Key Papers from the Most Recent Literature Relevant to Anesthesiologists

Glucagon-like peptide-1 receptor agonist use has precipitously increased as effective treatment for type 2 diabetes and weight management. These medications may slow gastric motility and anecdotal reports suggest increased risk for perioperative aspiration, but evidence to formulate preoperative cessation guidelines are lacking. A 1-month cross-sectional study was conducted at a university hospital from June to July 2023 measuring residual gastric contents by ultrasound in nonpregnant, fasted patients with normal gastric anatomy who presented for elective surgery and did (n = 65) or did not (n = 62) use glucagon-like peptide-1 receptor agonists. Diabetes was present in 24% of control and 71% of subjects on medication. The primary outcome, presence of solids, thick liquids, or more than 1.5 ml/kg clear liquids on gastric ultrasound, was present in 56% of patients on medication versus 19% of controls (adjusted odds ratio, 30.5%; 95% CI, 9.9 to 51.2%). There was no difference in the secondary outcome: duration of treatment interruption and presence of residual gastric contents (adjusted odds ratio, 0.86; 95% CI, 0.65 to 1.14).

Take home message: In this observational analysis, patients taking glucagon-like peptide-1 receptor agonists had higher prevalence of residual gastric contents after overnight fasting even more than 5 days after their last dose, supporting anecdotal reports of increased risk of aspiration during induction of anesthesia.