Can Patients Take GLP-1 RA Medications Before Surgery?

Can Patients Take GLP-1 RA Medications Before Surgery?

(HealthDay News) — Glucagon-like peptide-1 receptor agonist (GLP-1 RA) medications do slow gastric emptying but not by enough to warrant discontinuing medications before surgery, according to a review published in the June issue of the American Journal of Gastroenterology.

Brent Hiramoto, M.D., from Brigham and Women’s Hospital in Boston, and colleagues conducted a systematic review and meta-analysis to provide quantitative measures of gastric emptying relevant to mechanisms of weight loss and to periprocedural management of GLP-1 RAs.

For the five studies (247 patients) that utilized gastric emptying scintigraphy, the researchers found that mean T1/2 was 138.4 minutes for GLP-1 RAs versus 95.0 minutes for placebo, with a pooled mean difference of 36.0 minutes (I2 = 79.4 percent). For the 10 studies (411 patients) that used the acetaminophen absorption test, there was no significant delay in gastric emptying measured by Tmax, area under the curve (AUC)4hour, and AUC5hour with GLP-1 RAs. There was no impact on gastric emptying for the type of GLP-1 RA, mechanism of action, or treatment duration.

“Based on our study, we recommend that guidelines be updated with the following precautions for GLP-1 RA users undergoing endoscopic procedures: continue therapy, follow a liquid-only diet the day prior, and adhere to standard pre-anesthesia fasting,” Hiramoto said in a statement. “Until more data on solid diets is available, a conservative approach with a liquid diet while continuing therapy is advisable.”

One author disclosed ties to the pharmaceutical industry.

What is GLP-1 RA?

GLP-1 RA, short for Glucagon-like peptide-1 receptor agonist, refers to a class of medications used to combat type 2 diabetes and obesity. They work by mimicking the effects of a natural hormone, GLP-1, produced in the gut.

Our bodies naturally produce GLP-1, a key player in blood sugar regulation. It stimulates insulin release after meals, slows stomach emptying, and promotes feelings of fullness. In type 2 diabetes, the body either doesn’t produce enough GLP-1 or its cells become less responsive to it. This disrupts blood sugar control. GLP-1 RAs step in, acting like GLP-1 and triggering its beneficial effects.

GLP-1 RAs are typically injectable medications delivered under the skin. A newer oral formulation of semaglutide is available, but it requires specific considerations for optimal absorption.

As with any medication, there can be side effects. The most common are nausea, vomiting, and diarrhea, which usually subside with continued use. It’s crucial to consult with a doctor to determine if GLP-1 RAs are right for you and discuss potential side effects and interactions with other medications.

GLP-1 RAs can potentially affect surgery in two main ways: delayed gastric emptying and potential interaction with anesthesia.

GLP-1 RAs slow down the rate at which food leaves the stomach. This can be beneficial for weight management and blood sugar control, but it becomes a concern before surgery.

Why shouldn’t you eat before surgery?

The main reason you shouldn’t eat before surgery, particularly surgery involving general anesthesia, is to reduce the risk of aspiration.

General anesthesia renders you unconscious and relaxes the muscles that control swallowing and coughing. With food or drink in your stomach, there’s a chance it could regurgitate and travel up the windpipe into the lungs during surgery. This is called aspiration. Aspiration can be serious, leading to pneumonia or even death.

By avoiding food and drink for a specific period before surgery, your stomach is empty, significantly reducing the risk of aspiration. The exact fasting guidelines can vary depending on the type of surgery and anesthesia used.

While traditionally a complete fast was recommended, recent studies suggest allowing clear liquids up to two hours before surgery for most patients. This can help with hydration and potentially improve recovery.

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