78th Annual PostGraduate Assembly in Anesthesiology (PGA78) 2024

A Case Report of an Aspiration-Related Event Leading to Cardiac Arrest in the Acute Post-Operative Period of a Patient on a GLP-1 Agonist.

Mia A. Baringer, MD1 and M. Katherine Yurick, MD1

1Tower Health, Reading Hospital, Tower Health

Background:

•FDA approved for T2DM & weight loss management.

•Mimics endogenously produced GLP-1 polypeptide.

•Decreases gastric emptying and peristalsis

•GI upset is documented in up to 60% of patients.1

•Concern for increased risk of aspiration under anesthesia.

•2000 to 2014, 115 aspiration events – 14% severe, 57% fatal.2

•Recall this is BEFORE the surge of GLP-1RA use!

•Recent release of multisociety guidance recommendations.3

Case:

47-year-old male history of HFrEF 20%, NICM with ICD, atrial fibrillation, T2DM, CKDIIIB, OSA and morbid obesity on daily liraglutide presented for elective TEE and cardiac ablation.

Discussion:

•Prescription growth rates range from 12.9% to 250%.4

•GI symptoms directly correlate with residual gastric volume.

•Residual gastric content in 24.2% vs. 5.1% in non-GLP1.5

•Gastric US proves promising when used in the right context.

•Up to 30% residual volume despite following NPO guidelines.6

•Documented data remains limited, but continues to expand.

•Regurgitation during EGD in a patient without co-risk factors.7

•Perioperative aspiration despite current NPO compliance.8

•Enforce detailed preoperative aspiration risk assessments.

•Conduct multidisciplinary risk vs. benefit discussions.

•Clinicians continue to await concise evidence-based guidelines.

•Always use your best clinical judgement when proceeding!

78th Annual PostGraduate Assembly in Anesthesiology (PGA78) 2024

An Aspiration-Related Event Leading to Cardiac Arrest in the Acute Post-Operative Period of a Patient on a GLP-1 Agonist.

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