Rosemont, Ill. (AANA) – Glucagon-like peptide-1 (GLP-1) agonists such as Ozempic® or Wegovy® (semaglutide), Saxenda® (liraglutide), or Zepbound™ (tirzepatide), have become increasingly popular in promoting weight loss. To support the safety of patients and the knowledge of anesthesia professionals, such as Certified Registered Nurse Anesthetists (CRNAs), also known as nurse anesthesiologists or nurse anesthetists, the American Association of Nurse Anesthesiology (AANA) has published “Anesthesia Care of the Patient on a GLP-1 Receptor Agonist.”
These evidence-based perioperative considerations can be used to develop facility policies and procedures that align with the best available evidence on treating patients taking GLP-1 agonists.
GLP-1 agonists, designed initially to manage type 2 diabetes, bind and activate receptors located throughout the body, eliciting a biological response similar to naturally occurring GLP-1, a gut-derived hormone usually released after eating fats and carbohydrates. Patients feel full sooner and tend to eat less.
In addition to appetite suppression, these medications also slow gastric emptying. Clinical guidelines call for a patient to fast prior to anesthesia because food remaining in a patient’s stomach can cause serious complications such as vomiting and food aspiration.
“These medications have exploded in popularity, and CRNAs need to be prepared to see more patients actively take them” says Micah Walden, DNP, CRNA, a member of the AANA Practice Committee. “This means additional preparation for patients, anesthesia providers, and the surgical team to help minimize risks of complications during a procedure.”
Because of these risks, providers may need to do additional screenings such as a point-of-care ultrasound of a patient’s stomach contents before surgery. If the ultrasound indicates that gastric contents are present or imaging is inconclusive, the surgical team may consider delaying an elective procedure or proceeding as “full stomach” to mitigate the risks of regurgitation and aspiration while intubated for anesthesia care.
The length of time various GLP-1 medications continue to impact a patient were considered in developing these recommendations. Example recommendations include:
- If daily dose: Consider holding day of surgery/procedure.
- If weekly dose: Consider holding one week before surgery/procedure.
“Open communication between patients and the surgical team is important with regard to recommendations for withholding GLP-1 agonist medications prior to surgery” says Walden. “As providers, we take that information into account to perform an individualized, case-by-case assessment and create a care plan that will keep the patient safe and comfortable before, during, and after the procedure.”
CRNAs are highly educated, trained, and qualified anesthesia experts. They provide 50 million anesthetics per year in the United States, working in every setting in which anesthesia is delivered. CRNAs are the primary providers of anesthesia care in rural settings, enabling facilities in these medically underserved areas to offer obstetrical, surgical, pain management, and trauma stabilization services.
