Department of Anaesthesia, Westmead Hospital, Westmead, NSW, Australia.
Department of Diabetes and Endocrinology, St. Vincent's Hospital, Darlinghurst, NSW, Australia.
Anaesthesia. 2024 Jul;79(7):735-747. doi: 10.1111/anae.16306. Epub 2024 May 13.
Glucagon-like peptide-1 receptor agonists are used increasingly in the management of patients living with type 2 diabetes mellitus and obesity. In patients using glucagon-like peptide-1 receptor agonists, a key concern in the peri-operative period is the increased risk of pulmonary aspiration due to delayed gastric emptying. This review provides an overview of the pharmacodynamic and pharmacokinetic properties of glucagon-like peptide-1 receptor agonists and the risk of delayed gastric emptying and aspiration.
We conducted searches of MEDLINE and EMBASE databases of articles published before January 2024 using the keywords and medical subject headings: incretins; glucagon-like peptide-1; GLP-1; glucagon-like peptide-1 receptor agonists; GLP-1 RA; peri-operative period; perioperative; peri-operative; stomach emptying; gastric emptying; pulmonary aspiration; aspiration; food regurgitation; and regurgitation. The evidence was analysed, synthesised and reported narratively.
A total of 1213 articles were located after duplicates were removed. Two authors screened the titles and abstracts to identify those studies which assessed specifically the risk of delayed gastric emptying and pulmonary aspiration or regurgitation in the peri-operative period. We searched manually the reference lists of relevant studies to identify any additional case reports. Ten studies were identified. Available evidence was limited to case reports, case series and observational work.
There is insufficient evidence to put forward definitive guidance regarding the ideal cessation period for glucagon-like peptide-1 receptor agonists before elective surgery. Precautionary practice is required until more evidence becomes available. We suggest an individualised, evidence-based approach. In patients living with type 2 diabetes mellitus, there is concern that prolonged cessation before surgery will have a detrimental effect on peri-operative glycaemic control and discussion with an endocrinologist is advised. For patients taking glucagon-like peptide-1 receptor agonists for weight management, these drugs should be withheld for at least three half-lives before an elective surgical procedure.
胰高血糖素样肽-1 受体激动剂（GLP-1RA）在治疗 2 型糖尿病和肥胖症患者中的应用日益增多。在使用 GLP-1RA 的患者中，围手术期的一个主要关注点是由于胃排空延迟而导致的肺部吸入风险增加。本文综述了 GLP-1RA 的药效学和药代动力学特性，以及胃排空延迟和吸入的风险。
我们使用关键词和医学主题词在 MEDLINE 和 EMBASE 数据库中进行了文献检索，检索时间截至 2024 年 1 月前发表的文章：incretins；glucagon-like peptide-1；GLP-1；glucagon-like peptide-1 receptor agonists；GLP-1 RA；peri-operative period；perioperative；peri-operative；stomach emptying；gastric emptying；pulmonary aspiration；aspiration；food regurgitation；and regurgitation。我们对证据进行了分析、综合和叙述性报告。
去除重复后共定位了 1213 篇文章。两名作者筛选了标题和摘要，以确定那些专门评估围手术期胃排空延迟和肺部吸入或反流风险的研究。我们手动搜索了相关研究的参考文献列表，以确定任何其他病例报告。共确定了 10 项研究。现有证据仅限于病例报告、病例系列和观察性工作。
目前尚无确凿证据能明确提出 GLP-1RA 在择期手术前的最佳停药时间。在更多证据出现之前，需要采取预防措施。我们建议采用个体化、基于证据的方法。对于患有 2 型糖尿病的患者，人们担心手术前长时间停药会对围手术期血糖控制产生不利影响，建议与内分泌科医生进行讨论。对于因体重管理而服用 GLP-1RA 的患者，应在择期手术前至少停用三个半衰期。
