Role of Gastric Point-of-Care Ultrasound in Perioperative Management of Semaglutide

Introduction

Glucagon-like peptide-1 receptor agonists (GLP1-RAs) are used in the treatment of type 2 diabetes mellitus and obesity. A side effect of GLP1-RAs is delayed gastric emptying, which could increase the risk of pulmonary aspiration. This exploratory pilot study examines the use of ultrasound to identify high-risk patients taking GLP-1RAs before elective surgery.

Methods

A prospective study from July 2023 to February 2024 was conducted on patients who took their last weekly dose of semaglutide less than seven days before surgery. If preoperative gastric ultrasound revealed an empty stomach, surgery proceeded. Patients with residual gastric contents were rescheduled. Patient demographics, semaglutide dosage and timing, nil per os (NPO) time, and postoperative complications were reviewed. Statistical significance was set at p < 0.05.

Results

Twenty-five patients took their weekly semaglutide less than seven days before surgery. Twenty patients (80%) demonstrated empty stomachs on ultrasound and proceeded with surgery without complications. Gastric contents were found in five patients (20%), and surgery was rescheduled. Patients who took semaglutide one to three days before surgery were more likely to have residual gastric contents as compared to those who took semaglutide four to six days before surgery (p = 0.02).

Discussion

Gastric ultrasound is a useful tool that can prevent the cancellation of surgery for patients on semaglutide. Patients who took semaglutide within one to three days were more likely to have residual gastric contents compared to those who took it four to six days prior.

Conclusion

Preoperative gastric ultrasound can identify high-risk patients on semaglutide despite adequate NPO status.