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Regurgitation under anesthesia in a fasted patient prescribed semaglutide for weight loss: a case report

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Gulak, Michael A., Murphy, Patricia·2023·Canadian Journal of Anesthesia/Journal canadien d'anesthésie

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Abstract

Purpose Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as semaglutide are a class of medications prescribed to treat type 2 diabetes mellitus, and more recently, as an adjunct for weight loss because of its effects of delaying gastric emptying and suppressing appetite. Semaglutide is a long-acting agent with a half-life of approximately one week, and there are currently no guidelines that address the perioperative management of such agents. Clinical features We describe an unexpected case of regurgitation of a large volume of gastric contents upon induction of general anesthesia in a nondiabetic, nonobese patient despite a long preoperative fasting period (20 hr for solids and eight hours for clear fluids). This patient had no traditional risk factors for regurgitation or aspiration but was taking the GLP-1 RA semaglutide for weight loss and had last taken the medication two days before their scheduled procedure. Conclusions Patients taking long-acting GLP-1 RAs such as semaglutide may be at risk of pulmonary aspiration under anesthesia. We propose strategies to mitigate this risk including holding the medication four weeks prior to a scheduled procedure when feasible and considering full stomach precautions.

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Background
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*
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“Similarly, Gulak and Murphy [44] reported a 48-year-old female patient using semaglutide for weight loss who regurgitated and aspirated a large volume of liquid gastric contents during induction.”
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Authors: Gulak, M. A., & Murphy, P.
Affiliations: University of Toronto (CA)
University Health Network (CA)
Corresponding author: Gulak, Michael A.
ORCID: Gulak, Michael A.
Venue: Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Publisher: Springer Science and Business Media LLC
Published: 2023-06-06
Volume: 70
Issue: 8
Pages: 1397-1400
ISSN: 0832-610X (ISSN-L)
1496-8975
DOI: 10.1007/s12630-023-02521-3
OpenAlex: W4379522676
Cited by: 153
References: 16
Citations by year: 2026: 32 · 2025: 54 · 2024: 56 · 2023: 11
FWCI: 40.99
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.springernature.com/gp/researchers/text-and-data-mining (tdm)
www.springernature.com/gp/researchers/text-and-data-mining (vor)
Locations: Canadian Journal of Anesthesia/Journal canadien d anesthésie (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
Keywords: semaglutide, GLP-1 receptor agonists, gastric regurgitation, pulmonary aspiration, general anesthesia, preoperative fasting, anti-obesity drugs, perioperative care
MeSH terms: Glucagon-Like Peptide-1 Receptor, Glucagon-Like Peptide-1 Receptor Agonists, Semaglutide, Anesthesia, General, Diabetes Mellitus, Type 2, Fasting, Humans, Hypoglycemic Agents, Weight Loss, Glucagon-Like Peptide 1

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Regurgitation under anesthesia in a fasted patient prescribed semaglutide for weight loss: a case report

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