Study: GLP‑1 agonists increase the risk of mild aspiration during general anesthesia

• GLP-1 agonists increase the risk of mild aspiration during anesthesia
• The complication rate is 11 times higher in patients on these medications
• One in 71 patients experiences regurgitation or aspiration
• The risk is most often manifested during recovery from anesthesia

In a recent large study conducted in several hospitals in the UK, researchers examined the relationship between the use of glucagon-like peptide-1 (GLP-1) receptor agonists and the occurrence of mild aspiration or regurgitation of gastric contents in patients under general anesthesia. Medications in this group, such as semaglutide and liraglutide, are widely prescribed for the treatment of type 2 diabetes and, in recent years, for weight loss.

Methodology and main results

The study involved more than 2,000 patients, of whom about 1,200 received GLP-1 agonists for several weeks or months before scheduled surgery. The remaining patients, who did not take such medications, served as the control group. The authors recorded cases of mild aspiration — the entry of small volumes of gastric contents into the airways, as well as regurgitation, when stomach contents return to the esophagus and may be inhaled.

The data obtained showed that the frequency of these complications in patients receiving GLP-1 agonists was 11 times higher than in a comparable group without such medications. On average, one in 71 patients taking agonists encountered one of the specified complications. The most common time for problems to arise was during the recovery from anesthesia, when the reflex mechanisms of breathing are restored.

Why does the risk arise?

GLP-1 agonists are known for their delaying effect on gastric emptying. This property helps control postprandial glucose levels but can also contribute to food retention in the stomach. During general anesthesia, when swallowing and coughing reflexes are suppressed, the presence of a not fully emptied stomach increases the likelihood of regurgitation and subsequent aspiration.

Additionally, some GLP-1 medications may enhance feelings of nausea, further increasing the risk of content reflux. Combined with the weakening of protective reflexes due to anesthetics, these factors create favorable conditions for easy aspiration.

Practical recommendations

The authors of the study advise anesthesiologists to consider the use of GLP-1 agonists when planning surgeries. Possible measures include a longer postoperative postprandial period before surgery, eating 12-14 hours prior to the intervention, and using prokinetic agents to accelerate gastric emptying. In some cases, it may be advisable to temporarily suspend the medication before a planned surgery.

It is important to note that the complete cessation of therapy may negatively affect diabetes control, so the decision should be made jointly with an endocrinologist and anesthesiologist, considering the individual risks of the patient.

The study is published in the journal Anaesthesia and emphasizes the need for more thorough preoperative screening of patients receiving new drugs for the treatment of metabolic diseases. Given the growing popularity of GLP-1 agonists, their potential impact on anesthetic practice requires further study.

Source: N+1