- Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for the management of type 2 diabetes and obesity. As these medications interfere with gastric emptying, patients using these medications may be at increased risk for aspiration during anesthesia.
- This cross-sectional study evaluated residual gastric content (RGC) in patients undergoing elective procedures, comparing patients using GLP-1 RAs with those who did not use GLP-1 RAs. Among the patients in the GLP-1 RA group, patients had discontinued use of the medication for up to 7 days, although most had taken the medication within the past 5 days.
- The primary outcome was an increase in RGC, defined as the presence of solids, thick liquids, or more than 1.5 mL/kg of clear liquids, as assessed by gastric ultrasonography (GUS). Anesthesiologists with expertise in point-of-care GUS performed the evaluations, with a second blinded anesthesiologist independently reviewing the ultrasonography images.
- The study included 124 patients undergoing elective procedures under anesthesia: 62 (50%) used a once-weekly GLP-1 RA (treatment group), and 62 (50%) served as controls without GLP-1 RA use. All participants adhered to fasting guidelines of at least 2 hours for clear liquids, 6 hours for a light meal, and 8 hours for a full meal.
- Unadjusted for confounders, 56% of the patients taking GLP-1 RAs had an increased RGC, compared to 19% of the patients not taking GLP-1 RAs, a difference of 37%.
- After adjusting for confounders, GLP-1 RA use was linked to a 30.5% (95% CI, 9.9%–51.2%) higher prevalence of increased RGC compared to the control group.
- No association was found between the duration of GLP-1 RA discontinuation and the prevalence of increased RGC, up to 7 days. Similarly, there was no association between the specific type of GLP-1 RA used and increased RGC prevalence.
- These findings suggest that discontinuing GLP-1 RAs up to 7 days before surgery is insufficient to reduce RGC levels, and further research is needed to determine the optimal timing for GLP-1 RA discontinuation to minimize the risk of aspiration during anesthesia.
Summary of "Glucagon-Like Peptide-1 Receptor Agonist Use and Residual Gastric Content Before Anesthesia"
Summary published December 17, 2024
