Perioperative Practice Patterns of Anaesthesiologists Surrounding Glucagon-Like Peptide-1 (GLP-1) Agonist Medications

Abstract

Objective: Aspiration of gastric contents during induction of anaesthesia is a rare but well-recognized complication with high morbidity and mortality risk. Patients at highest risk include those with full stomachs, diabetes, hiatal hernias, gastrointestinal obstructions, severe gastroesophageal reflux, and known delayed gastric emptying. Recently, the use of glucagon-like peptide-1 (GLP-1) agonists has expanded rapidly, including their application in cosmetic weight loss. This drug class suppresses glucagon release after meals, thereby delaying gastric emptying over an undefined duration. For patients taking these medications in the perioperative period, the effect on overall aspiration risk is unknown. This survey details the current practice pattern of anaesthesiologists regarding GLP-1 agonists. Methods: An IRB-approved 30-question, uncompensated survey was distributed to 30,096 self-reported actively practicing United States members of the American Society of Anesthesiologists (ASA). The survey collected demographic information, practice information, and included questions about the management of patients taking GLP-1 agonists. To ensure participant confidentiality, no identifiable information was collected. Results: The survey response rate was 5.98%, with 1,801 surveys returned. Ninety-seven percent of respondents indicated familiarity with GLP-1 agonists, and eighty-one percent indicated they had not personally witnessed complications in patients taking GLP-1 agonists. Most respondents indicated perioperative aspiration as the largest concern and the most commonly reported witnessed complication. 62% reported having “some” to “a lot” of experience providing anaesthesia to patients taking these medications. Most respondents reported NPO guidelines consistent with current ASA practice guidelines. Conclusion: The majority of anaesthesiologists report perioperative aspiration as their highest concern for patients taking this class of medications.

Keywords

• anaesthesiologists
• glucagon-like peptide-1
• off-label use
• physicians
• practice patterns