In recent months, the topic of GLP-1 receptor agonists, such as Ozempic (semaglutide), has sparked significant discussion in the anesthesia community. With the growing popularity of these medications for diabetes and weight loss, anesthesia professionals need to be aware of the potential impacts these drugs can have on sedation and anesthesia. In this month's discussion, I’ll focus on the current understanding of how GLP-1 agonists influence anesthesia care, referencing the recent article from the American Society of Anesthesiologists (ASA), the Anesthesia Patient Safety Foundation (APSF), and the American Association of Nurse Anesthesiology (AANA).
What are GLP-1 Agonists?
GLP-1 agonists are well-regarded for their ability to manage diabetes and promote weight loss, but they come with some anesthetic implications. These drugs delay gastric emptying, leading to increased residual gastric contents despite adherence to fasting guidelines. The delay poses a risk for regurgitation and pulmonary aspiration during anesthesia, especially concerning in a field where airway management complications are among the most feared.
The ASA, as noted in their June 2023 guidance, suggests withholding these medications prior to elective procedures: one day for daily dosing and one week for weekly dosing schedules. The presence of gastrointestinal symptoms like nausea or vomiting requires even more caution, and elective procedures might be postponed if these symptoms are severe.
Real-World Implications: Case Reports
Case reports compiled by the APSF highlight real-world scenarios where patients on GLP-1 agonists experienced significant gastric retention despite standard preoperative fasting. For instance, one patient—despite adhering to fasting guidelines—developed large-volume emesis during anesthesia. Fortunately, the airway was protected due to the endotracheal tube still being in place, but it serves as a stark reminder of the anesthetic risks posed by these drugs.
AANA's Approach: Individualized Patient Assessment
In parallel, the AANA has provided additional considerations for anesthesia professionals managing patients on these medications. They emphasize the importance of individualized patient assessment, suggesting the use of gastric ultrasound to evaluate gastric content when there's uncertainty regarding the adequacy of preoperative fasting. This approach helps decide whether to proceed or treat the patient with "full stomach" precautions.
Consensus and Next Steps
The consensus across these organizations is that more research is needed to determine optimal discontinuation intervals and fasting guidelines. Meanwhile, the prudent course of action involves evaluating each patient based on their clinical presentation and potential risks, considering the delayed gastric emptying effect of GLP-1 agonists. As we navigate these challenges, it's essential to maintain open communication with patients about the importance of withholding these medications before surgery, while also ensuring glycemic control is appropriately managed.
Conclusion: Staying Informed
I encourage all my colleagues to stay informed as more data become available and to adapt their practices to these evolving recommendations. Whether it’s a routine day in the OR or an unanticipated sedation case, understanding the impact of GLP-1 agonists can make a significant difference in patient safety and outcomes.
We would love to hear your personal experience with GLP-1 Receptive agonists! Feel free to email me at travis@xchart.com to continue the conversation.
- Travis Coulter, DDS Co-founder, Xchart