top of page

MHRA issues GLP-1 and dual GIP/GLP-1ra update on potential risk of pulmonary aspiration during general anaesthesia or deep sedation

owenhaskins

Updated: Feb 5

Healthcare professionals should be aware of the potential risk of pulmonary aspiration in patients using GLP-1 or dual GIP/GLP-1 receptor agonists who undergo surgery or procedures with general anaesthesia or deep sedation, according to a Medicines and Healthcare products Regulatory Agency (MHRA) Safety Update.


GLP-1 and dual GIP/GLP-1 receptor agonists are known to cause delayed gastric emptying, which may increase the risk of residual gastric contents despite preoperative fasting.


The MRHA’s advice for healthcare professionals includes:

  • Consider that patients taking these medicines who are undergoing surgeries or procedures with general anaesthesia or deep sedation may have residual gastric contents despite preoperative fasting

  • Anaesthetists should consider the potential risk of aspiration within their risk assessment of patients being treated with GLP-1 or dual GIP/GLP-1 receptor agonists for all indications and manage the aspiration risk, in line with usual anaesthetic practice


Anaesthetists should provide an individualised assessment of the aspiration risk. Within the risk assessment, consider the following points:

  • That patients taking GLP-1 or dual GIP/GLP-1 receptor agonists who have underlying diabetic gastroparesis, as well as other comorbidities such as obesity or gastroesophageal reflux disease, and symptoms of delayed gastric emptying (such as nausea, vomiting, and abdominal pain) may be at higher risk of aspiration

  • Patients should be asked about whether they are taking GLP-1 or dual GIP/GLP-1 receptor agonists

  • Consider the possibility that patients may have purchased GLP-1 or dual GIP/GLP-1 receptor agonists for aesthetic weight loss and may not readily disclose this information unless directly asked. Be aware that private prescriptions may not always be included in the patient’s medical notes or drug history

  • Healthcare professionals should identify the increased risk of aspiration as early as possible before surgery and specifically at pre-assessment clinic before surgery

  • Remind patients to inform their healthcare teams and anaesthetists if they are on GLP-1 or dual GIP/GLP-1 receptor agonists

  • Report suspected adverse drug reactions associated with GLP-1 and dual GIP/GLP-1 receptor agonists, aspiration and other surgical complications on a Yellow Card


In addition, they issued that advice for healthcare professionals to patients should include:

  • If you are taking a GLP-1 or dual GIP/GLP-1 receptor agonist, make sure you inform your healthcare team including the anaesthetist about this prior to your surgical procedure

  • This medicine slows the emptying of your stomach, increasing the risk that stomach contents (e.g. food and drink) could enter into your airways and lungs during surgery or procedures whilst you are under general anaesthesia or deep sedation. This means that a modification to the pre-procedure instruction and anaesthetic technique may be required

  • Take your prescribed medicine(s) as usual and do not stop your treatment without first discussing this with your doctor


A recent European review of the available evidence for all GLP-1 and dual GIP/GLP-1 receptor agonists concluded that the data supports an association between GLP-1 or dual GIP/GLP-1 receptor agonists and the potential risk of pulmonary aspiration during anaesthesia or deep sedation because of the delayed gastric emptying associated with these medicines. The findings of this review were considered by the Pharmacovigilance Expert Advisory Committee (PEAG) of the Commission on Human Medicines (CHM), which agreed with the recommendations. The product information of all GLP-1 and dual GIP/GLP-1 receptor agonists has been updated to include the potential risk of pulmonary aspiration under general anaesthesia or deep sedation.


The PEAG recommended that the MHRA inform healthcare professionals and patients of the possibility of aspiration in patients using GLP-1 or dual GIP/GLP-1 receptor agonists who undergo surgery or procedures requiring general anaesthesia or deep sedation.


The European assessment evaluated whether a specific time to pause the use of a GLP-1 or dual GIP/GLP-1 receptor agonist prior to anaesthesia could be recommended, as well recommending new fasting guidelines or an appropriate medical procedure to confirm an empty stomach. The evidence to support further recommendations was limited and it was concluded that anaesthetists should retain the flexibility to provide individualised assessment.


New warnings have been added to the Summaries of Product Characteristics (SmPC) and Patient Information Leaflets. The new advice aims to raise awareness of the risk of pulmonary aspiration amongst healthcare professionals and patients. Anaesthetists are warned that residual gastric contents may remain despite routine recommended fasting in patients taking a GLP-1 or dual GIP/GLP-1 receptor agonists. This should be considered within the preoperative risk assessment, with subsequent management in preventing or minimising the risk.


As of 12 December 2024, the MHRA has received a very small number of reports of aspiration during a surgical procedure associated with GLP-1 or dual GIP/GLP-1 receptor agonists, including one case that resulted in aspiration pneumonia.


In January 2025, the Association of Anaesthetists published a multidisciplinary consensus statement on ‘Elective peri-operative management of adults taking glucagon-like peptide-1 receptor agonists (GLP-1). Association of Anaesthetists’ , which advises taking the GLP-1 or dual GIP/GLP-1 receptor agonist as normal (irrespective of dosing schedule i.e. daily or weekly).

 

Comments


Weekly Digest

Get a round-up of the main headlines from Bariatric News, directly to your inbox each week.

Thanks for submitting!

Get in touch!
Email: info@bariatricnews.net

©2023 Dendrite Clinical Systems Ltd. All rights reserved.
No part of this website may be reproduced, stored in a retrieval system, transmitted in any form or by any other means without prior written permission from the Managing Editor. The views, comments and opinions expressed within are not necessarily those of Dendrite Clinical Systems or the Editorial Board. Bariatricnews.net is a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

bottom of page