| GLP-1 Management in the Pediatric Patient Undergoing General Anesthesia Diana Matusiak1, Kelsey Lipiner1, Natalie Weatherred1, Hubert Benzon1, 2. 1Ann and Robert H.Lurie Children's Hospital of Chicago, Chicago, IL, USA.2Northwestern University Feinberg School of Medicine, Chicago, IL, USA |
Abstract
CASE PRESENTATION: This vignette describes the perioperative management of pediatric patients (ages 12–22) receiving glucagon-like peptide-1 (GLP-1) receptor agonists undergoing general anesthesia. In accordance with the 2024 American Society of Anesthesiologists (ASA) consensus-based guidance, select patients may continue GLP-1 receptor agonists prior to undergoing general anesthesia and adhere to a liquid diet for the 24 hours preceding anesthesia. Our protocol included a 24-hour full liquid diet, cessation of full liquids eight hours before the scheduled arrival time, and allowance of clear liquids until one hour before anesthesia induction.
DISCUSSION: The rising prevalence of pediatric obesity has led to an increased use of GLP-1 receptor agonists for weight management. However, these agents delay gastric emptying, raising concern for aspiration risk during anesthesia. The perioperative team must balance the metabolic benefits of continued GLP-1 therapy against potential anesthetic complications while modifying fasting guidelines. Patients must adhere to strict dietary modifications within the immediate pre-operative period to minimize gastric residual contents and the risk of aspiration. Implementation of a 24-hour full liquid diet prior to anesthesia offers a practical approach to mitigate risk while maintaining glycemic control and medication adherence.
CONCLUSIONS: This vignette highlights the safe and effective perioperative management of pediatric patients on GLP-1 therapy through a structured diet protocol. Adherence to this regimen prior to general anesthesia resulted in no intraoperative or postoperative aspiration events. This vignette underscores the importance of individualized perioperative planning for GLP-1 users and supports ongoing evaluation of fasting and medication management strategies in this growing patient population. Early institutional experience suggests that adherence to this protocol avoids unnecessary medication interruptions while maintaining patient safety.
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