Consideraciones Perioperatorias de los Análogos GLP-1.

CRITICAL CARE & EMERGENGY MEDICINE VOL. 3

Perioperative Considerations of GLP-1 Analogs

Enviar Artículo

www.doi.org/10.58281/ccem24120907

Santiago Andrés Berrón Pérez 1, Irlanda Guerrero Baraja 1, Natasha Mey Ruíz 1, José Ricardo Solorzanó Beltrán 1, Manuel A. Guerrero Gutiérrez 3

1 Fellow en Alta Especialidad en Anestesiología Bariátrica. Tijuana, México.
2 Departamento de Anestesiología Bariátrica, Centro Médico Bariátrico. Tijuana, México.

Abstract

GLP-1 agonists are novel medications. Its relationship with the decrease in gastric motility is clear; this presents a challenge when performing an induction under general anesthesia. Therefore, knowing its pharmacokinetics and the current recommendations described by the American Society Anesthesiologists (ASA) to evaluate perioperative risk during elective surgery are important. The objective is to review pharmacokinetics of GLP-1 analogues and evaluate current recommendations for perioperative management in patients undergoing elective surgery. We searched for articles using the keywords and medical topic titles: incretins; glucagon-like peptide-1; GLP-1; glucagon-like peptide 1 receptor agonists; GLP-1 RA; perioperative period; perioperative; perioperative; stomach emptying; gastric emptying; pulmonary aspiration; aspiration of gastric content; regurgitation of food; and regurgitation. The evidence was analyzed, synthesized and reported narratively. The elimination half-life of GLP-1 agonists determines the suspension time prior to the surgical procedure. Gastric ultrasound is a potentially quantitative tool to evaluate gastric contents prior to elective surgery.

Los agonistas de GLP-1 son medicamentos novedosos. Es clara su relación con la disminución de la motilidad gástrica; Esto presenta un desafío al realizar una inducción bajo anestesia general. Por tanto, es importante conocer su farmacocinética y las recomendaciones actuales descritas por la Sociedad Americana de Anestesiólogos (ASA) para evaluar el riesgo perioperatorio durante la cirugía electiva. El objetivo es revisar la farmacocinética de los análogos de GLP-1 y evaluar las recomendaciones actuales para el manejo perioperatorio en pacientes sometidos a cirugía electiva. Se buscaron artículos utilizando las palabras clave y títulos de temas médicos: incretinas; péptido-1 similar al glucagón; GLP-1; agonistas del receptor del péptido 1 similar al glucagón; GLP-1 AR; período perioperatorio; perioperatorio; perioperatorio; vaciado del estómago; vaciado gástrico; aspiración pulmonar; aspiración de contenido gástrico; regurgitación de alimentos; y regurgitación. La evidencia fue analizada, sintetizada y reportada narrativamente. La vida media de eliminación de los agonistas del GLP-1 determina el tiempo de suspensión previo al procedimiento quirúrgico. La ecografía gástrica es una herramienta potencialmente cuantitativa para evaluar el
contenido gástrico antes de la cirugía electiva.

GLP-1 analogues, type 2 diabetes mellitus, perioperative risk, obesity, aspiration of gastric contents.

Santiago Andrés Berrón Pérez
Fellow en Alta Especialidad en Anestesiología Bariátrica. Tijuana, México.

Irlanda Guerrero Baraja
Fellow en Alta Especialidad en Anestesiología Bariátrica. Tijuana, México.

Natasha Mey Ruíz
Fellow en Alta Especialidad en Anestesiología Bariátrica. Tijuana, México.

José Ricardo Solorzanó Beltrán
Fellow en Alta Especialidad en Anestesiología Bariátrica. Tijuana, México.

Manuel A. Guerrero Gutiérrez
Departamento de Anestesiología Bariátrica, Centro Médico Bariátrico. Tijuana, México.

