- Design
- National prospective multicentre cohort
- Population
- 47,039 adults having procedures with an anaesthetist, 119 UK sites
- Primary outcome
- Proportion receiving GLP-1 RAs; aspiration or regurgitation (secondary)
- Effect
- 1.41% vs 0.12%; OR 11.39 (95% CI 6.47 to 20.05)
A UK national prospective cohort screened 47,039 adults having elective or emergency procedures with an anaesthetist at 119 sites. Of these, 1348 (2.9%, about 1 in 36) had taken a GLP-1 receptor agonist in the previous three months.
Pulmonary aspiration or regurgitation occurred in 1.41% (95% CI 0.85 to 2.19%) of those taking a GLP-1 agonist, against 0.12% of others — an odds ratio of 11.39 (6.47 to 20.05). Events were most frequent at emergence, not induction. Management varied widely: stopping the drug, fasting, gastric ultrasound, rapid sequence induction, airway device choice.
The abstract reports an unadjusted comparison, and these patients differ in other ways, including diabetes. But an elevenfold difference on this scale warrants a deliberate plan for every patient taking one, and attention at extubation as well as induction.
- Identify GLP-1 agonist use at every pre-assessment.
- Follow your national or society guidance on withholding and fasting.
- Consider gastric ultrasound when the stomach contents are uncertain.
- Plan for aspiration risk at emergence: extubate awake, positioned, with suction ready.
Why it matters
Precautions have focused on induction; this cohort found most events at emergence.
Don't overread it
Observational and, as reported, unadjusted; it cannot say which precautions work.
The statistics, in plain English
1.41% versus 0.12% means about 1 in 71 against 1 in 802. The odds ratio of 11 is not adjusted for diabetes, obesity or procedure type, which also raise risk, so part of the difference may come from them.
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