Glucagon Like Peptide-1 (GLP-1) Agonists and delayed gastric emptying: Anesthetic and clinical considerations

Abstract

Glucagon-like peptide 1 (GLP-1) is an intestinal hormone with beneficial effects on blood glucose control. It stimulates insulin release, reduces glucagon production and decreases appetite, making it a therapeutic tool for the treatment of type 2 diabetes and obesity. GLP-1 receptor agonists have been approved by the FDA for these indications and their use is steadily increasing. One of the main side effects of GLP-1 agonists is delayed gastric emptying, which can lead to nausea, vomiting and bloating. The following nonsystematic review presents multiple reports evidencing delayed gastric emptying related to the use of GLP-1 agonists, including cases of pulmonary aspiration during anesthesia (despite adequate fasting periods). These findings underscore the need for anesthesiologists and perioperative physicians to be aware of the potential risks associated with these drugs. It is suggested that these drugs be discontinued days before elective surgical procedures, depending on the frequency of dosing. It is critical to evaluate the presence of gastrointestinal symptoms, as they may indicate an increase in residual gastric contents and increase the risk of complications. As the use of GLP-1 agonists continues to expand, it is critical to recognize and manage the risks associated with delayed gastric emptying in patients using them. Gastric ultrasonography performed by trained anesthesiologists is a useful tool for assessment of gastric contents and clinical definition. Further research is needed to establish more precise guidelines and reduce the perioperative risks associated with these drugs.