Retrospective audit of the current anaesthetic peri–operative approach to patients prescribed semaglutide

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Introduction There is contentious evidence on the risk of aspiration in patients prescribed glucagon–like peptide–1 receptor agonists at the time of sedation or general anaesthesia. With, to the best of our knowledge, no studies outlining real world anaesthetic practice. This study aims to determine the approach to these patients, including pre–operative assessment, risk identification, and real–world management with note of adverse events. Methods This study was a retrospective review, conducted at a quaternary hospital with data between 1 January and 9 October 2024. Reviewing surgical patients discharged within the target period taking semaglutide at the time of a surgery that proceeded. Noting semaglutide formulation, anaesthetic assessment and risk identification, sedation and airway approach, and adverse events. Results 118 patients were eligible for inclusion with a mean age of 61, even sex distribution (53/118 female), and were predominantly on 1 mg weekly semaglutide. 112 of 118 patients had a documented pre–operative anaesthetic assessment with 75% (84/112) identifying semaglutide and 33% (39/112) documenting an aspiration risk. Of those with a documented risk, 44% (17/39) used general anaesthetic, 41% (16/39) rapid sequence induction, and 16% (6/39) an intubation sparing approach. Most cases used an endotracheal tube with limited use of laryngeal mask airways. There was targeted use of gastric ultrasound and prokinetic (3.4%, 4/118 each). There was a statistically significant difference in sedation approach and use of a non–fasted technique in those with a documented risk (P < 0.001). Discussion There is appropriate identification of semaglutide and its risk in the peri‑operative period. With an individualised approach and emerging use of pre–induction techniques. There is need for further integration of emerging guidelines into practice in this area given the possible implication on patient outcomes. However, this data does not identify any adverse events with current practice.