GLP1 Receptor Agonists Sedation

An increasing number of adult and pediatric patients are taking glucagon-like peptide-1 (GLP-1) receptor agonists for the treatment of type-2 diabetes mellitus or obesity, as well as for weight loss. This drug class includes: 

• dulaglutide (Trulicity), 
• exenatide (Byetta, Bydureon BCise), 
• liraglutide (Victoza, Saxenda), 
• lixisenatide (Adlyxin), and 
• semaglutide (Ozempic injection, Rybelsus oral, Wegovy).

These GLP-1 receptor agonists are associated with delayed gastric emptying and may increase the risk of regurgitation and aspiration of gastric contents in patients during general anesthesia or sedation. The American Society of Anesthesiologists (ASA) has published a consensus-based guideline on the preoperative management of adult and pediatric patients who are taking GLP-1 receptor agonists. The Departments of Anesthesiology throughout HMH have adopted these ASA guidelines.

ASA Guidance Summary

For elective procedures:

• Patients on DAILY dosing should HOLD their GLP-1 receptor agonist on the DAY OF surgery/procedure, irrespective of indication, dose, or type of procedure/surgery.
• Patients on WEEKLY dosing should HOLD their GLP-1 receptor agonist ONE WEEK PRIOR to surgery/procedure, irrespective of indication, dose, or type of procedure/surgery.
• If a patient is taking a GLP-1 receptor agonist for the treatment of diabetes and will be holding these medications for longer than the above dosing recommendations, CONSIDER CONSULTING WITH THEIR ENDOCRINOLOGIST FOR BRIDGING THERAPY to avoid hyperglycemia.
• If a patient who is taking these medications PRESENTS WITH GI SYMPTOMS (nausea/vomiting, retching, abdominal bloating or pain), then we should CONSIDER DELAYING AN ELECTIVE PROCEDURE

To review the full guidance, click here.

What to Discuss with Your Patient

HMH’s Departments of Anesthesiology ask that physicians who are scheduling and performing operative and invasive procedures requiring anesthesia or sedation, educate and instruct your patients about holding these medications prior to their planned procedure or operation in order to decrease any risk of regurgitation and aspiration or to avoid any delay or postponement of their procedure.

HMH’s anesthesiologists will have our perioperative/periprocedural nursing staff to discuss and instruct patients on the guidelines during the preoperative/preprocedure interview. As these interviews may take place less than 7 days prior to a procedure, it’s imperative that these discussions take place in your office at the time of determination of the need for surgery or a procedure.

Anesthesia personnel caring for patients on GLP-1 receptor agonists may consider them to have full stomachs and may proceed with full stomach precautions, including rapid sequence induction and endotracheal intubation, even for procedures where we would not traditionally intubate the patient.

Questions

Please feel free to contact your respective Chair/Chief of Anesthesiology with any questions or concerns.

North

• Hackensack University Medical Center: Mark Schlesinger, M.D., HMH Northern Region Chair
• Palisades Medical Center: Stephen Landauer, M.D.
• Mountainside Medical Center: Jonathan Siskind, D.O.
• Pascack Valley Medical Center: Jerome You, M.D.

Central

• JFK University Medical Center: Michael Armao, D.O., HMH Central Region Chair
• Raritan Bay Medical Center: Timothy McNair, M.D.
• Old Bridge Medical Center: David Handlin, M.D.
• Bayshore Medical Center: James Dooley, M.D.

South

• Jersey Shore University Medical Center: Michael H. Entrup, M.D., HMH Southern Region Chair
• Riverview Medical Center: James Dooley, M.D.
• Ocean University Medical Center: Lori Russo, M.D.
• Southern Ocean Medical Center: Richard Richlan, M.D.