Relationship between residual gastric content and peri‐operative semaglutide use assessed by gastric ultrasound: a prospective observational study

🥉 Top 5% JournalOct 22, 2024Anaesthesia

Link between stomach contents and semaglutide use before surgery measured by stomach ultrasound

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Abstract

Increased residual gastric content was found in 40% of patients using semaglutide within 10 days of surgery.

Semaglutide use was associated with a significantly higher rate of increased residual gastric content compared to non-semaglutide users.
In the semaglutide group, 43 out of 107 patients (40%) had increased residual gastric content, while only 3 out of 113 (3%) in the non-semaglutide group did.
Propensity-weighted analysis indicated that semaglutide use was strongly linked to increased residual gastric content, with an odds ratio of 36.97.
Age and male sex were also associated with increased residual gastric content, suggesting these factors may influence outcomes.
No instances of pulmonary aspiration of gastric contents were reported in either group.

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BACKGROUND: Semaglutide is a long-acting glucagon-like peptide-1 receptor agonist known to delay gastric emptying. Despite a growing body of evidence, its peri-operative safety profile remains uncertain, particularly with regard to the risk of increased residual gastric content and aspiration of gastric contents during anaesthesia. We hypothesised that semaglutide interruption of ≤ 10 days before elective surgical procedures is insufficient to reduce or normalise the residual gastric content, despite fasting intervals that comply with current guidelines.

METHODS: In this prospective observational study, we recruited patients who received pre-operative once-weekly subcutaneous semaglutide within 10 days of the procedure (semaglutide group) and control patients who had not been exposed to semaglutide (non-semaglutide group). On the day of surgery, all patients underwent pre-operative point-of-care gastric ultrasound to evaluate their residual gastric content. Increased residual gastric content was defined as any solid content or > 1.5 ml.kgof clear fluids as assessed by gastric ultrasound. -1

RESULTS: We recruited 220 patients, 107 in the semaglutide group and 113 in the non-semaglutide group. Increased residual gastric content was found in 43/107 patients (40%) in the semaglutide group and 3/113 (3%) in the non-semaglutide group (p < 0.001). In propensity-weighted analysis, semaglutide use (OR 36.97, 95%CI 16.54-99.32), age (OR 0.95, 95%CI 0.93-0.98) and male sex (OR 2.28, 95%CI 1.29-4.06) were significantly associated with increased residual gastric content. There were no cases of pulmonary aspiration of gastric contents.

CONCLUSION: Pre-operative semaglutide use within 10 days of elective surgical procedures was independently associated with increased risk of residual gastric content on pre-operative gastric ultrasound assessment.

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