Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietySeptember 2024
Patients who used these drugs had higher prevalence of residual gastric contents on the day of surgery.
Because glucagon-like peptide-1 (GLP-1) receptor agonists can slow gastric emptying, they might confer risk for residual gastric contents – and possibly aspiration – in patients under going surgical procedures under anaesthesia. Anaesthesiologists and gastroenterologists have weighed in on this concern (NEJM JW Gen Med Oct 15 2023 and J Diabetes Investig 2023; 14: 767773; NEJM JW Gen Med Jun 15 2024 and Clin Gastroenterol Hepatol 2024; 22: 705-707).
In this study, researchers performed gastric ultrasound just prior to elective surgery in 62 patients who were using weekly injected GLP-1 agonists (semaglutide, dulaglutide or tirzepatide) and in 62 nonusers (controls). Prior to surgery, patients had fasted at least two hours for clear liquids, six hours for light meals and eight hours for full meals (per American Society of Anesthesiologists [ASA] guidelines; Anesthesiology 2017; 126: 376-393).
The prevalence of residual gastric contents was significantly higher in the GLP-1 group than in the control group (56% vs 19%). After adjustment for confounders (including diagnosis of diabetes), GLP-1 users remained significantly more likely than controls to have residual gastric contents (adjusted prevalence ratio, 2.5). Date of the most recent GLP-1 agonist injection was distributed across the week prior to scheduled surgery, but the study was not powered to detect whether the timing of that dose affected prevalence of residual gastric contents.
Comment: We still do not know the overall clinical consequences of residual gastric contents in GLP-1 users who undergo elective surgery under anaesthesia. For now, clinicians who provide preoperative consultation should try to find out policies of local anaesthesiology groups. If that is not possible, holding a single dose preoperatively, as currently recommended by the ASA, seems reasonable.
Allan S. Brett, MD, Clinical Professor of Medicine, University of Colorado School of Medicine, Aurora, USA.
Sen S, et al. Glucagon-like peptide-1 receptor agonist use and residual gastric content before anesthesia. JAMA Surg 2024; 159: 660-667.
This summary is taken from the following Journal Watch titles: Ambulatory Medicine, Hospital Medicine, Gastroenterology.