The edition · Anaesthesiology
1 in 71 patients on GLP-1 agonists regurgitated or aspirated under anaesthesia, against 1 in 802 not taking them — mostly at emergence
A UK national cohort of 47,039 anaesthetics puts a number on GLP-1 aspiration risk; drug allergy labels were associated with more complications; a caudal-versus-penile block trial and a dexamethasone-versus-ondansetron trial after caesarean; and a Class II dexmedetomidine recall.
The edition in brief
Today's anaesthesia edition closes on a national prospective UK cohort (Anaesthesia, 16 September) of 47,039 adults at 119 sites. One in 36 was taking a GLP-1 receptor agonist. Pulmonary aspiration or regurgitation occurred in 1.41% of them against 0.12% of others (OR 11.39, 6.47 to 20.05), most often at emergence, despite varied precautions. It is observational and unadjusted in the abstract, but the size of the difference warrants a plan for every patient taking one. The lead is a BJA cohort (10 September) of 13,646 surgical patients: the 29% carrying a drug allergy label had more 30-day complications (25% vs 20%; OR 1.21) and more infections. A multicentre randomised trial in children under 2 having hypospadias repair (RAPM, 11 September), stopped early, found no clear difference in fistula between caudal and penile block (RR 0.98, 0.35 to 2.76), with less opioid after caudal. A 95-patient trial after caesarean (Anesthesia & Analgesia, 10 September) found dexamethasone 8 mg no better than ondansetron 4 mg as first-line antiemetic. On regulation, the FDA has a Class II recall of Baxter's premixed dexmedetomidine 4 mcg/mL in 100 mL Galaxy containers for manufacturing-practice deviations. The pearl is on asking the GLP-1 question at pre-assessment.
Drug allergy labels were associated with more complications after surgery
Question every drug allergy label at pre-assessment — labelled patients had more complications and infections, and most labels are wrong.
Hypospadias repair under 2: no clear fistula difference between caudal and penile block, and caudal needed less opioid
Caudal block need not be avoided for hypospadias repair on fistula grounds; it gave better analgesia in this trial.
After caesarean, dexamethasone was no better than ondansetron as first-line antiemetic
For antiemetic prophylaxis after caesarean, choose dexamethasone or ondansetron on local practice; neither was better in this trial.
FDA Class II recall: Baxter premixed dexmedetomidine 4 mcg/mL in 100 mL Galaxy containers
Check with pharmacy whether you stock the recalled Baxter premixed dexmedetomidine bags, and switch lots if so.
Ask 'Any weekly injections?' at pre-assessment
At pre-assessment, ask by name about weekly GLP-1 injections, including those bought privately for weight loss.
GLP-1 agonists: aspiration or regurgitation in 1 in 71 anaesthetics
Plan airway management for every patient taking a GLP-1 agonist, and treat emergence as a high-risk moment as well as induction.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for anaesthesiology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free