Comparison of societal guidance on perioperative management of glucagon-like peptide-1 receptor agonists: implications for clinical practice and future investigations

Aug 26, 2024Canadian journal of anaesthesia = Journal canadien d'anesthesie

Comparing medical guidelines on managing diabetes drugs around surgery and what this means for care and research

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Abstract

Fourteen major anesthesiology, endocrinology, and gastroenterology societies provided endorsed statements regarding the perioperative management of GLP-1 receptor agonists.

Significant variation exists among societies in recommendations for withholding GLP-1 receptor agonists before surgery.
Guidance differs on the duration of withholding these medications and assessment for avoiding deep sedation or general anesthesia.
Societies vary in their recommendations regarding rapid sequence intubation and the need for prolonged fasting periods before surgery.
There are differences in recognizing signs of aspiration risk and managing glucose levels during the perioperative period.
Point-of-care ultrasound is recommended variably for risk assessment related to aspiration.

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PURPOSE: The use of glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) by patients undergoing surgery and procedures requiring anesthesia has become a topic of significant concern for perioperative providers because of the potential increased risk of aspiration resulting from the medication's effect of delaying gastric emptying. There is currently a lack of high-quality data regarding the safety of GLP-1 RAs in patients undergoing surgery, which has led to variations in practice.

SOURCE: We performed an internet search of society-endorsed statements and guidelines related to perioperative management of GLP-1 RAs, focusing on the top 20 countries with the largest anesthesiology societies determined by membership data from the World Federation of Societies of Anesthesiologists. We excluded articles and websites that were not in English.

PRINCIPAL FINDINGS: Our search revealed endorsed statements from fourteen major anesthesiology, endocrinology, and gastroenterology societies. There was considerable variation between societies in the recommendations and guidance for withholding these medications before surgery, the duration of withholding, assessment of the need for avoiding deep sedation or general anesthesia, use of rapid sequence intubation, need for prolonged fasting periods and clear fluid before a nil per os period, recognition of signs and symptoms for aspiration risk, the management of glucose in the perioperative period, and the use of point-of-care ultrasound for risk assessment.

CONCLUSION: Society-endorsed statements and guidelines provide varying recommendations on the perioperative management of GLP-1 RAs. The insights gained from this comparative analysis may help guide clinical practice, develop institutional practice guidelines, and direct future research efforts.

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Comparison of societal guidance on perioperative management of glucagon-like peptide-1 receptor agonists: implications for clinical practice and future investigations

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