Skidmore Kimberly L, Le Hong, Segredo Veronica, Boullion Jolie A, Daniel Charles P, Smith Van, Varrassi Giustino, Shekoohi Sahar, Kaye Alan D
Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA.
Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, USA.
Cureus. 2025 Jul 12;17(7):e87774. doi: 10.7759/cureus.87774. eCollection 2025 Jul.
Glucagon-like peptide-1 agonists (GLP-1), obesity, and diabetes may delay gastric emptying in some settings. We tested three hypotheses. First, the duration of GLP1-hold is associated with a larger difference between pulse oximetry at room air immediately preoperatively and one hour postoperatively, just prior to discharge home (DSpO2), as a marker of clinically important atelectasis and/or micro-aspiration. Second, we tested the hypothesis that the duration of GLP1-hold affects fasting glucose. Third, we tested the hypothesis that DSpO2 is linked to morbid obesity.
In this retrospective observational cohort study, we screened the cohort of all 1571 patients undergoing urologic ambulatory surgery in one stand-alone center between September 2023 and September 2024. The inclusion criteria were diabetics using GLP-1 within 30 days, creatinine below 2 mg/dL, and age between 18 and 80 years. The outcomes of fasting glucose and DSpO2 were compared between the groups holding GLP-1 longer and shorter than seven days. The outcome DSpO2 was also compared between the groups with and without morbid obesity, defined generally as a body mass index (BMI) of over 35 kg/m² in the presence of one major comorbidity. All of our study subjects had diabetes mellitus, a major comorbidity.
Among all 107 subjects, 56% had laryngeal mask airways and 9% endotracheal tubes. GLP-1 was held 12 ± 8 days (mean ± SD). DSpO2 was 1.5% ± 1.9 with short GLP-1-hold versus 1.8% ± 2.0 with long GLP-1-hold (p=0.41). The mean glucose was 130 mg/dL ± 49 with short GLP1-hold versus 138 mg/dL ± 39 with long GLP-1-hold (p=0.69). DSpO2 was 2.29% ± 1.78 with morbid obesity (N=38) versus 1.43% ± 1.99 without (N=69, p=0.0254, unpaired two-tailed t-test). Patients with morbid obesity showed a trend toward twice the incidence (at 24%) for DSpO2 > 4% (chi-square, p=0.14).
It may be prudent to protect the airway with endotracheal intubation for patients with morbid obesity and diabetes using GLP-1, especially in the lithotomy position.
胰高血糖素样肽-1激动剂（GLP-1）、肥胖和糖尿病在某些情况下可能会延迟胃排空。我们检验了三个假设。第一，GLP-1停药时间与术前即刻室内空气中脉搏血氧饱和度和术后一小时（即将出院前，DSpO2）之间的较大差异相关，以此作为临床上重要肺不张和/或微误吸的标志物。第二，我们检验了GLP-1停药时间影响空腹血糖的假设。第三，我们检验了DSpO2与病态肥胖相关的假设。
在这项回顾性观察队列研究中，我们筛选了2023年9月至2024年9月期间在一个独立中心接受泌尿外科门诊手术的所有1571例患者。纳入标准为在30天内使用GLP-1的糖尿病患者、肌酐低于2mg/dL且年龄在18至80岁之间。比较了GLP-1停药时间长于和短于7天的两组患者的空腹血糖和DSpO2结果。还比较了病态肥胖组（一般定义为存在一种主要合并症时体重指数（BMI）超过35kg/m²）和非病态肥胖组的DSpO2结果。我们所有的研究对象都患有糖尿病这一主要合并症。
在所有107名受试者中，56%使用喉罩气道通气，9%使用气管内插管。GLP-1停药时间为12±8天（均值±标准差）。GLP-1停药时间短的患者DSpO2为1.5%±1.9，而GLP-1停药时间长的患者为1.8%±2.0（p=0.41）。GLP-1停药时间短的患者平均血糖为130mg/dL±49，而GLP-1停药时间长的患者为138mg/dL±39（p=0.69）。病态肥胖患者（N=38）的DSpO2为2.29%±1.78，非病态肥胖患者（N=69）为1.43%±1.99（p=0.0254，非配对双尾t检验）。病态肥胖患者DSpO2>4%的发生率有两倍的趋势（为24%）（卡方检验，p=0.14）。
对于使用GLP-1的病态肥胖和糖尿病患者，尤其是在截石位时，采用气管内插管保护气道可能是谨慎的做法。
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