Newswise – Safety concerns for patients under anesthesia using glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which are medications approved for diabetes and weight management, have been revealed in a UTHealth Houston study published today JAMA Surgery.
The study was led by the first author Sudipta Sen, MD, associate professor; and senior author Omonele NwokoloMD, Professor, both in the Department of Anesthesiology, Critical Care Medicine and Pain Medicine at McGovern Medical School at UTHealth Houston.
“Our results were quite surprising. More than half of patients with GLP-1 RA had significant gastric contents on gastric ultrasound before elective surgery, despite adhering to preoperative fasting,” said Sen. “This incidence was lower than that in patients without GLP-1 RA significantly higher, demonstrating a strong association between GLP-1 RA medications and the potential risk of aspiration under anesthesia.”
The study was prompted by internal quality reviews led by Nwokolo and Srikanth Sridhar, MD, associate professor in the department, after staff reported isolated cases of aspiration under anesthesia in patients taking drugs in this class for weight loss, even though they were previously adequate had fasted procedures. Aspiration is a potentially dangerous condition in which stomach contents enter the lungs.
Sen and study co-authors Nadia Hernandez, MD, associate professor, and Christina Goehl, MD, assistant professor, are subspecialty anesthesiologists with expertise in point-of-care ultrasound, which provides bedside assessment of stomach contents. One mechanism of GLP-1 RA drugs that is central to weight loss and blood sugar control is slowing the emptying of gastric contents from the stomach. This increase in residual stomach volume is identified as a “full stomach” on gastric ultrasound.
This study, designed by Paul Potnuru, MD, assistant professor, examined more than 120 patients scheduled for elective procedures between June and July 2023. The results showed that 56% of patients who used GLP-1 RAs had increased residual stomach contents, compared to 19% of those who did not take the drugs. The study also showed a 30.5% prevalence of increased residual gastric contents with the use of GLP-1 RAs.
Given the increasing use of GLP-1 RA drugs and their increasing indications for treating various diseases, traditional fasting regimens may need to be re-examined for this patient subgroup, Sen said.
“Patients must ensure that they disclose the use of this medication to their surgeons and anesthesiologists,” said Sen. “This information is critical for us to make appropriate recommendations, such as: “For example, adjusting drug administration before elective procedures, recommending extended fasting, or postponing elective surgery if necessary.”
In June 2023, the American Society of Anesthesiologists published new ones Guidance to screen the use of GLP-1 RA before surgery and to educate patients about the risk of adverse outcomes. Recommendations included considering pausing GLP-1 RAs before elective surgery.
“Our study fills a significant gap in the current understanding and management of patients with GLP-1 RAs undergoing surgery,” said Nwokolo. “The lack of data had previously led to societies relying on expert opinion for guidance. Our findings pave the way for informed guidelines and further research to reduce anesthesia-related risks in this patient population.”
The results of the study lead to a reassessment of preoperative protocols in this subgroup of patients and highlight the importance of patients openly communicating their GLP-1 RA use before surgery.
McGovern Medical School student Caroline Praestholm, MS, also contributed to the study.