49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Beyond blocks: Timely use of gastric POCUS by regional anesthesia team in assessment of a patient on GLP-1 therapy
Tabitha Eckert, MD; Charles D Arno III, DO; Sabrina Dhillon, MD.
VCU Health System Department of Anesthesiology, Richmond, VA.

Background

•GLP-1 receptor agonists (GLP-1-RA) can lead to delayed gastric emptying and prolonged gastric fullness after fasting which can increase the risk of aspiration on induction of general anesthesia.

•Gastric point of care ultrasound (POCUS) can assess gastric fullness in this population with high sensitivity and specificity.

•Gastric POCUS is an accessible, economical way to reduce aspiration risk in patients on GLP-1-RA therapy or with unclear fasted time.

Case

•62-year-old female with past medical history significant for obesity on Ozempic, hypertension, and a known history of post-operative nausea and vomiting (PONV) undergoing open reduction and internal fixation of the distal right fibula.

•The patient provided inconsistent reports of fasting time and last Ozempic dosing during initial evaluation by the acute pain service (APS) team.

•Gastric POCUS imaging performed by the APS team showed large volume of gastric contents consistent with a full stomach and the case was postponed for one week.

•Repeat gastric ultrasound was performed when the patient for surgery one week later. Ozempic was appropriately held prior to presentation and on US the absence of gastric contents was consistent with appropriate fasting.

Discussion

•GLP-1-RA are gaining traction as treatments for type 2 diabetes (DM2) and obesity.

•FDA-approved GLP-1-RAs include liraglutide, dulaglutide, semaglutide, exenatide, lixisenatide, and albiglutide.

•Current or recent use of any GLP-1-RA introduces safety considerations including increased aspiration risk due to delayed gastric emptying 2.

•Gastric POCUS can be used to assess stomach volumes in patients at risk for aspiration due to gastroparesis or less than recommended fasting time. This mode of evaluation is easily accessible at most institutions and is highly sensitive and specific for detecting the presence of gastric contents 5.

•This case clearly demonstrates that the use of gastric POCUS is a reliable way to assess the risk of aspiration in patients on GLP-1-RA therapy or with unclear fasted time.

Reference:

1. Nakatani, Y., Maeda, M., Matsumura, M., Shimizu, R., Banba, N., Aso, Y., . . . Harasawa, H. (2017). Effect of GLP-1 receptor agonist on gastroinstestinal tract motility and residue rates as evaluated by capsule endoscopy. Diabetes and Metabolism, 430-7.

2. Weber, M. M. (2024). Trust the Gold Standard: All Glucagon-like Peptide-1 Receptor Agonists Can Delay Gastric Emptying. Anesthesiology, 178-180.

3. Joshi, G. P., Abdelmalak, B. B., Weigel, W. A., Soriano, S. G., Harbell, M. W., Kuo, C. I., . . . Fasting, A. S. (2023, June 29). American Society of Anesthesiologists consensus-based guidance on preoperative management of patients (Adults and children) on glucagon-like peptide-1 (GLP-1) receptor agonists. Retrieved from American Society of Anesthesiologists: https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative

4. Kalas, M. A., Galura, G. M., & McCallum, R. W. (2021). Medication-Induced Gastroparesis: A Case Report. Journal of Investigative Medicine High Impact Case Reports, 1-3.

5. Godschalx, V., Vanhoof, M., Soetens, F., Van de Putte, P., Hadzic, A., Van de Velde, M., & Van Herreweghe, I. (2023). The role of gastric ultrasound in anaesthesia for emergency surgery: A review and clinical guidance. European Journal of Anaesthesiology and Intensive Care.

49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

BEYOND BLOCKS: TIMELY USE OF GASTRIC POCUS BY REGIONAL ANESTHESIA TEAM IN ASSESSMENT OF A PATIENT ON GLP-1 THERAPY

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