Most patients do not need to pause their GLP-1 medications prior to elective surgery, according to updated guidance from several medical societies, including the American Society of Anesthesiologists, MedPage Today reported Oct. 30.
Here are four takeaways from the updated guidance:
1. The update guidance greatly differs from 2023 guidance from the ASA, which originally recommended a one-week and one-day hold of injectable and oral GLP-1 agents, respectively, prior to surgery.
2. The updated guidance says that this no longer applies to the majority of patients. Most can continue their medication up until the day of surgery, but should follow a liquid diet for 24 hours before the procedure, depending on the specific circumstances.
3. "In many cases, patients with scheduled procedures should continue taking the drug. Scheduling of elective procedures should integrate awareness of circumstances when the risk of delayed stomach emptying is highest, such as when the patient is just beginning the drug and the dose is being increased, as well as for patients with significant GI [gastrointestinal] symptoms," said ASA President Donald Arnold, MD, in the report.
4. Physicians should consider the following actors when individually evaluating a patient's metabolic need for the GLP and the risks associated with the perioperative period:
- Whether or not patients are in the dose-escalation phase
- Higher doses
- Weekly versus daily dosing
- Presence of GI side effects suggestive of delayed gastric emptying
- Other medical conditions that may delay gastric emptying