  1. American Diabetes Association Professional Practice Committee. 16. Diabetes care in the hospital: Standards of Medical Care in Diabetes—2022. Diabetes Care 2022; 45 (Suppl 1): S244–S253.
  2. Milder DA, Milder TY, Liang SS, Kam PC. Glucagon-like peptide-1 receptor agonists: a narrative review of clinical pharmacology and implications for peri-operative practice. Anaesthesia. 2024 May 13.
  3. Wang, T., Sun, S., & Huang, S. (2018). The association of body mass index with difficult tracheal intubation management by direct laryngoscopy: a meta-analysis. BMC anesthesiology, 18(1), 79. https://doi.org/10.1186/s12871-018-0534-4
  4. American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures. An updated report by the American Society of Anesthesiologists task force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. Anesthesiology 2017; 126:376-93.
  5. Evangelisti B, Brunet L, Antonello Penna MD, Penna A. Particularidades del manejo perioperatorio de agonistas GLP-1 en pacientes obesos. Análisis crítico de las recomendaciones actuales. Rev. Chil. Anest. 2024;53(4):355-60.
  6. Drucker DJ. GLP-1 physiology informs the pharmacotherapy of obesity. Molecular metabolism. 2022 Mar 1;57:101351.
  7. Van de Putte, P., & Perlas, A. (2014). Ultrasound assessment of gastric content and volume. British journal of anaesthesia, 113(1), 12–22. https://doi.org/10.1093/bja/aeu151
  8. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Care in Diabetes–2024.” Diabetes Care 47, no. Supplement_1 (2024): S145-S157.
  9. Xu D, Nair A, Sigston C, Ho C, Li J, Yang D, Liao X, Chen W, Kuang M, Li Y, Reid C. Potential roles of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) in nondiabetic populations. Cardiovascular Therapeutics. 2022;2022(1):6820377.
  10. Jensterle M, Rizzo M, Haluzík M, Janež A. Efficacy of GLP-1 RA approved for weight management in patients with or without diabetes: a narrative review. Advances in therapy. 2022 Jun;39(6):2452-67.
  11. Jain AB, Ali A, Gorgojo Martinez JJ, Hramiak I, Kavia K, Madsbad S, Potier L, Prohaska BD, Strong JL, Vilsbøll T. Switching between GLP-1 receptor agonists in clinical practice: expert consensus and practical guidance. International journal of clinical practice. 2021 Feb;75(2):e13731
  12. Vosoughi K, Atieh J, Khanna L, Khoshbin K, Prokop LJ, Davitkov P, Murad MH, Camilleri M. Association of glucagon-like peptide 1 analogs and agonists administered for obesity with weight loss and adverse events: a systematic review and network meta-analysis. EClinicalMedicine. 2021 Dec 1;42.
  13. Holst JJ. Glucagon-like peptide-1: Are its roles as endogenous hormone and therapeutic wizard congruent?. Journal of Internal Medicine. 2022 May;291(5):557-73
  14. Ryder RE, DeFronzo RA. Diabetes medications with cardiovascular protection as we enter a new decade: can SGLT2 inhibitors, long-acting GLP-1 receptor agonists, pioglitazone and metformin complement each other to save lives?. British Journal of Diabetes. 2020 Jun 5;20(1):5-8
  15. Capehorn MS, Catarig AM, Furberg JK, Janez A, Price HC, Tadayon S, Vergès B, Marre M. Efficacy and safety of once-weekly semaglutide 1.0 mg vs once-daily liraglutide 1.2 mg as add-on to 1–3 oral antidiabetic drugs in subjects with type 2 diabetes (SUSTAIN 10). Diabetes & metabolism. 2020 Apr 1;46(2):100-9.
  16. Andraos J, Muhar H, Smith SR. Beyond glycemia: Comparing tirzepatide to GLP-1 analogues. Reviews in Endocrine and Metabolic Disorders. 2023 Dec;24(6):1089-101.
  17. Klein SR, Hobai IA. Semaglutide, delayed gastric emptying, and intraoperative pulmonary aspiration: a case report. Canadian Journal of Anesthesia/Journal canadien d’anesthésie. 2023 Aug;70(8):1394-6-
  18. Gulak MA, Murphy P. Regurgitation under anesthesia in a fasted patient prescribed semaglutide for weight loss: a case report. Canadian Journal of Anesthesia/Journal canadien d’anesthésie. 2023 Aug;70(8):1397-400.
