Most patients should not stop taking GLP-1 receptor agonists before elective surgery, according to updated tips of several medical societies, including the American Society of Anesthesiologists (ASA).

This recommendation, published in Surgery for obesity and associated diseasescontrasts sharply with Guidance 2023 of the ASA, which originally advised holding injectable and oral GLP-1 agents for 1 week and 1 day, respectively, before surgery. Since these popular weight loss and diabetes medications delay gastric emptying, the idea was that drug interruption would reduce the risk of aspiration and regurgitation under anesthesia.

However, the new guidelines – endorsed by the ASA, the American Gastroenterological Association, the American Society for Metabolic and Bariatric Surgery, the International Society for Perioperative Care of Patients with Obesity and the Society of American Gastrointestinal and Endoscopic Surgeons – indicate that this is no longer the case. applies to the majority of patients. Instead, most can continue taking their medications until the day of surgery, but must follow a liquid diet for 24 hours before surgery, depending on the specific circumstances.

“As anesthesiologists, we are committed to considering all factors to ensure that patients receive the best and safest care whenever anesthesia care is needed,” said the president of the ASA, Donald E. Arnold, MD, in a statement. “In many cases, patients with scheduled procedures must continue to take the medication. Planning for elective procedures should incorporate knowledge of the circumstances in which the risk of delayed gastric emptying is greatest, such as when the patient begins have just started taking the medication and the dose is increased, as well as for patients with significant gastrointestinal symptoms.”

“Ideally, these risk factors should be assessed and minimized in advance, so that the surgery or procedure can proceed safely,” he added.

According to the guidelines, healthcare teams should consider the following factors when individually assessing a patient’s GLP metabolic needs and risks during the perioperative period:

• If patients are in the dose escalation phase (associated with a greater delay in gastric emptying) compared to the maintenance phase
• Higher dose (e.g., 2.4 mg semaglutide (Wegovy) vs. 1 mg (Ozempic))
• Weekly dosing (which has more gastrointestinal side effects) versus daily dosing
• Presence of gastrointestinal side effects suggestive of delayed gastric emptying
• Medical conditions beyond GLP-1 use that may also delay gastric emptying (eg, intestinal dysmotility, gastroparesis, Parkinson’s disease)

“Assessment of these risk factors should occur sufficiently in advance before surgery to allow adjustments to preoperative care if indicated, including modification of diet and assessment of the feasibility of a medication transition if necessary. ‘Discontinuation of GLP-1 RA (receptor agonist) is indicated’, guidance noted.

If concerns remain on the day of surgery, a point-of-procedure gastric ultrasound may be used to assess the risk of aspiration. However, this technology “may be clinically limited depending on institutional resources, variability among users, and accreditation requirements,” the guide’s authors write.

These updates follow several recent studies investigating GLP-1 interruption before surgery that divided the anesthetistssome research indicating a low risk of aspiration with the use of GLP-1 and other studies suggesting the opposite.

Ultimately, the guidelines emphasize shared decision-making between “the patient, the prescribing care team, the proceduralist or surgeon, and the anesthesiologist,” noted the guideline co-author Girish P. Joshi, MBBS, MD, vice chair of the ASA Committee on Practice Parameters. , and colleagues in a corresponding letter to the editor published in Anesthesiology. They advised healthcare providers to balance the risk of aspiration with the risks associated with stopping a GLP-1 receptor agonist, such as high blood sugar, which could further complicate interventions. surgical.