Translation of a-t 2024; 55: 48

ONCE AGAIN: ASPIRATION RISK IN PATIENTS TREATED WITH GLP-1 AGONISTS

The German Society of Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, DGAI) is adapting its recommendations on the preoperative management of patients who use GLP-1 agonists such as semaglutide (OZEMPIC, WEGOVY; a-t 2020; 51: 25-8, 2023; 54: 57-61 and others) or the twincretin tirzepatide (MOUNJARO; a-t 2023; 54: 91-2, 2024; 55: 29-30) to treat type 2 diabetes or for weight reduction in the case of obesity.¹ It is thus following the American Society of Anesthesiologists (ASA). Back in June 2023, the ASA warned of an increased risk of regurgitation and aspiration in patients treated with GLP-1 agonists, particularly if the patient has simultaneous gastrointestinal symptoms, on the basis of individual reports and small studies (a-t 2023; 54: 64).²

Based on the recommendation, patients who undergo an elective procedure under general anaesthetic or deep sedation and use a GLP-1 agonist (independent of the indication) should pause the daily injection of the medication on the day of the surgery. For preparations that are administered once a week, the final application should be one week before the planned surgery. Careful monitoring of the blood sugar level is needed after the medication is stopped. If no break is taken in the medication or the patient has gastrointestinal symptoms, they should be considered not to have an empty stomach. In this case, an individual and interdisciplinary risk assessment is recommended, which may also result in a postponement of the procedure.³ The European Medicines Agency (EMA) is now tracking the potential risk too. No assessment has yet been carried out.⁴

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