I am looking for hospitalists, anesthesiologists, obesity medicine doctors, or other docs to answer questions on the difficulties of managing GLP-1s in the hospital for a story I'm writing for Medscape. Here are the questions I'm looking to have answered, please. If you respond, I'd appreciate it if you'd please also send a headshot with a photo credit. Thanks so much for your time! Perioperative management: What are your hospital's current protocols for patients on GLP-1 agonists who are scheduled for some kind of elective surgery? Can you comment on how these protocols are evolving in light of recent guidance from organizations like the American Society of Anesthesiologists? What about with emergency surgery? Risk of delayed gastric emptying: Given that GLP-1 agonists slow gastric emptying, how does one manage the risk of aspiration pneumonia in patients who need to be intubated or who present with gastrointestinal symptoms like nausea and vomiting? Medication reconciliation: When a patient is admitted, what is the process for determining whether they are taking a GLP-1 agonist, especially if it's for weight loss rather than diabetes? What specific information do you look for to inform the inpatient care plan? Dosing and re-initiation: If a patient's GLP-1 agonist is held for a period during their hospital stay, what is the standard procedure for restarting the medication? Is there a need to re-titrate the dose from the beginning, and how does this affect their overall treatment plan? Hypoglycemia management: How do you manage the risk of hypoglycemia in patients on GLP-1 agonists, particularly those who are also taking other glucose-lowering medications like insulin? Are there specific protocols for dose adjustments during periods of NPO or poor oral intake? Multidisciplinary collaboration: What is the role of other specialists, such as gastroenterologists, endocrinologists, and dietitians, in managing hospitalized patients on GLP-1 agonists? How is communication and care coordination handled between these different teams?

I can definitely help unpack some of these issues! In my hospital, we've updated our protocols for managing patients on GLP-1 agonists during elective surgery, aligning closely with recent guidelines from the American Society of Anesthesiologists. Primarily, these patients are advised to skip their GLP-1 dose on the day of surgery to mitigate the risk of delayed gastric emptying. For emergency surgeries, the approach is a bit more nuanced, but typically centers around ensuring the drug has enough time to clear from the system. On the topic of managing the risk of aspiration pneumonia, which is a concern due to the slowing of gastric emptying by GLP-1 agonists, careful patient assessment and monitoring are key. If a patient presents with symptoms like nausea, we might opt for a more conservative approach, such as delaying surgery if feasible, or using additional medications to speed up gastric emptying if immediate surgery is necessary. Moving on to medication reconciliation, it's crucial to thoroughly review all medication, especially since GLP-1 agonists are now frequently prescribed for weight loss, not just diabetes. We make it a point to ask specifically about these medications during admission interviews and check medical records, as well. For the dosing and re-initiation, if we've held the GLP-1 agonist, re-starting depends on the individual's overall condition and their response to hospital treatments. Sometimes, we could go back to the normal dose, but other times, a recalibration might be necessary, and we closely monitor the patient during this phase. As for hypoglycemia management, especially with concurrent insulin use, frequent glucose monitoring, and adjusting doses are our go-tos to avert any severe dips in blood sugar levels. Lastly, the multidisciplinary approach is critical. Regular meetings and detailed handoffs between gastroenterologists, endocrinologists, and dietitians ensure all aspects of a patient's care are addressed. This collaboration helps in tailoring a comprehensive plan that considers all facets of the patient's condition and treatment, making transitions smoother and outcomes better. So, always remember, communication is the glue that keeps patient care together in these complex situations.

Good Day, Perioperative management: Usually, we withhold GLP-1 agonists for 24 - 48 hr before elective surgery, as recommended in recent anesthesia guidelines, due to the risk of aspiration owing to delayed gastric emptying. However, for an emergency situation, we will evaluate the risk on an individual basis with anesthesia and endocrinology since it is sometimes not an option to withdraw the medication beforehand. Aspiration risk: Aspiration risk during the intubation may be increased in these patients due to slowed gastric emptying from the GLP-1. We further prolong fasting if possible, practice rapid-induction intubation, and at times perform gastric ultrasounds for measuring gastric contents. We are watching for aspiration pneumonia closely. Medication reconciliation: They are used for weight loss also; hence, we ask for detailed medication histories and also check for pharmacy records to verify use and indication. It thus helps in blood sugar management and also serves as a warning for probable GI side effects during the patient's hospital stay. Dosing and re-initiation: If on hold, then GLP-1s will be restarted at a lower dose with gradual titration to avoid nausea or any intolerance. Timing and doses are adjusted according to the patient status and are usually coordinated with endocrinology. Hypoglycemia management: The risk of hypoglycemia is higher in combination with insulin or sulfonylureas with NPO patients due to the addition of the GLP-1s. Hypoglycemic events are avoided by ambulating but preemptively towards dose adjustments and frequent glucose checks to avoid unsafe levels. Multidisciplinary collaboration: Coordinating care initiatives between endocrinology, gastroenterology, anesthesia, and dietitians will significantly enhance patient safety and outcomes by ensuring that consistent nutrition, medication, and perioperative plans will be available to nursing through rounds and shared records.