ImportanceGlucagon-like peptide-1 receptor agonist (GLP-1 RA) use is rapidly increasing in the US, driven by its expanded approval for weight management in addition to hyperglycemia management in patients with type 2 diabetes. The perioperative safety of these medications, particularly with aspiration risk under anesthesia, is uncertain.ObjectiveTo assess the association between GLP-1 RA use and prevalence of increased residual gastric content (RGC), a major risk factor for aspiration under anesthesia, using gastric ultrasonography.Design, Setting, and ParticipantsThis cross-sectional study prospectively enrolled patients from a large, tertiary, university-affiliated hospital from June 6 through July 12, 2023. Participants followed preprocedural fasting guidelines before an elective procedure under anesthesia. Patients with altered gastric anatomy (eg, from previous gastric surgery), pregnancy, recent trauma (<1 month), or an inability to lie in the right lateral decubitus position for gastric ultrasonography were excluded.ExposureUse of a once-weekly GLP-1 RA.Main Outcomes and MeasuresThe primary outcome was the presence of increased RGC, defined by the presence of solids, thick liquids, or more than 1.5 mL/kg of clear liquids on gastric ultrasonography. Analysis was adjusted for confounders using augmented inverse probability of treatment weighting, a propensity score–based technique. Secondarily, the association between the duration of drug interruption and the prevalence of increased RGC was explored.ResultsAmong the 124 participants (median age, 56 years [IQR, 46-65 years]; 75 [60%] female), the prevalence of increased RGC was 56% (35 of 62) in patients with GLP-1 RA use (exposure group) compared with 19% (12 of 62) in patients who were not taking a GLP-1 RA drug (control group). After adjustment for confounding, GLP-1 RA use was associated with a 30.5% (95% CI, 9.9%-51.2%) higher prevalence of increased RGC (adjusted prevalence ratio, 2.48; 95% CI, 1.23-4.97). There was no association between the duration of GLP-1 RA interruption and the prevalence of increased RGC (adjusted odds ratio, 0.86; 95% CI, 0.65-1.14).Conclusions and RelevanceUse of a GLP-1 RA was independently associated with increased RGC on preprocedural gastric ultrasonography. The findings suggest that the preprocedural fasting duration suggested by current guidelines may be inadequate in this group of patients at increased risk of aspiration under anesthesia.

中文翻译：

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麻醉前胰高血糖素样肽 1 受体激动剂的使用和残留胃内容物

重要性胰高血糖素样肽 1 受体激动剂 (GLP-1 RA) 在美国的使用正在迅速增加，这是由于其在 2 型糖尿病患者的体重管理和高血糖管理方面得到了广泛批准。这些药物的围手术期安全性，特别是麻醉下误吸风险尚不确定。 目的 使用胃超声检查评估 GLP-1 RA 使用与残留胃内容物 (RGC) 增加患病率之间的关联，RGC 是麻醉下误吸的主要危险因素设计、设置和参与者这项横断面研究前瞻性地招募了 2023 年 6 月 6 日至 7 月 12 日期间来自一家大型三级大学附属医院的患者。参与者在麻醉下进行择期手术前遵循术前禁食指南。胃解剖结构改变（例如，以前的胃手术）、怀孕、近期外伤（<1 个月）或无法右侧卧位进行胃超声检查的患者被排除在外。 GLP-1 RA. 主要结果和测量主要结果是 RGC 增加，定义为胃超声检查中存在固体、粘稠液体或超过 1.5 mL/kg 的透明液体。使用增强的治疗加权逆概率（一种基于倾向评分的技术）对混杂因素进行了分析调整。其次，探讨了药​​物中断持续时间与 RGC 增加的患病率之间的关联。 结果 在 124 名参与者（中位年龄，56 岁 [IQR，46-65 岁]；75 名 [60%] 女性）中，RGC 增加的患病率使用 GLP-1 RA 药物的患者（暴露组）中，RGC 为 56%（62 人中的 35 人），而未服用 GLP-1 RA 药物的患者（对照组）中，RGC 为 19%（62 人中的 12 人）。调整混杂因素后，GLP-1 RA 的使用与 RGC 增加的患病率升高 30.5%（95% CI，9.9%-51.2%）相关（调整后的患病率，2.48；95% CI，1.23-4.97）。GLP-1 RA 中断的持续时间与 RGC 增加的患病率之间没有关联（调整后的比值比，0.86；95% CI，0.65-1.14）。结论和相关性 GLP-1 RA 的使用与 RGC 增加独立相关术前胃超声检查。研究结果表明，当前指南建议的术前禁食时间对于这组麻醉下误吸风险增加的患者来说可能不够。