Glucagon-like peptide receptor agonists (GLP-1RAs) are used to improve glycemic control in type 2 diabetes. Semaglutide, a GLP-1RA, delays gastric emptying, resulting in sustained satiety and weight loss. However, concerns exist regarding an increased aspiration risk during the perioperative period. This report presents a patient with recurrent vomiting induced by GLP-1RA before surgery.
A 64-year-old male was scheduled to undergo a mandibulectomy under general anesthesia for medication-related osteonecrosis. The patient had diabetes mellitus, chronic renal failure requiring hemodialysis, hypertension, and hypothyroidism. The patient received weekly subcutaneous semaglutide, with the last injection administered four days before surgery. He was admitted to the hospital two days before surgery and vomited a moderate amount of undigested stomach contents during the night on the day of admission. Vomiting recurred during hemodialysis on the following day, at dinner, and at midnight. He reported a history of repeated vomiting prior to admission. A nasogastric tube was inserted while the patient was awake before the induction ; however, no gastric contents were aspirated. After oxygenation in the semi-Fowler’s position, rapid sequence induction was performed using remifentanil, propofol, and rocuronium, followed by nasal intubation. No vomiting occurred during the anesthesia induction.
We experienced general anesthesia to a patient with type 2 diabetes with repeated vomiting suspected to be caused by GLP-1RAs. Anesthesiologists should confirm that patients are receiving GLP-1RAs for gastrointestinal symptoms such as vomiting preoperatively and consider the induction of anesthesia, including rapid sequence induction similar to that in patients with full stomachs.
