We read with interest the study by Nersessian et al., in which they showed that semaglutide use was associated with increased residual gastric content in patients having surgery [1]. They call for urgent revision of current societal guidelines recommending a 1-week pre-operative discontinuation interval of semaglutide in patients undergoing elective procedures under anaesthesia [1]. It is salutary to note that the exclusion criteria for the study were very extensive and included patients with diabetes; hiatus hernia; previous gastric surgery; chronic renal failure; and the pre-operative use of medication known to affect gastric emptying. The exclusion of so many patients and conditions has an impact on the suitability and applicability of the results of this study to influence routine practice.

There are many other drugs that can delay gastric emptying. These include opioids; anticholinergics; calcium channel blockers; and tricyclic antidepressants, and there is no call for revised societal guidelines on the peri-operative use of these drugs to reduce the risk of pulmonary aspiration. Furthermore, the evidence linking any potential increased residual gastric content associated with glucagon-like peptide-1 receptor agonist (GLP-1 RA) use to an increased risk of aspiration and regurgitation is lacking.

Peri-operative cessation of GLP-1 RAs has unintended consequences, particularly when used for the treatment of diabetes. This includes increasing the risk of further delays to surgery due to deranged pre-operative glucose and harm from peri-operative hyperglycaemia [2]. Having the patient reviewed by a diabetologist and replacing the GLP-1 RAs with alternative drugs in the peri-operative period is an option, but this may lead to further delays in surgery and harm from hypoglycaemia [2].

In response to the American Society of Anesthesiologists consensus-based guidance on the pre-operative management of patients on GLP-1 RAs, the Centre for Perioperative Care released UK guidance in September 2023 [3]. This stated that anaesthetists should undertake individualised clinical assessment and precautions, which include regional anaesthesia; tracheal intubation; modified rapid sequence intubation; ramped position; awake tracheal extubation; avoidance of first-generation supraglottic airway devices; and pre-operative gastric ultrasound [3]. A more recent clinical practice guideline also supports this stance, but with other caveats, including greater emphasis on shared decision-making and a pre-operative liquid diet for the 24 h before surgery for those at high risk [4]. It is noteworthy that the American Society of Anesthesiologists has also approved this new guideline [4].

Rather than curtailing the peri-operative use of GLP-1 RAs, we argue that the study by Nersessian et al. reinforces the stated position of the Centre for Perioperative Care, and other societies, that GLP-1 RAs should be continued in the peri-operative period, but suitable precautions are taken.

我们饶有兴趣地阅读了 Nersessian 等人的研究，其中他们表明 semaglutide 的使用与手术患者残余胃内容物的增加有关 [1]。他们呼吁紧急修订当前的社会指南，建议在麻醉下接受择期手术的患者术前停用 semaglutide 应为 1 周 [1]。值得一提的是，该研究的排除标准非常广泛，包括糖尿病患者;食管裂孔疝;既往胃部手术史;慢性肾功能衰竭;以及术前使用已知会影响胃排空的药物。排除如此多的患者和病症会影响本研究结果的适用性和适用性，从而影响常规实践。

还有许多其他药物可以延迟胃排空。这些包括阿片类药物;抗胆碱能药;钙通道阻滞剂;和三环类抗抑郁药，并且没有呼吁修订关于围手术期使用这些药物以降低肺误吸风险的社会指南。此外，缺乏证据表明与胰高血糖素样肽-1 受体激动剂 （GLP-1 RA） 的使用相关的残余胃内容物增加与误吸和反流风险增加有关。

GLP-1 RAs 的围手术期停止会产生意想不到的后果，尤其是在用于治疗糖尿病时。这包括因术前血糖紊乱和围手术期高血糖而增加进一步延误手术的风险 [2]。在围手术期，让糖尿病专科医生对患者进行复查并用替代药物替代GLP-1 RA是一种选择，但这可能会导致手术进一步延误和低血糖的危害[2]。

针对美国麻醉医师学会关于 GLP-1 RA 患者术前管理的共识指南，围手术期护理中心于 2023 年 9 月发布了英国指南[3]。该指南指出，麻醉师应进行个体化的临床评估和预防措施，包括区域麻醉;气管插管;改良的快速序列插管;斜坡位置;清醒气管拔管;避免使用第一代声门上气道装置;和术前胃超声 [3]。最近的临床实践指南也支持这一立场，但也有其他注意事项，包括更加强调共同决策和高危患者术前 24 h 的流质饮食 [4]。值得注意的是，美国麻醉医师学会也批准了这一新指南[4]。

我们认为，Nersessian 等人的研究加强了围手术期护理中心和其他学会的既定立场，即 GLP-1 RA 应在围手术期继续使用，但要采取适当的预防措施。