Low-risk patients can continue GLP-1 receptor agonists perioperatively, guideline says
Decision making about perioperative use of glucagon-like peptide-1 (GLP-1) receptor agonists should be collaborative and balance patients' metabolic need for the medication with their risk of delayed gastric emptying and aspiration, according to a new multisociety guideline.
A group of medical societies released a joint guideline on perioperative glucagon-like peptide-1 (GLP-1) receptor agonist use.
The guidance was developed by experts representing the American Gastroenterological Association, American Society for Metabolic and Bariatric Surgery, American Society of Anesthesiologists, International Society of Perioperative Care of Patients with Obesity, and the Society of American Gastrointestinal and Endoscopic Surgeons. It was published by Surgery for Obesity and Related Diseases on Oct. 29, as well as in other society journals.
The guideline includes two main recommendations. The first is that use of GLP-1 receptor agonists in the perioperative period should be based on shared decision making by the patient with procedural, anesthesia, and prescribing care teams, balancing the metabolic need for the medication with the individual patient's risk.
GLP-1 receptor agonists may be continued preoperatively in patients who don't have elevated risk of delayed gastric emptying and aspiration, the guideline noted. If elevated risk is present, it should be “balanced with the surgical and medical risk of inducing the potential for a hazardous, metabolic disease state, like hyperglycemia.”
The second main recommendation in the guideline calls for minimizing the aspiration risk of delayed gastric emptying, which the guideline said can be achieved by preoperative diet modification and/or alteration of the anesthesia plan to consider rapid sequence induction of general anesthesia for tracheal intubation.
A more complete summary of the guideline is available in the Nov. 6 ACP Hospitalist, a publication exclusive to ACP members.