Glucagon-like Peptide-1 Receptor Agonist-induced Delayed Gastric Emptying: An Educational Module
Abstract
Quality Improvement
Utilization of Gastric Ultrasound for evaluation of Glucagon-like Peptide-1 Receptor Agonist-induced delayed gastric emptying
Lemya Alarab BSN, RN; Christina Vera, PhD, DNP, CRNA, APRN, CNE
Background: The rise in the prevalence of chronic diseases like cardiovascular illness and diabetes is a direct result of the epidemic of obesity, which poses a risk to the future of human civilization. These findings have changed recommendations for treating patients with established cardiovascular disease, suggesting that GLP-1 RAs be considered the first supplementary medicine following metformin, with some studies suggesting before metformin.1 Due to their promising profile in enhanced weight loss, reduced risk for hypoglycemia, and reduced glycated hemoglobin, additional GLP-1 RAs have been on the rise.1 Currently, there is a lack of fundamental organizational data on the use of GLP1-agonists at the facility. However, the conventional practice is to consider any patient receiving GLP1-agonists as a candidate for rapid sequence intubation. The goal of this quality improvement project is to increase providers' knowledge on Glucagon-like Peptide-1 Receptor Agonist-induced delayed gastric emptying to prevent aspiration pneumonia in the adult perioperative population.
Method: This was a blind quality improvement project that enabled a maximum of 10 practitioners to effectively evaluate specific perioperative interventions. A preliminary survey was conducted to assess the initial level of awareness and utilization of gastric ultrasonography, as well as perceived obstacles to its use. This was followed by an online educational session and post-survey that emphasized the significance and application of gastric ultrasound in patients taking GLP-1 RAs in the perioperative period. The anesthesia providers were educated on the mechanisms of GLP-1 RAs that contribute to the high risk of aspiration and how to use gastric ultrasound to assess the presence of any remaining gastric volume contents.
Results: A convenience sample of 9 pre/post assessments were obtained and analyzed. The educational module improved post-test knowledge on various items. The most significant improvements in knowledge were noted in the timeframe in which Semaglutide enhances glucose and lipid metabolism (50% difference), incidence of aspiration pneumonia (30% difference), and the deadliest complication being pneumonia (20% difference). Improvements in knowledge following administration of an education module showed a 10% improvement in difference in the following categories: Organ effected by GLP-1 agonists, Semaglutide half-life, gastric volume and gastric volume baselines. No changes in difference between pre-test and post-tests were observed in the following categories: How GLP-1 agonists reduce gastric emptying, positioning for assessing gastric emptying via ultrasound, and whether or not it was standard practice to consider obese patients at a higher risk for aspiration. Interestingly, one item showed a decrease in correct response knowledge which was facility policy for holding Semaglutide prior to surgery (-20% difference). This finding indicates the increased need for facilities to educate providers on policies that mirror safe standards of practice.
Discussion: There is a lack of specific literature on the most recent research about Glucagon-like Peptide-1 Receptor Agonist-induced delayed stomach emptying and its role in preventing aspiration pneumonia in adults during the perioperative period. Aspiration pneumonitis remains a significant and worrisome consequence related to anesthesia. The necessity for this initiative arose from the desire to establish the use of preoperative gastric ultrasound as a routine method for evaluating residual volume during preoperative assessments, to instill confidence in anesthesia professionals. Focused educational interventions can be used as an initial step to enhance knowledge and proficiency in the field of anesthesia.
Key words: “semaglutide”, "liraglutide," "gastric emptying," "aspiration pneumonitis," and "anesthesia”