Sedation, Aspiration, and the Risk of GLP-1 Agonists

September 10, 2024

Written by Aaron Lacy

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Patients on GLP-1 agonists might be at risk of delayed gastric emptying, which has significant implications for procedural sedation and endotracheal intubation.

Our understanding of GLP-1 agonists and risks continues to evolve
Gastroparesis and delayed gastric emptying are a recognized side effect of GLP-1 agonists. In one study, those who completed appropriate preoperative fasting on GLP-1 agonists were five times more likely to have residual gastric contents compared to controls.

The American College of Emergency Physicians policy statement on unscheduled procedural sedation reports that, “concerns regarding aspiration vastly exceed the actual risk.” Unfortunately, this was from 2019, and the explosion of GLP-1 agonist prescriptions and subsequent evidence was not yet prominent. More recently, the American Society of Anesthesiologists recommend withholding any GLP-1 agonist before elective surgery to reduce risk of aspiration.

How will this change my practice?
Emergency clinicians often find themselves in the position where urgent procedural sedation or endotracheal intubation is required, despite suboptimal patient preparation. We should start screening patients for GLP-1 use prior to “elective” procedural sedation and have a risk/benefit conversations with both the patient and specialists involved in care. Consider delaying “elective” procedural sedation or performing pre-procedural gastric ultrasound (if trained) when possible.

While we should always be prepared for potential complications during sedation and intubation, when a procedure must be performed in the setting of known GLP-1 use, be prepared for possible large volume emesis/aspiration – time to have the large-bore suction ready.

Editor’s note: Sometimes we choose an article just because it has a single teaching point. That’s what this is – simply a letter to the editor to raise awareness for you. The marked increase in prescription of semaglutide, tirzepatide, and the other GLP-1 agonists (which all end in -tide) will likely increase risk for patients who take them and need emergent intubation or sedation. Need a primer on all the new diabetes drugs? See this YouTube video we made! ~Clay Smith

Source
Use of Glucagon-Like Peptide-1-Agonists and Increased Risk of Procedural Sedation and Endotracheal Intubation in the Emergency Department. Ann Emerg Med. 2024 Aug;84(2):226-227. DOI: 10.1016/j.annemergmed.2024.03.007. PMID: 39032988.