ISMP Canada report warns of aspiration in patients undergoing anesthesia who take GLP-1 receptor agonists for weight loss

Patients taking glucagon-like peptide-1 (GLP-1) receptor agonists are having pulmonary aspiration of regurgitated gastric contents while under anesthesia, a new Institute for Safe Medication Practices Canada (ISMPC) report says. It’s thought to be caused by the fact that GLP-1 receptor agonists cause delayed gastric emptying. One patient whose case was reported to the Canada Vigilance Program was taking semaglutide for weight loss and then had orthopedic surgery. The person had not eaten solid food for 12 hours before anaesthesia, but when they had endotracheal extubation and woke from anaesthesia, they vomited a large amount of undigested food. The medical team applied suction and offered supplemental oxygen, and the patient didn’t have significant pulmonary aspiration. Pulmonary aspiration can cause lung injuries, aspiration pneumonia and pneumonitis, leading to long-term issues or death.Read: Semaglutide eliminated the need for insulin in 70% of patients with newly diagnosed Type 1 diabetes: studyThis June, the Canadian Anesthesiologists’ Society sent a bulletin to its members about the risk for patients using GLP-1 receptor agonists. The Canadian Journal of Anesthesiology recently wrote an editorial on the issue. It offered recommendations to anaesthesiologists, including the patient stopping using the medication for a set time before the procedure, considering rapid-sequence induction of general anesthesia, which lowers the risk of aspiration, and considering using gastric ultrasonography to look for gastric contents before procedures. This was done to a patient covered by a published case report. They were taking semaglutide, had fasted for 18 hours and were scheduled for MRI imaging under sedation. They were found to have solid gastric contents in gastric ultrasonography performed before the imaging. The MRI was cancelled because of the aspiration risk. ISMPC says that primary-care practitioners should talk to their patients who are taking GLP-1 receptor agonists and are going to have anesthesia about the risks of aspiration. They should also get advice from specialists on how people who are on these medications to treat diabetes can manage their blood glucose if they need to go off of them. Read: Popular weight loss drugs like Wegovy may raise risk of complications under anesthesiaPharmacists should tell patients starting GLP-1 receptor agonists that this may be a risk if they require anaesthesia for imaging or procedures. They should also advise patients to tell their healthcare providers—including the pre-procedure assessment team and anesthesiologist—that they are on the medication and ask for recommendations about how to reduce their risk of aspiration. Pharmacy informatics specialists should include drug-drug interactions in computerized prescribing, pharmacy and medication administration systems between GLP-1 receptor agonists and the medications that are used for anesthesia. The report also offers advice to preprocedural and pre-imaging risk assessment clinicians and manufacturers. It adds that provincial and regional health authorities and hospitals should send out provincial, regional or hospital alerts to make sure all staff are aware of the increased risk. Read: POLL: Have patients been pushing to be prescribed Ozempic for weight loss?ISMPC highlights three other published case reports where other patients who were taking GLP-1 receptor agonists had fasted before surgery and had residual food or fluid in their stomachs. All three recovered. It points out that all three were using the medication for weight loss, which might be more dangerous because the medication is prescribed in higher doses for weight loss than it is for diabetes. In addition, a small study found that patients who took semaglutide within the past month were five times more likely to have residual gastric contents despite following fasting instructions. “Although more research and consensus are needed to determine the optimal length of time for holding GLP-1 receptor agonists before a procedure requiring anesthesia, it is important for practitioners and patients to be aware of the increased risks for aspiration and to consider strategies to mitigate harm,” the report concludes. Read: Health Canada assessing if drugs used to help with diabetes and weight loss increase the risk of suicide

ISMP Canada report warns of aspiration in patients undergoing anesthesia who take GLP-1 receptor agonists for weight loss

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