50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Effects of GLP-1 Agonists on Preoperative Ultrasound Assessment of Gastric Volume:

A Prospective Observational Cohort Study

Chris Wolla MD, Travis Pecha MD, Joel Sirianni MD, Lexi Schorg BS, Bethany Wolf PhD, Sylvia Wilson MD

Medical University of South Carolina, Charleston, SC

INTRO

•Continue GLP-1 perioperatively

•Consider holding if risk factors are present

•Risk Factors

•Recent escalation of GLP-1 dose

•Higher doses of GLP-1

•WEEKLY DOSING

•Presence of GI symptoms

•Medical conditions that delay gastric emptying

METHODS

•Population à Diabetic patients undergoing elective surgery

•N = 206

•106 taking GLP-1, 100 control

•Preoperative gastric ultrasound

•Gastric Volume in RLD

•Perlas grade

Should we hold the GLP-1?

YES!*+

*But don’t just cancel. Assess further!

+96.3% of our patients were WEEKLY dosed

RESULTS

•SIGNIFICANT increase in gastric volume if weekly GLP-1 taken within 7 days

•11x risk of full stomach

•Median GV ~3.8x higher in GLP-1 users

Median Gastric Volumes

•< 7 day = 1.2 mL/kg

•7-14 days = 0.4 mL/kg

•> 14 days = 0.5 mL/kg

•Control = 0.2 mL/kg

•Median GV GLP-1 vs control

•0.61mL/kg vs 0.16mL/kg (p < 0.001)

•Odds of full stomach

•OR 11.3 (p < 0.001)

•Increased Perlas grade in GLP-1 users (p < 0.001)

•1 aspiration event in GLP-1 group (~1%)

•No difference in holding medication >7 days vs 7-14 days vs control (p < 0.001, p = 0.002, p < 0.001)

References

1.Van de Putte P, Perlas A. https://doi.org/10.1111/anae.14164

2.Perlas A, Mitsakakis N, Liu L, Cino M, Haldipur N, Davis L, et al. https://doi.org/10.1213/ane.0b013e318274fc19.

3.Joshi GP, Abdelmalak BB, Weigel WA, Soriano SG, Harbell MW, Kuo CI, et al. https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative.

4.Kindel TL, Wang AY, Wadhwa A, Schulman AR, Sharaiha RZ, Kroh M, et al. https//:doi.org/10.1016/j.soard.2024.08.033

50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

EFFECTS OF GLP-1 AGONISTS ON PREOPERATIVE ULTRASOUND ASSESSMENT OF GASTRIC VOLUME: A PROSPECTIVE OBSERVATIONAL COHORT STUDY

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