The use of GLP-1 drugs has been a relatively new consideration for the surgical world, but it becomes more of a consideration by the month, especially as an ever-growing number of patients use them for more than simply blood sugar control. It’s estimated that approximately 11 percent of Americans currently take the medications for weight loss, and that’s probably an underestimation.
During a session at Periop Leader Week, Henry Ford Jackson Hospital anesthesiologist Matthew J. Dellaquila, MD, MBA, FASA, FACHE, president of the Michigan Society of Anesthesiologists, said no clear-cut policy has yet emerged on how best to safely manage patients who take these drugs, especially if they are getting them outside of a pharmacy or they are not listing them during the pre-op phase. He said the recommendations change virtually every day.
That was the bad news. The good news, which he delivered during his session, "When the Guidelines Disagree: GLP-1 Receptor Agonists and the Perioperative Policy You Have to Write," is the benefits of these medications, such as reduction in cardiac events, better overall kidney and liver function and improved pulmonary health, and glucose control. Because of their effectiveness, GLP-1s will likely be prescribed even more widely.
But they come with risks for surgical teams, namely in terms of how they slow gastric emptying, which can cause life-threatening pulmonary aspiration. Dr. Dellaquila said surgeons and anesthesiologists have already faced lawsuits over complications in patients using these medications. He would like to see a more robust approach to effective protocols, early screening and proactive communication with patients who may not even realize they are taking a GLP-1.
Attendees were not surprised. It’s not uncommon, one said, to cancel a surgery day-of because a patient didn’t tell them they were taking a GLP-1.
Ultimately, Dr. Dellaquila said, there needs to be a step-by-step guide that alleviates last minute surprises, and that puts patient safety first, though he admitted it will be an ever-evolving approach as new meds are introduced.
“Build for change,” he said, “not for correctness.”
