The use of GLP-1 receptor agonists in treating type 2 diabetes and obesity in pediatric and adolescent populations has become common. Children and teenagers may experience perioperative risks and pharmacological effects like those in adult patients, such as delayed gastric emptying and related risks during anesthesia. However, the creation of standardized guidelines is challenging due to the lack of information on the long-term use of these drugs in children.
Current evidence suggests that GLP-1 receptor agonists affect gastric motility in pediatric patients through similar pharmacologic mechanisms observed in adults, although pediatric-specific perioperative data remain limited. Pharmacokinetics (how the body absorbs, distributes, metabolizes, and excretes a medication) and pharmacodynamics (the effects of the drug on the body) of the medications differ in pediatric patients as follows:
- Children absorb substances at different rates, which can affect the efficacy and adverse effects of GLP-1 receptor agonists.
- Children have faster metabolic rates than adults, so drugs may not stay active in their systems as long as they do in adults.
- Children's GI systems are still growing, so the effect of GLP-1 receptor agonists on delayed stomach emptying may be particularly noticeable in this age group, raising the possibility of regurgitation and aspiration under anesthesia.
Children also may not fully understand why their medication is being withheld or why they need to fast before surgery. This can make them feel anxious or upset, especially if they are used to taking their medication regularly. It is important to communicate with children in a clear and age-appropriate manner to help them understand the process and the importance of following preoperative instructions.
Caregivers play a crucial role in the perioperative care of pediatric patients because they are actively involved in decision-making, particularly when understanding the pros and cons of postponing the use of GLP-1 receptor agonists until after surgery. They also play a vital role in ensuring that a child adheres to fasting guidelines and understands the reasons behind certain actions, such as delaying medication.
In addition to the general guidelines, certain steps can be used to effectively manage the challenges in pediatric patients receiving GLP-1 receptor agonists:
- Tailored fasting rules: Standard fasting rules may need to be adjusted and longer fasting periods or diagnostic tools such as gastric ultrasonography to assess any remaining stomach contents before administering anesthesia can be used.
- Individualized care plans: The treatment approach for each pediatric patient should be individualized, considering their overall health, type of GLP-1 receptor agonist, and medical history. This approach should be developed in collaboration with pediatricians, endocrinologists, and anesthesiologists to ensure comprehensive care.
