Preoperative considerations of new long-acting glucagon-like peptide-1 receptor agonists in diabetes mellitus

Particulate Gastric Contents in Patients Prescribed Glucagon-Like Peptide 1 Receptor Agonists After Appropriate Perioperative Fasting: A Report of 2 Cases

“…The apparent tachyphylaxis to slowed gastric motility that weekly dosing of GLP-1 agonists may promote is favorable, as dulaglutide and semaglutide in once-weekly administration are currently the most commonly prescribed GLP-1 agonists. 12 In a recent editorial, Hulst et al 13 recommend that all GLP-1 therapies be continued uninterrupted in the perioperative period considering this tachyphylaxis effect, given both the impracticality of holding long-acting medications preoperatively as well as concerns regarding blood glucose control in diabetic patients; however, perioperative studies specifically addressing aspiration risk in long- versus short-acting agents are lacking. Holding short-acting GLP-1 agonists like oral semaglutide (Rybelsus), as was encountered with our second patient, is less cumbersome.…”

Prehabilitation of Cardiac Surgical Patients, Part 1: Anemia, Diabetes Mellitus, Obesity, Sleep Apnea, and Cardiac Rehabilitation

“…61 The injectable glucagon-like peptide-1 agonists (GLP-1) exenatide and liraglutide are typically held on the morning of surgery due to concerns over delaying gastrointestinal mobility 62 ; there are no consensus perioperative guidelines for newer GLP-1 agonists like dulaglutide. 63 In other surgical lines, preoperative oral hydration with glucose-containing beverages have been part of clinical pathways shown to improve outcomes. 64 Given the risk of intraoperative hyperglycemia, even in non-diabetic patients undergoing cardiac surgery due to the inflammatory response of initiating cardiopulmonary bypass, this practice has been debated.…”

“…61 The injectable glucagon-like peptide-1 agonists (GLP-1) exenatide and liraglutide are typically held on the morning of surgery due to concerns over delaying gastrointestinal mobility 62 ; there are no consensus perioperative guidelines for newer GLP-1 agonists like dulaglutide. 63…”

Anesthetic Considerations in Adult Patients on Glucagon-Like Peptide-1 Receptor Agonists: Gastrointestinal Focus

“…It is incumbent on anesthesiologists to be well-versed in the pharmacology and perioperative considerations of GLP-1RAs (Table ). 4 GLP-1RAs are associated with adverse gastrointestinal (GI) effects such as nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal distension, and abdominal discomfort/pain. 1,2 GLP-1RAs can also delay gastric emptying, which can be further exacerbated by the gastroparesis associated with advanced DM.…”

“…It is incumbent on anesthesiologists to be well-versed in the pharmacology and perioperative considerations of GLP-1RAs (Table). 4…”