Anesthesia implications of Glucagon-Like Peptide-1 receptor agonist
James Billings RN, BSN Amy Snow, DNP, CRNA
- Sigma Affiliation
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Glucagon-like peptide-1 receptor agonists (GLP-1RA) were traditionally utilized as second-line therapy in the type II diabetic population in conjunction with exercise and diet modifications when metformin was either contradicted or not appropriately controlling glucose levels. Today, the use of these medications has drastically increased due to the U.S. Food and Drug Administration's 2017 decision to approve this therapy for weight management. The common GLP-1RAs seen in clinical practice today have the suffix "glutide." However, there is a popular glucose-dependent insulinotropic polypeptide drug that has similar effects as GLP-1RAs containing the suffix "atide." Currently, liraglutide (Sanxenda) and semaglutide (Wegovy) are the only drugs in this class approved for weight loss. Although these medications have delivered promising results, including reductions in glycosylated hemoglobin levels, cardiovascular disease, heart failure, obesity, and other co-morbidities, there are several adverse gastrointestinal side effects impacting patient safety during an anesthetic. Specifically, the increased delay of gastric emptying requires anesthesia providers to be knowledgeable and vigilant in their practices to minimize intraoperative surgical risk in patients taking GLP-1RA medications. Limited research is currently available regarding GLP-1RA use resulting in an increase of intraoperative adverse events. Although minimal research is available, some studies highlight the prevalence of adverse gastrointestinal effects, specifically delayed gastric emptying. This is evidenced by increased residual gastric content, which can easily lead to intraoperative pulmonary aspiration. With the projection of sustained growth of GLP-1RA use and the increased need for additional data to develop best practices, future research should focus on evaluation of delayed gastric emptying for each medication. This data can aid in developing better guidelines that help determine appropriate times to discontinue the medications preoperatively. Until then, anesthesia providers should strongly consider adopting the current ASA guidelines to help minimize anesthetic complications.
|DNP Capstone Project
|None: Degree-based Submission
|Translational Research/Evidence-based Practice
Glucagon-like-peptide-1 Receptor Agonists;
Delayed Gastric Emptying;
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