GLP-1RAs associated with increased residual gastric content, despite preprocedural fasting
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Key takeaways:
- Fasted patients taking GLP-1RAs before an elective procedure under anesthesia had a higher prevalence of increased residual gastric content.
- Despite fasting, these patients may still be at risk for aspiration.
Once-weekly glucagon-like peptide-1 receptor agonist use was associated with a “significantly higher prevalence” of increased residual gastric content among fasted patients undergoing elective procedures under anesthesia, research showed.
“Despite their increasing use, the safety of GLP-1RAs in the perioperative period remains uncertain,” Sudipta Sen, MD, associate professor in the department of anesthesiology, critical care and pain medicine at UT Health Houston McGovern Medical School, and colleagues wrote in JAMA Surgery. “Use of GLP-1RAs has been associated with slowed gastric emptying, leading to increased residual gastric content (RGC) in patients presenting for elective procedures, despite following recommended preoperative fasting guidelines.
“Recent consensus-based guidance from the American Society of Anesthesiologists offers expert-opinion recommendations to address the aspiration risk associated with GLP-1RA based on sparse evidence, noting the urgent need for more evidence,” they added.
In a cross-sectional study, Sen and colleagues assessed the association between glucagon-like peptide-1 receptor agonist (GLP-1RA) use and the prevalence of increased RGC among 124 adult patients (median age, 56 years; 60% women) who followed fasting guidelines before an elective procedure under anesthesia from June 6 through July 12, 2023. Sixty-two patients were taking once-weekly GLP-1RAs, including semaglutide (63%), dulaglutide (23%) and tirzepatide (14%). Researchers noted most patients took their last dose within 5 days of their procedure.
Studied outcomes included increased RCG, defined as the presence of solids, thick liquids or more than 1.5 mL/kg of clear liquids on gastric ultrasonography, as well as the association between the duration of drug interruption and prevalence of increased RCG.
According to study results, the prevalence of increased RGC was 56% among those taking GLP-1RAs compared with 19% among those who did not. After adjustment for confounding, use of GLP-1RAs was associated with a 30.5% (95% CI, 9.9-51.2) higher prevalence of increased RCG on gastric ultrasonography, which corresponded with an adjusted prevalence ratio of 2.48 (95% CI, 1.23-4.97).
Researchers reported no association between the duration of GLP-1RA interruption and the prevalence of increased RCG (adjusted OR = 0.86; 95% CI, 0.65-1.14).
“In this cross-sectional study of fasted patients presenting for elective procedures under anesthesia, once-weekly GLP-1RA use was associated with a significantly higher prevalence of increased RGC on preprocedural [gastric ultrasonography],” Sen and colleagues wrote. “Additionally, we found that GLP-1RA interruption for up to 7 days was not associated with a decrease in the prevalence of increased RGC back to the baseline prevalence observed in similar patients without GLP-1RA use.”
They continued: “Future studies are needed to evaluate safe discontinuation intervals and preprocedural fasting times for these agents before elective procedures under anesthesia.”
Perspective
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Roberto Simons-Linares, MD, MSc
This is an important study to raise awareness that patients who take GLP-1RAs retain more gastric content before anesthesia for elective surgeries or procedures.
The use of pre-anesthesia ultrasound is useful, but it’s not a perfect tool. A meta-analysis published this year showed a high degree of heterogeneity across studies evaluating this method, which could be due to the patient population or the ultrasound operators.
I’d like more details about the group of patients in the GLP-1RA group and how they were selected, as that could influence the study. For example, were there any patients with uncontrolled diabetes or undiagnosed gastroparesis? I would like to have more information about the patient population selected in this study.
More studies are needed to go a step further and better understand what patient population on GLP-1RAs retain more gastric content so we can develop guidelines for that population.
Reference:
- Pan X, et al. Insights Imaging. 2024;doi:10.1186/s13244-024-01665-0.
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