A case series of incidents reported to webAIRS relating to glucagon-like peptide 1 agonist use

Mar 27, 2025Anaesthesia and intensive care

Reported cases of side effects from using glucagon-like peptide 1 drugs

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Abstract

Among 11,700 anaesthetic incident reports, 13 incidents related to GLP-1 agonist use were identified.

Seven of the reported incidents involved cases of aspiration during anesthesia.
Higher body mass index, type 2 diabetes, and gastro-oesophageal reflux disease may contribute to increased aspiration risks.
Most incidents were associated with rapid sequence induction for general anesthesia without the use of gastric ultrasound.
There were no reports of preoperative nasogastric tube insertion or intravenous erythromycin administration in these cases.
Collaboration between anaesthetists, surgeons, and other healthcare professionals is necessary to develop preoperative guidelines for patients on GLP-1 agonists.

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The increasing prescription of glucagon-like peptide 1 (GLP-1) agonists presents a peri-operative challenge for anaesthetists. These drugs delay gastric emptying, potentially increasing pulmonary aspiration risk. Despite recent recommendations from the Australian and New Zealand College of Anaesthetists, Australian Society of Anaesthetists, and American Society of Anesthesiologists, there remain no formalised guidelines regarding preoperative optimisation for patients taking GLP-1 agonists. Given the current lack of evidence, we present a case series of incidents involving patients treated with GLP-1 agonists reported to webAIRS, a web-based anaesthetic incident reporting system in Australia and New Zealand. Among 11,700 reports from July 2009 to April 2024, 13 incidents related to GLP-1 agonist use were identified, including seven cases concerning aspiration. Patient factors potentially contributing to increased aspiration risks in these incidents included a higher body mass index, type 2 diabetes mellitus, gastro-oesophageal reflux disease, emergency case, and time from GLP-1 agonist cessation. Most incidents involved a rapid sequence induction for general anaesthesia with no cases utilising gastric ultrasound, preoperative nasogastric tube insertion, or intravenous erythromycin use. This case series highlights the potential concerns relating to GLP-1 treatment in the perioperative setting. Interdisciplinary collaboration and communication between anaesthetists, surgeons, general practitioners and endocrinologists are required to further investigate and establish preoperative guidelines for safe GLP-1 agonist use. Specifically, consideration in determining actual gastric contents of each patient despite generic fasting guidelines is needed. Early preoperative risk stratification should also improve patient safety and outcomes.

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A case series of incidents reported to webAIRS relating to glucagon-like peptide 1 agonist use

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