Abstract

Glucagon-like peptide-1 (GLP-1) receptor agonists (RA) have become popular medications over the last several years for the treatment of type 2 diabetes mellitus, cardiovascular risk reduction, and most recently for weight loss. There are several types of GLP-1 RA medications with various actions and half-lives, but the most popular of these is semaglutide. Semaglutide is a long-acting GLP-1 RA that selectively binds to GLP-1 receptors which increases insulin and suppresses glucagon secretion with a half-life of seven days and is a once-weekly injection. An additional mechanism of action includes inhibition of stomach peristalsis which causes delayed gastric emptying, nausea, and vomiting. This effect is particularly concerning for patients taking this medication who then need surgical procedures. Current practice guidelines for fasting include two hours for clear fluids, six hours for a light meal, and eight hours for full solid meals including fatty or friend foods. However, in patients taking a GLP-1 RA, these guidelines may not be sufficient. There have been numerous case reports of GLP-1 RA patients following fasting guidelines yet still showing retained gastric food contents. Retained gastric contents can cause pulmonary aspiration following sedation or general anesthesia which can lead to pneumonia, sepsis, extended hospital stays, and death. The American Society of Anesthesiologists (ASA) has recently published fasting guidelines for patients taking GLP-1 agonists. These guidelines include several options including treating the patient as a "full stomach" and using a rapid sequence intubation technique, holding the GLP-1 agonist for 1 week prior to the procedure, and using gastric ultrasound to identify retained gastric contents.

Author Details

Alexa Pratt, BSN and Lauren Barnes, DNP, CRNA

Sigma Membership

Unknown

Lead Author Affiliation

Samford University, Birmingham, Alabama, USA

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

GLP-1 Agonist, Glucagon-Like Peptide 1 Receptor, Delayed Gastric Emptying, Pulmonary Aspiration

Advisor

Barnes, Lauren

Degree

DNP

Degree Grantor

Samford University

Degree Year

2024

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Self-submission

Date of Issue

2024-01-29

Full Text of Presentation

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