IntroductionL
•Obesity, affecting around 650 million adults globally, is a chronic disease linked to serious health risks such as type 2 diabetes and heart disease. While lifestyle interventions like diet and exercise are essential for obesity treatment, many patients experience suboptimal weight loss and weight regain, prompting the need for additional therapies like Anti-Obesity Medications (AOMs).
•Semaglutide, a GLP-1 receptor agonist, has gained significant attention due to its efficacy in managing both type 2 diabetes and promoting weight loss by enhancing insulin secretion and slowing gastric emptying. However, this delayed gastric emptying increases the risk of pulmonary aspiration during anesthesia, necessitating updated preoperative fasting guidelines and anesthesia management strategies.
•As the use of semaglutide rises, healthcare providers must carefully assess and adjust perioperative protocols to ensure patient safety, emphasizing the need for modified fasting recommendations and risk mitigation measures in surgical settings.
Case Reports/ Literature Review:
Several case reports have documented significant risks for patients taking semaglutide during anesthesia, particularly due to its effect of delaying gastric emptying. This delay increases the risk of pulmonary aspiration, even when fasting protocols are followed.
In one case, a 42-year-old male on semaglutide for weight loss aspirated during an endoscopy after fasting for over 18 hours. Despite adhering to the fasting guidelines, the delayed gastric emptying caused by semaglutide resulted in the presence of residual gastric contents, leading to aspiration complications.
Similarly, a 66-year-old man, who had been using semaglutide for weight management, experienced delayed gastric emptying during a CT-guided procedure for renal nodule ablation, despite fasting for 9 hours. In both cases, the medication’s effect on gastric motility posed a serious perioperative risk.
Discussion:
•Semaglutide’s delayed gastric emptying presents significant risks during anesthesia, particularly the increased chance of pulmonary aspiration, even when standard fasting guidelines are followed. Case reports have shown aspiration complications in patients despite fasting for extended periods, highlighting the inadequacy of current preoperative protocols for GLP-1 receptor agonist users.
•The updated guidelines from the American Society of Anesthesiologists (ASA) recommend pausing semaglutide before surgery—daily doses on the day of surgery and weekly doses one week prior—to minimize these risks. When discontinuation isn’t feasible, treating patients as having a "full stomach" and using ultrasound to check for residual gastric contents are important precautions.
Conclusions:
•Further research is needed to develop optimal fasting guidelines and risk mitigation strategies, as the use of semaglutide continues to grow. These updates are crucial to improving patient safety during anesthesia for semaglutide users.
