AB128. SOH25_AB_092. A systematic literature review of anaesthesia guidelines for GLP-1 medications and proposed fasting times

Background: Glucagon-like peptide-1 (GLP-1) is an incretin hormone that stimulates insulin secretion, inhibits glucagon, delays gastric emptying, and reduces appetite. GLP-1 agonists, approved for managing type 2 diabetes and obesity, have also been shown to reduce major adverse cardiovascular events (MACE). Their benefits in promoting satiety, weight loss, glycaemic control, and cardiovascular protection have led to widespread use in primary and secondary care. Due to these benefits, a growing number of patients presenting for elective and emergency surgery are taking these medications. However, their association with delayed gastric emptying introduces specific perioperative challenges, including an increased risk of pulmonary aspiration. Published studies provide conflicting advice on managing GLP-1 agonists in the perioperative period, further complicating anaesthetic care.

Methods: A search of PubMed and EMBASE databases of published articles prior to June 2024 was conducted under the following keywords subject headings: “GLP-1”, “GLP1”, “Anaesthesia”, and “Anaesthesia”. This review systematically analysed, consolidated, and reported the studies, case reports, and evidence.

Results: Existing recommendations differ across perioperative societies, making a universal approach unfeasible.

Conclusions: While there is extensive research on perioperative management in diabetes, guidance on GLP-1 agonists is limited. Further research is necessary to develop clear, evidence-based guidelines for the perioperative management of GLP-1 agonists.

Keywords: Anaesthesia; glucagon-like peptide-1 agonists (GLP-1 agonists); GLP-1; peri-operative; management