sridhar S, et al. Glucagon-Like Peptide-1 Receptor Agonist Use and Residual Gastric Content Before Anesthesia. JAMA Surgery [Internet]. 2024 Mar 6 [cited 2024 Mar 7.