DP38: GASTRIC ULTRASOUND AND PERIOPERATIVE MANAGEMENT OF GLP-1 RECEPTOR AGONISTS: A QUALITY IMPROVEMENT PROJECT
Ahmed Rashid, BA; Erica Matich, BS; Michael Lafferty, BS; Peggy A White, MD; Amanda M Frantz, MD
University of Florida Department of Anesthesiology
Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1RA) have transformed metabolic disease management by reducing hyperglycemia and enhancing satiety. In the past few years, the FDA has approved the use of GLP-1RA for medical weight loss and to reduce the risk of cardiovascular complications in overweight and obese patients. Given the recent rise of GLP-1RA, concerns have risen about perioperative GLP-1RA use due to delayed gastric emptying, which may result in residual gastric contents and increase the risk of pulmonary aspiration during sedation or anesthesia.
Prior recommendations per the ASA initially recommended holding doses of GLP-1RA before surgery; however, recently it has been recommended to continue GLP-1RA as scheduled except for certain high-risk groups. Gastric point-of-care ultrasound should be considered when assessing patients, however, very little research has been done to identify indications or the benefits of implementation in standard of care for GLP-1RA patients.
Methods: To evaluate potential participants, the investigators collaborated with EPIC personnel to develop an in-house server list for clinicians to identify all patients using GLP-1RA at three surgical sites. Once a participant was identified, data on patient demographics, pertinent medical history, and medication history—including GLP-1RA use for at least eight weeks and other relevant medications—were collected. Subsequently, a certified anesthesiologist performed a bedside gastric point-of-care ultrasound to assess gastric contents. The ultrasound findings were discussed with the primary anesthesia team to optimize participant safety, which included considerations such as the placement of an NG tube during surgery. Details of the surgical procedure were documented both intraoperatively and postoperatively, with complications such as bronchoaspiration, hypoxia, nausea/vomiting, and ileus recorded.
Results: A total of 29 participants were included in the study, with the cohort being stratified to empty (n=22) or full stomach (n=7). Both cohorts were found to have similar patient demographics in regards to age, gender, BMI, and other medical comorbidities. In regards to preoperative fasting, it was found on average the empty stomach cohort refrained from eating solids 27.8 hours while the full stomach cohort refrained from eating solids 15.9 hours. Both cohorts had similar incidence of postoperative complications with no events of bronchoaspiration recorded.
Discussion: Preliminary data from this study suggest that patients with full stomachs spent significantly less time on a clear liquid diet when compared to patients with empty stomachs, highlighting the importance of adherence to preoperative fasting protocols. Patient adherence to institutional guidelines is key to preventing full stomachs and possibly reducing the risk of perioperative complications. However, further data is needed to better understand the relationship between discontinuation of GLP-1RA drugs, fasting habits, and postoperative complications. This will help refine preoperative recommendations and improve patient safety in the perioperative setting.