  19. Sherwin M, Hamburger J, Katz D, DeMaria Jr S. Influence of semaglutide use on the presence of residual gastric solids on gastric ultrasound: a prospective observational study in volunteers without obesity recently started on semaglutide. Canadian Journal of Anesthesia/Journal canadien d’anesthésie. 2023 Aug;70(8):1300-6.
  20. Raven LM, Brown C, Greenfield JR. Considerations of delayed gastric emptying with peri-operative use of glucagon-like peptide-1 receptor agonists. Medical Journal of Australia. 2024 Jan 15;220(1):14-6.
  21. Willson CM, Patel L, Middleton P, Desai M. Glucagon-Like Peptide-1 Agonists and General Anesthesia: Perioperative Considerations and the Utility of Gastric Ultrasound. Cureus. 2024 Apr;16(4).
  22. Sherwin M, Hamburger J, Katz D, DeMaria Jr S. Influence of semaglutide use on the presence of residual gastric solids on gastric ultrasound: a prospective observational study in volunteers without obesity recently started on semaglutide. Canadian Journal of Anesthesia/Journal canadien d’anesthésie. 2023 Aug;70(8):1300-6.
  23. Zhou Y, Chen M, Liu L, Chen Z. Difference in gastrointestinal risk associated with use of GLP-1 receptor agonists: a real-world pharmacovigilance study. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2022 Jan 1:155-63.
  24. Ushakumari, D. S., & Sladen, R. N. (2024). ASA Consensus-based Guidance on Preoperative Management of Patients on Glucagon-like Peptide-1 Receptor Agonists. Anesthesiology, 140(2), 346–348. https://doi.org/10.1097/ALN.0000000000004776
  25. Van de Putte, P., & Perlas, A. (2014). Ultrasound assessment of gastric content and volume. British journal of anaesthesia, 113(1), 12–22. https://doi.org/10.1093/bja/aeu151
  26. Khalil AM, Ragab SG, Botros JM, Abd-Aal HA, Boules ML. Gastric residual volume assessment by gastric ultrasound in fasting obese patients: a comparative study. Anesthesiology and Pain Medicine. 2021 Feb;11(1).
  27. Ushakumari, D. S., & Sladen, R. N. (2024). ASA Consensus-based Guidance on Preoperative Management of Patients on Glucagon-like Peptide-1 Receptor Agonists. Anesthesiology, 140(2), 346–348. https://doi.org/10.1097/ALN.0000000000004776
  28. Seet E, Nagappa M, Wong DT. Airway management in surgical patients with obstructive sleep apnea. Anesthesia & Analgesia. 2021 May 1;132(5):1321-7.
  29. Hiremath, A. S., Hillman, D. R., James, A. L., Noffsinger, W. J., Platt, P. R., & Singer, S. L. (1998). Relationship between difficult tracheal intubation and obstructive sleep apnoea. British journalof anaesthesia, 80(5), 606–611. https://doi.org/10.1093/bja/80.5.606.
  30. Rosenblatt WH, Yanez ND. A decision tree approach to airway management pathways in the 2022 difficult airway algorithm of the American Society of Anesthesiologists. Anesthesia & Analgesia. 2022 May 1;134(5):910-5.
  31. Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspira-tion: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. (2017). Anesthesiology, 126(3), 376–393. https://doi.org/10.1097/ALN.0000000000001452

[1] Santiago Andrés Berrón Pérez, Irlanda Guerrero Baraja, Natasha Mey Ruíz, José Ricardo Solorzanó Beltrán, and Manuel A. Guerrero Gutiérrez. 2024. Consideraciones Perioperatorias de los Análogos GLP-1. CRITICAL CARE & EMERGENGY MEDICINE. Vol. 3, pp. 22–29. DOI: www.doi.org/10.58281/ccem24120907.

PDF
HTML

Licencia

© 2025 Critical Care & Emergency Medicine by Ediciones Prado. This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) .

Licencia Creative Commons CC BY 4.0

The copyrights of the articles published in Critical Care & Emergency Medicine belong to Ediciones Prado. The contents of the articles that appear in the Journal are exclusively the responsibility of the authors and do not necessarily reflect the opinions of the Editorial Committee of the Journal. It is allowed to reproduce the material published in Critical Care & Emergency Medicine without prior authorization for non-commercial use.

ISSN

2992-6785

eISSN: 2992-6785
DOI: 10.3989/ccem

Indexación

Patrocinadores

Otros artículos

Scroll al inicio