A new study published in April sheds light on the concerns of anesthesiologists across the United States related to the perioperative management of patients taking glucagon-like peptide-1 (GLP-1) agonists, a class of drugs now commonly prescribed for both diabetes and cosmetic weight loss. GLP-1 agonists such as semaglutide (marketed as Ozempic and Wegovy) have surged in popularity in recent years due to their appetite-suppressing effects. However, these drugs also delay gastric emptying—raising concerns among anesthesia professionals about the potential risk of aspiration, a rare but life-threatening complication during the induction of general anaesthesia.
To explore this issue, UF Department of Anesthesiology faculty members Meghan Brennan, M.D., M.S., and Sonia Mehta, M.D., were joined by colleagues from Stanford University, the University of Chicago, the University of California Irvine, and private surgical practice in co-authoring the article “Perioperative Practice Patterns of Anaesthesiologists Surrounding Glucagon-Like Peptide-1 (GLP-1) Agonist Medications,” which was published in the Turkish Journal of Anaesthesiology & Reanimation. To explore current medical practice and concerns, the researchers conducted a nationwide survey of all members of the American Society of Anesthesiologists (ASA). Over 1,800 physicians responded, providing valuable insight into how they are navigating the use of GLP-1 agonists.
An overwhelming 97% of respondents reported being familiar with GLP-1 agonists, and 62% indicated having moderate to significant experience with patients on these medications. While 81% of respondents had not personally observed complications in these patients, aspiration due to delayed gastric emptying and subsequently an increased aspiration risk was identified as the primary concern by the majority of respondents. While the precise duration of delayed gastric emptying caused by GLP-1 agonists remains unclear, the possibility of retained stomach contents at the time of surgery has prompted many anesthesiologists to remain cautious. Most practitioners reported following current ASA “nothing by mouth” (NPO) guidelines for patients taking GLP-1 agonists.
As off-label use of GLP-1 agonists continues to rise, particularly for weight loss in otherwise healthy individuals, the authors cite the need for additional guidelines and research. “Free-text responses indicated providers wanted further guidance from the ASA, as current guidelines may be insufficient regarding the NPO as well as medication cessation recommendations,” the article states. “As the use of these drugs becomes ubiquitous, widespread implementation of preoperative anaesthesia clinics should be considered, and excellent communication with the surgical team is essential.”
The study provides insight into understanding how medical professionals are navigating the intersection of popular drug use and surgical safety—and underscores the need for clear, evidence-based guidance as the use of GLP-1 agonists shows no signs of slowing.
Congratulations to Drs. Brennan and Mehta!