From the Guidelines
Current Preoperative Guidelines for Patients Taking GLP-1 Agonists
For patients taking GLP-1 agonists, current preoperative guidelines recommend withholding the medication for at least three half-lives before surgery, depending on the specific medication and the patient's individual risk factors 1, 2, 3.
Medication-Specific Recommendations
- For patients taking GLP-1 receptor agonists for weight loss, it is recommended to hold the medication for at least three half-lives ahead of the procedure to clear approximately 88% of the drug 1.
- For patients taking GLP-1 receptor agonists for type 2 diabetes mellitus, consultation with the treating endocrinologist is advised to discuss the risks and benefits of holding the drug for at least three half-lives ahead of the procedure 1.
Key Considerations
- Aspiration risk reduction strategies should be considered for patients who are unable to hold the GLP-1 receptor agonist for three half-lives before the procedure, those who have recently started the medication or increased their dose, and those experiencing nausea, vomiting, or abdominal distention 1.
- Prokinetic drugs such as metoclopramide or erythromycin may be considered pre-operatively to reduce the risk of pulmonary aspiration 1.
- Point-of-care gastric ultrasound may be used to inspect residual gastric contents and guide decision-making 1.
- Rapid-sequence intubation may be considered to reduce the risk of pulmonary aspiration in high-risk patients 1.
Importance of Individualized Approach
It is essential to consider the patient's renal function, as GLP-1 agonists may need to be withheld for a longer period in patients with impaired renal function. Additionally, the anesthesiologist and surgeon should be informed of the patient's GLP-1 agonist use to ensure proper perioperative management. A shared decision-making approach with patients is recommended to openly discuss the risks and benefits of each option before the procedure 1.
From the Research
Preoperative Guidelines for Patients Taking GLP-1 Agonists
The current preoperative guidelines for patients taking Glucagon-like peptide-1 (GLP-1) agonists are as follows:
- Patients taking GLP-1 receptor agonists should continue these drugs before surgery 4
- Patients should have a full risk assessment and stratification 4
- Peri-operative techniques that may mitigate the risk of pulmonary aspiration should be used before, during, and after sedation or general anesthesia 4
- The risk of aspiration during general anesthesia is unknown, but caution is advised in patients who recently commenced on GLP-1 receptor agonists 5
- After over 12 weeks of treatment, standard fasting times likely suffice to manage the risk of pulmonary aspiration for most otherwise low-risk patients 5
Key Considerations
- GLP-1 receptor agonists delay gastric emptying, which may increase the risk of bronchoaspiration despite fasting intervals that comply with current guidelines 6
- The use of GLP-1 receptor agonists may increase the risk of pre-procedural gastrointestinal symptoms and elevated residual gastric content 7
- GLP-1 receptor agonists may improve glycemic control and decrease the rate of rescue insulin administration 7
Recommendations
- Clinicians should be aware of the potential risks associated with the perioperative use of GLP-1 receptor agonists and follow the recommendations put forth by their respective Anesthesiology Societies 6
- A shared decision-making approach should be used to discuss risks and mitigation strategies with patients 4