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Case Reports
. 2023 Aug;70(8):1397-1400.
doi: 10.1007/s12630-023-02521-3. Epub 2023 Jun 6.

Regurgitation under anesthesia in a fasted patient prescribed semaglutide for weight loss: a case report

Michael A Gulak  1 , Patricia Murphy  2
Affiliations
Case Reports

Regurgitation under anesthesia in a fasted patient prescribed semaglutide for weight loss: a case report

Michael A Gulak et al. Can J Anaesth. 2023 Aug.

Abstract
in English, French

Purpose: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as semaglutide are a class of medications prescribed to treat type 2 diabetes mellitus, and more recently, as an adjunct for weight loss because of its effects of delaying gastric emptying and suppressing appetite. Semaglutide is a long-acting agent with a half-life of approximately one week, and there are currently no guidelines that address the perioperative management of such agents.

Clinical features: We describe an unexpected case of regurgitation of a large volume of gastric contents upon induction of general anesthesia in a nondiabetic, nonobese patient despite a long preoperative fasting period (20 hr for solids and eight hours for clear fluids). This patient had no traditional risk factors for regurgitation or aspiration but was taking the GLP-1 RA semaglutide for weight loss and had last taken the medication two days before their scheduled procedure.

Conclusions: Patients taking long-acting GLP-1 RAs such as semaglutide may be at risk of pulmonary aspiration under anesthesia. We propose strategies to mitigate this risk including holding the medication four weeks prior to a scheduled procedure when feasible and considering full stomach precautions.

RéSUMé: OBJECTIF: Les agonistes des récepteurs du glucagon-like peptide-1 (AR GLP-1) tels que le sémaglutide sont une classe de médicaments prescrits pour traiter le diabète sucré de type 2 et, plus récemment, comme complément à la perte de poids en raison de ses effets de retardement de la vidange gastrique et de suppression de l’appétit. Le sémaglutide est un agent à action prolongée dont la demi-vie est d’environ une semaine, et il n’existe actuellement aucune ligne directrice traitant de la prise en charge périopératoire de ces agents. CARACTéRISTIQUES CLINIQUES: Nous décrivons un cas inattendu de régurgitation d’un important volume de contenu gastrique lors de l’induction de l’anesthésie générale chez une personne non diabétique et non obèse malgré une longue période de jeûne préopératoire (20 heures pour les solides et huit heures pour les liquides clairs). Cette personne ne présentait aucun facteur de risque traditionnel de régurgitation ou d’aspiration, mais prenait du sémaglutide (AR GLP-1) à des fins de perte de poids et avait pris le médicament pour la dernière fois deux jours avant l’intervention prévue. CONCLUSION: Les patient·es prenant des AR GLP-1 à action prolongée tels que le sémaglutide peuvent être à risque d’aspiration pulmonaire sous anesthésie. Nous proposons des stratégies pour atténuer ce risque, y compris d’interrompre la prise du médicament quatre semaines avant une intervention prévue lorsque cela est possible et d’envisager de prendre les précautions requises pour un estomac plein.

Keywords: general anesthesia; glucagon-like peptide-1 receptor agonists; pulmonary aspiration; semaglutide.

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References

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