From the Guidelines
GLP-1 receptor agonists should be held for at least three half-lives ahead of the procedure to minimize the risk of pulmonary aspiration and other complications. This recommendation is based on the potential of these medications to delay gastric emptying, which could increase the risk of aspiration during anesthesia, as highlighted in a recent narrative review 1. The specific timing of holding GLP-1 receptor agonists depends on the medication's half-life, with shorter-acting agents potentially being held for a shorter duration. Some key points to consider when managing GLP-1 receptor agonists preoperatively include:
- Enquiring about and documenting the patient's GLP-1 receptor agonist use, including indication, dose, and last dose taken 1
- Considering the patient's individual risk factors for pulmonary aspiration, such as recent intake of recreational drugs or co-prescribed medications that can delay gastric emptying 1
- Using a shared decision-making approach with patients to discuss the risks and benefits of holding the GLP-1 receptor agonist preoperatively 1
- Considering alternative glucose management strategies for patients with diabetes during the perioperative period 1 It is essential to weigh the potential benefits of holding GLP-1 receptor agonists preoperatively against the potential risks of withholding these medications, particularly for patients with diabetes or obesity, as highlighted in a recent consensus statement 1. Ultimately, the decision to hold GLP-1 receptor agonists preoperatively should be made on a case-by-case basis, taking into account the individual patient's needs and risk factors.
From the Research
Perioperative Management of GLP-1 Receptor Agonists
The management of Glucagon-like peptide-1 (GLP-1) receptor agonists in the perioperative period is a topic of interest due to their effects on gut motility and potential risks of aspiration.
- The American Society of Anesthesiologists (ASA) recommends holding GLP-1 receptor agonists on the procedure day or a week before the elective procedure based on the respective daily or weekly formulations, regardless of the dose, indication, or procedure type 2.
- However, the American Gastroenterological Association (AGA) advises an individualized approach, stating that more data are needed to decide if and when the GLP-1 receptor agonists should be held prior to elective endoscopy 2.
- A review of the current clinical guidelines and available studies regarding the effect of GLP-1 receptor agonists on GI endoscopies suggests that the decision to hold these medications should be made on a case-by-case basis 2.
Risks of Peri- and Postoperative Complications
Several studies have investigated the risks of peri- and postoperative complications associated with the use of GLP-1 receptor agonists.
- A retrospective observational cohort analysis found that GLP-1 receptor agonist users had a lower risk of peri- and postoperative complications for decelerated gastric emptying and antiemetic use compared with non-users 3.
- Another study found that treatment with GLP1 receptor agonists, such as liraglutide and semaglutide, can lead to significant weight loss in patients on a waiting list for bariatric surgery, which may impact their decision to undergo the procedure 4.
- The available evidence suggests that the risks of peri- and postoperative complications associated with GLP-1 receptor agonists are not significantly increased, but high-quality studies are needed to provide definitive answers 5.
Duration of Preoperative Drug Cessation
The optimal duration of preoperative drug cessation for GLP-1 receptor agonists is not well established.
- The ASA recommends holding GLP-1 receptor agonists on the procedure day or a week before the elective procedure based on the respective daily or weekly formulations 2.
- However, the available evidence suggests that the decision to hold these medications should be made on a case-by-case basis, taking into account the individual patient's risk factors and the type of procedure being performed 2, 5.