Dr Anne Peters discusses the conflicting recommendations from FDA and medical societies regarding managing patients on GLP-1s prior to elective surgery.
Professor, Department of Clinical Medicine, Keck School of Medicine; Director, University of Southern California Westside Center for Diabetes, University of Southern California , Los Angeles, California Serve on the advisory board for: Abbott Diabetes Care; Becton Dickinson; Boehringer Ingelheim Pharmaceuticals, Inc.; Eli Lilly and Company; Lexicon Pharmaceuticals, Inc.; Livongo; Medscape; Merck & Co., Inc.
The problem with this is that the FDA says they don't really actually know what to tell us to do or not to do because we don't have knowledge as to how to truly mitigate the risk for pulmonary aspiration during general anesthesia or deep sedation. They don't know if modifying preoperative fasting recommendations should be changed or if temporary discontinuation of the drugs could reduce this problem.
They basically look at who is at highest risk, and they say the following: Patients in the escalation phase of their incretin therapy — that is, early in treatment when the dose is increasing — are most likely to have delays in gastric emptying because that effect is lessened over time. They say that the elective surgery should be deferred until the escalation phase has passed and the GI symptoms have dissipated.
If it's somebody where you think they’re having symptoms but they want to have the procedure anyway, you can put them on a liquid diet for 24 hours or so, so that there's less of a risk for retained gastric contents, at least solid gastric contents. Anesthesiologists can help with this as well because in many cases, they can do a point-of-care gastric ultrasound to check for retained food or fluid.
Diabetes Mellitus Type Ii Type 2 Diabetes Type 2 DM T2DM T2D Obesity Obese Weight Management Biologic Therapy Biologics Toxicology Toxicity Poisoning Toxins Surgery GLP-1 Receptor Agonists Glucagon-Like Peptide-1 Receptor Agonists U.S. Food And Drug Administration United States Food And Drug Administration Fda Pain Management California Incretin Hormones
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