GLP associated with aspiration during intubation
- related: ICU intensive care unit
- tags: #literature #icu
The glucagon-like peptide-1 (GLP-1) receptor agonists, including semaglutide, have been associated with massive aspiration at the time of intubation, even in patients who have not recently ingested food (choice C is correct).
GLP-1 receptor agonists have been used for several decades as part of the management of diabetes, but trials demonstrating significant weight loss in nondiabetics have resulted in the approval of two drugs, semaglutide and tirzepatide, for chronic weight management, with more agents in this class likely to be brought to market in coming years. The use of these agents for this indication grew so rapidly after initial approval that prescriptions outstripped production, causing some shortages in the United States. While initial trials assessing the use of GLP-1 receptor agonists for weight loss did not report major gastrointestinal side effects, retrospective studies after drug release found 9-fold increase in the incidence of pancreatitis, 4-fold increase in bowel obstruction, and 3-fold increased risk for gastroparesis. While the incidence of these complications was low, the extraordinary popularity of these agents makes it likely that these complications will be seen by critical care physicians. In the anesthesia literature, case reports began to accumulate describing massive aspiration in patients intubated for elective surgery who had been without solid food ingestion for 6 h or more prior to surgery and without clear liquids for 2 h prior to surgery. The American Society of Anesthesiologists issued a warning for daily preparations of GLP-1 receptor agonists to be held on the day prior to surgery and for the weekly preparation (as this patient uses) to be held for a week prior to surgery. These gastrointestinal effects of this class of drugs are not surprising, since these have hormonal effects similar to glucagon itself which affects gut motility and secretory function.
Neither prednisone nor tiotropium would be expected to cause significant gastrointestinal side effects that would result in risk of aspiration at the time of intubation (choices A and B are incorrect).
Azithromycin can be associated with nausea and diarrhea, but the patient reports none of these symptoms. As a class, the macrolides (particularly erythromycin) increase gut motility and in fact have been used to hasten gastric emptying when urgent endoscopy is required (choice D is incorrect).123