Semaglutide and delayed gastric emptying: case report and analysis of anesthetic implications

Prescriptions and use of glucagon-like peptide-1 receptor agonists (GLP-1) are dramatically increasing as indications expand, from treating diabetes mellitus to weight loss in obese individuals. One of the effects of GLP-1 receptor agonists is delayed gastric emptying, which perioperatively may be a reason for concern because of the potential increased risk of aspiration during anesthetic induction and emergence. This study discusses the case of a patient on weekly semaglutide treatment scheduled for elective surgery, with 12 hours of preoperative fasting. Gastric ultrasound (US) showed a full stomach with images suggestive of solid and liquid food content. The surgical procedure was suspended due to high risk of bronchoaspiration and rescheduled after three half-lives of semaglutide. Current evidence-based recommendations for perioperative care of patients on GLP-1 receptor agonists are discussed, reviewing the pharmacokinetic and pharmacodynamic considerations of semaglutide and published case reports to integrate the best care strategy for patients scheduled for elective surgery on GLP-1 analogs.