Perioperative management of patients taking GLP-1 receptor agonists

This algorithm is applicable for patients taking GLP-1 RAs (eg, semaglutide, liraglutide, tirzepatide) for any indication (eg, diabetes, obesity, heart failure). The algorithm should be used in conjunction with UpToDate content on rapid sequence induction and intubation for anesthesia and perioperative medication management.

ASA: American Society of Anesthesiologists; GI: gastrointestinal; GLP-1: glucagon-like peptide 1; RA: receptor agonist.

* Gastrointestinal side effects of GLP-1 RAs are dose related. The specific doses that increase risk of delayed gastric emptying are unclear.

¶ The decision to withhold the drug should involve shared decision making among the prescribing care team, surgeon or proceduralist, and anesthesia care team, including consideration of the risks of stopping the drug and the required plan for restarting it. The optimal duration to withhold GLP-1 RAs is not known. Based on recommendations from the ASA, patients taking GLP-1 RAs daily should withhold the dose on the day of the procedure, and patients on weekly dosing should withhold the dose for one week.

Δ Management should involve shared decision making, and may depend on availability and expertise with gastric ultrasound and the risks of delaying the procedure.

References:

Kindel TL, Wang AY, Wadhwa A, et al. Multisociety clinical practice guidance for the safe use of glucagon-like peptide-1 receptor agonists in the perioperative period. Surg Obes Relat Dis 2024.
American Society of Anesthesiologists Consensus-Based Guidance on Preoperative Management of Patients (Adults and Children) on Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists. American Society of Anesthesiologists. https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative (Accessed on November 19, 2024).

Graphic 147071 Version 1.0

خرید پکیج

Perioperative management of patients taking GLP-1 receptor agonists