GLP-1 Agonists, Aspiration Risk, and Anaesthetic Consent in Ireland

Abstract

The rapid rise of glucagon-like peptide-1 (GLP-1) receptor agonists such as semaglutide is transforming the management of diabetes and obesity. In Ireland, prescribing now extends beyond endocrinology clinics to general practice and private weight-loss services. Others obtain them through unauthorised supply routes, including informal resale or purchase from unregulated online suppliers. As a result, anaesthesiologists are now regularly encountering patients who use these agents.

This presents a specific clinical challenge: by inhibiting gastric motility, these drugs can result in residual gastric content despite adherence to standard fasting guidelines, thereby elevating the risk of pulmonary aspiration. While pulmonary aspiration is a rare event — with the 4th National Audit Project citing an incidence of death or brain damage of approximately 1 in 350,000 cases — the nature of the aspirate is critical. Aspiration of particulate food matter carries a higher mortality than fluid aspiration. Given that GLP-1 agonists specifically cause the retention of solid gastric contents, the specific risk profile for these patients arguably exceeds that of the general population.