An FDA label change and consensus guidance notwithstanding, endocrinologists seem to have made up their minds on how to handle patients on GLP-1s at high risk for aspiration.
Guidance from professional societies on how to handle the risk for pulmonary aspiration during general anesthesia or deep sedation for patients taking glucagon-like peptide 1 receptor agonists continues to evolve, as does the US Food and Drug Administration’s labeling for the drugs.
The letter highlights three overarching recommendations and then expands upon them: Standardized preoperative assessment for risk for delayed gastric emptying ; selective preoperative care plan based on delayed gastric emptying assessment and shared decision-making; and on the day of the procedure, reassess for delayed gastric emptying and mitigate risk if there is clinical concern.
“In my practice, I individualize what I say, depending on the person and the circumstance,” she said. “Mostly, I have people hold one dose before planned surgery, so they have been 10 days at least without a dose. But if worried about gastrointestinal symptoms or gastroparesis, I have them do a clear liquid diet for 24 hours presurgery. Or at least avoid heavy fat meals the day before.”
“In my opinion, all patients should follow a strict liquid diet or NPO status prior to a surgery to further decrease the risk of aspiration,” she said. “I generally hold the GLP-1 RA for a week before a surgery. If additional glycemic control is necessary, I will add to or adjust one of the patient’s other diabetes medications.
“That way,” he said, “it becomes logistically easy to manage because the recommendation from the group is that patients who are at higher risk should receive a 24-hour liquid diet — the same as colonoscopy. But sometimes it can be challenging to do so.”
Diabetes Mellitus Type Ii Type 2 Diabetes Type 2 DM T2DM T2D Aspiration Pain Management Acute Pain Surgery U.S. Food And Drug Administration United States Food And Drug Administration Fda Anesthesia Anesthetic Anesthaesia Anaesthetic General Anesthesia GLP-1 Receptor Agonists Glucagon-Like Peptide-1 Receptor Agonists Patient Safety Diet Adverse Effects
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