GLP-1 Receptor Agonists - An Anaesthesiologist’s Perspective – A Comprehensive Review
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Abstract
GLP-1 receptor agonists help in regulating blood sugar levels and encouraging weight reduction in individuals with non-insulin-dependent diabetes mellitus who adhere to dietary guidelines and exercise regularly. Semaglutide is a commonly utilized type of GLP-1 receptor agonist. The injection is usually administered once every seven days subcutaneously, beginning at 0.25 mg, with the highest weekly dosage is between 2.0 and 2.4 mg (larger doses are employed to promote weight loss instead of regulating blood sugar). Semaglutide’s half-life is approximately one week, indicating it remains active in the body for a long duration. So, it requires roughly five weeks to reach its stable level in the body, and it also takes the same amount of time for its effects to cease after discontinuation. There is now an oral formulation, and its effects might resemble those of the injection (1,2)
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References
I. Expert anesthesiologist provides guidance for perioperative care of patients on GLP-1RA therapy. Wolters Kluwer. (n.d.).
II. Jones, P. M., Hobai, I. A., & Murphy, P. M. (2023). Anesthesia and glucagon-like peptide-1 receptor agonists: proceed with caution!. Anesthésie et agonistes des récepteurs du peptide-1 de type glucagon : la prudence est de mise!. Canadian journal of anaesthesia = Journal canadien d’anesthesie, 70(8), 1281–1286.
https://doi.org/10.1007/s12630-023-02550-y
III. Sidik S. M. (2023). Diabetes and obesity are rising globally – but some nations are hit harder. Nature, 10.1038/d41586-023-00676-z. Advance online publication. https://doi.org/10.1038/d41586-023-00676-z
IV. Deepu S. Ushakumari, Robert N. Sladen; ASA Consensus-based Guidance on Preoperative Management of Patients on Glucagon-like Peptide-1 Receptorm Agonists. Anesthesiology 2024; 140:346–348 doi:https://doi.org/10.1097/ALN.0000000000004776
V. Joshi G. P. (2024). Anesthetic Considerations in Adult Patients on Glucagon-Like Peptide-1 Receptor Agonists: Gastrointestinal Focus. Anesthesia and analgesia, 138(1), 216–220. https://doi.org/10.1213/ANE.0000000000006810
VI. Gulak, M. A., & Murphy, P. (2023). Regurgitation under anesthesia in a fasted patient prescribed semaglutide for weight loss: a case report. Régurgitation sous anesthésie chez une personne à jeun à qui du sémaglutide a été prescrit pour une perte de poids : une présentation de cas. Canadian journal of anaesthesia = Journal canadien d’anesthesie, 70(8), 1397–1400.
https://doi.org/10.1007/s12630-023-02521-3
VII. Schirra, J., Houck, P., Wank, U., Arnold, R., Göke, B., & Katschinski, M. (2000). Effects of glucagon-like peptide-1(7-36)amide on antro-pyloro-duodenal motility in the interdigestive state and with duodenal lipid perfusion in humans. Gut, 46(5), 622–631. https://doi.org/10.1136/gut.46.5.622
VIII. Are serious anesthesia risks of SEMAGLUTIDE and other GLP-1 agonists under-recognized? Case reports of retained solid gastric contents in patients undergoing anesthesia. Anesthesia Patient Safety Foundation. (2024, February 17). https://www.apsf.org/article/are-serious-anesthesia-risks-of-semaglutide-and-other-glp-1-agonists-under-recognized/
IX. Sherwin, M., Hamburger, J., Katz, D., & DeMaria, S., Jr (2023). Influence of semaglutide use on the presence of residual gastric solids on gastric ultrasound: a prospective observational study in volunteers without obesity recently started on semaglutide. Influence de l’utilisation du sémaglutide sur la présence de solides gastriques résiduels à l’échographie gastrique : une étude observationnelle prospective auprès de volontaires sans obésité ayant récemment commencé à prendre du sémaglutide. Canadian journal of anaesthesia = Journal canadien d’anesthesie, 70(8), 1300–1306. https://doi.org/10.1007/s12630-023-02549-5
X. Fawcett, W. J., & Thomas, M. (2019). Pre-operative fasting in adults and children: clinical practice and guidelines. Anaesthesia, 74(1), 83–88. https://doi.org/10.1111/anae.14500
XI. Charlesworth, M., & Wiles, M. D. (2019). Pre-operative gastric ultrasound – should we look inside Schrödinger’s gut?. Anaesthesia, 74(1), 109–112. https://doi.org/10.1111/anae.14516
XII. American Society of Anesthesiologists Consensus-based guidance on preoperative management of patients (adults and children) on glucagon-like peptide-1 (GLP-1) receptor agonists. American Society of Anesthesiologists (ASA). (n.d.). https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative
XIII. Bloomgarden Z. (2023). Should glucagon-like peptide-1 receptor agonist treatment be withheld in preoperative management?. Journal of diabetes, 15(9), 712–713. https://doi.org/10.1111/1753-0407.13469
XIV. Dungan K, DeSantis A. Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus. In: Post T, ed. UpToDate; 2023. Accessed 28, April 2024
XV. Hall, S., Isaacs, D., & Clements, J. N. (2018). Pharmacokinetics and Clinical Implications of Semaglutide: A New Glucagon-Like Peptide (GLP)-1 Receptor Agonist. Clinical pharmacokinetics, 57(12), 1529–1538. https://doi.org/10.1007/s40262-018-0668-z
XVI. Smith, L. L., Mosley, J. F., 2nd, Parke, C., Brown, J., Barris, L. S., & Phan, L. D. (2016). Dulaglutide (Trulicity): The Third Once-Weekly GLP-1 Agonist. P & T : a peer-reviewed journal for formulary management, 41(6), 357–360.
XVII. Jackson, S. H., Martin, T. S., Jones, J. D., Seal, D., & Emanuel, F. (2010). Liraglutide (victoza): the first once-daily incretin mimetic injection for type-2 diabetes. P & T : a peer-reviewed journal for formulary management, 35(9), 498–529.
XVIII. Bray G. M. (2006). Exenatide. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 63(5), 411–418.
https://doi.org/10.2146/ajhp050459
XIX. Lixisenatide. (2019). In LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. National Institute of Diabetes and Digestive and Kidney Diseases.
XX. Openanesthesia. (2023, August 23). Glucagon-like peptide 1 receptor agonists and aspiration risk. OpenAnesthesia. https://www.openanesthesia.org/keywords/glucagon-like-peptide-1-receptor-agonists-and-aspiration-risk/