Differentiated proactive risk management among GLP-1 agonists...

Differentiated proactive risk management among GLP-1 agonists…


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Hamburg In order to reduce the risk of aspiration during anesthesia when taking GLP-1 agonists, the German Society for Anesthesiology and Intensive Care Medicine (DGAI) recommends interrupting therapy during planned procedures in a recent statement.

The revised recommendations are intended to enable a structured and interdisciplinary approach to the proactive evaluation of those affected. When preparing for an operation, the most important thing is to make joint agreements with those being treated and the attending physicians (Anesthesiology & Intensive Care Medicine, 2024; DOI: 10.19224/ai2024.240).

In order to ensure the highest level of patient safety, the increasing spread of GLP-1 agonists requires a differentiated approach to preventive risk evaluation and anesthesia, emphasized Christian Zllner, Director of the Clinic and Polyclinic for Anesthesiology and the Center for Anesthesiology and Intensive Care Medicine at the University Hospital Hamburg- Eppendorf, who played a leading role in the DGAI publication.

The background is that an increase in aspiration pneumonia after surgical procedures has been reported with medication containing GLP-1 agonists. These drugs increase insulin secretion and inhibit the release of glucagon in type 2 diabetes and are also used for weight loss because they delay gastric emptying. Delayed gastric emptying is problematic during surgical procedures because food particles enter the respiratory tract and can cause severe pneumonia.

An individualized assessment of the perioperative risks with GLP-1 agonists should always be carried out, taking into account patient-specific factors and the type of procedure. In the case of elective surgery, therapy with a daily GLP-1 agonist should be interrupted on the day of the operation. For GLP-1 agonists that are administered only once a week, the last time the drug is administered should be one week before the planned operation, the authors write.

These periods must be adhered to regardless of the indication (diabetes mellitus type 2, weight reduction) for therapy with a GLP-1 agonist. In people with type 2 diabetes, close monitoring of blood sugar is also necessary after stopping the medication. If there is no medication break and gastrointestinal symptoms such as nausea, vomiting, bloating or abdominal pain, the patient should be considered not fasting during elective procedures, said Zllner.

In the case of medication with GLP-1 agonists, which are only administered once a week, consultation with the person being treated and the medical staff involved would be particularly important. Zllner believes that this coordination will become increasingly important in the preparation of an operation. Checklists could be considered as possible supports. The DGAI expert recommended that these projects should be further expanded, not only in view of the current discussion about GLP-1 agonists.

The recommendations for the preventive evaluation of adult patients before elective, non-cardiothoracic surgical procedures were drawn up by the DGAI in cooperation with the German Society for Surgery (DGCH) and the German Society for Internal Medicine (DGIM).

It contains 70 recommendations that summarize the current status of proactive risk evaluation. The recommendations for action are divided into 3 chapters with general principles, advanced diagnostics and preoperative handling of long-term medication.

Due to a lack of sufficient evidence, the recommendations were decided upon as an expert consensus with the aim of facilitating decisions for targeted preventive management in everyday clinical practice. © cw/aerzteblatt.de

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