A number of case studies can demonstrate the application of these recommendations as follows.
Let's consider a patient diagnosed with type 2 diabetes who is scheduled for an elective cholecystectomy and is currently taking a weekly GLP-1 receptor agonist. Given that the patient falls within a higher risk window for delayed stomach emptying since their last dosage was administered five days before surgery, the anesthesia provider decides, in accordance with ASA recommendations, to postpone the operation for two days to ensure that the effects of the medication have subsided. During the preoperative evaluation, short-acting insulin is administered to monitor and control the patient's blood glucose levels, while closely observing for any symptoms of gastroparesis.
In a different case, a patient who has experienced a catastrophic injury and is taking a daily GLP-1 receptor agonist shows up for emergency surgery. On the morning of the procedure, the patient took their final dose. Here, the anesthesia provider decides to perform a rapid-sequence induction to minimize the risk of aspiration, using cricoid pressure and positioning the patient to reduce the likelihood of regurgitation.
These incidents demonstrate the value of tailored treatment and the necessity for anesthesia professionals to understand the pharmacology of GLP-1 receptor agonists. Clinical judgment is essential in managing the specific hazards these drugs represent in the perioperative period, even if guidelines offer a framework.
