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[Account1]

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[BLADEMDA]

These drugs will be fairly common within the next year. Are the side-effects dose related? likely. Delayed gastric emptying is a concern because many of us use LMAs/Igels/etc a lot even on obese patients. Will we see more minor aspirations on obese patients? What about obesity and DM with some existing gastroparesis combined with the GLP1?

In clinical trials of Wegovy as an adjunct to lifestyle modification, participants lost 15 percent of their body weight on average – with more than half the people treated with Wegovy losing more than 15 percent of their starting weight. That’s approximately 45 lbs. for a 300-pound patient – up to five times the average weight loss seen with traditional diet and exercise plans.

 

[BLADEMDA]

How GLP-1 receptor agonist drugs work for weight loss​

GLP-1 receptor agonists mimic a protein of the same name that is made naturally in the intestines when we eat. When used for weight management, these medications pump the brakes on our appetites and the rate at which food exits the stomach. As a result, we eat less because we are thinking less about food, and we are satisfied with smaller portions – even if we weren’t overeating.

GLP-1 receptor agonist medications make the stomach empty slower and signal the brain that you are full, reducing cravings. They can also help improve fatty liver.
GLP-1 receptor agonist medications were originally developed to treat type 2 diabetes and were found to cause weight loss while also decreasing the risk of cardiovascular event like heart attacks and strokes in people with diabetes. These medications are not insulin, and you don’t have to monitor your blood sugars unless directed by your healthcare team.
For people with chronic obesity and cardiovascular complications, GLP-1 receptor agonists are preferred to amphetamine-based therapies like phentermine, which can worsen blood pressure, heart rate, anxiety, and insomnia.
While any doctor can prescribe GLP-1 receptor agonists, primary care providers are often not familiar with prescribing these drugs. Starting at too high of a dose or increasing the dose too quickly can lead to symptoms such as indigestion, nausea, vomiting, diarrhea, or constipation. You will have better outcomes by working with a team of obesity management experts who can help you use these medications to create new, healthy, and sustainable habits.

Anti-obesity drugs are closing the gap between dieting and bariatric surgery | Diet and Nutrition | Prevention | UT Southwestern Medical Center

“Eat less, move more” is not a long-term weight management solution. But anti-obesity medications like GLP-1 agonists can change a patient’s relationship with food so they can focus on creating healthy, sustainable habits.

utswmed.org

 

[BLADEMDA]

 

[BLADEMDA]

Jim Cramer, of Mad Money, thinks this drug (shown below) by Eli-Lilly will be the best selling drug of all time:

 

[coffeebythelake]

preop gastric ultrasound for everyone of these pts?

 

[gunnershow]

preop gastric ultrasound for everyone of these pts?

I tried to do this but it's time consuming bringing the probe to preop and making these fat as fk patients turn lateral.

 

[deleted87051]

preop gastric ultrasound for everyone of these pts?

Or just tube all of them.

 

[coffeebythelake]

Or just tube all of them.

Well if it is a case that would otherwise be done MAC, would you just tube them? There are lots of office based procedures out there not set up for GA and pacu recovery

 

[deleted87051]

Well if it is a case that would otherwise be done MAC, would you just tube them? There are lots of office based procedures out there not set up for GA and pacu recovery

Light sedation and handholding or GA/ETT. No deep sedation no man’s land and I wouldn’t use LMA.

 

[jwk]

Light sedation and handholding or GA/ETT. No deep sedation no man’s land and I wouldn’t use LMA.

I think that's what's going to be really interesting to watch. Virtually all our GI endoscopy cases are deep sedation. The logistics of converting a significant number of those to GA will be a big problem.

 

[deleted87051]

FYI LMAs don't really increase aspiration risk. Idk if it holds up in court but it's pretty much a disproven myth at this point

About 15 yrs ago at our hospital, we had a young trauma patient fasted over 24 hrs aspirate with a LMA during an ORIF ankle. He subsequently died so I’d rather not take chances in high risk patients.

 

[coffeebythelake]

Light sedation and handholding or GA/ETT. No deep sedation no man’s land and I wouldn’t use LMA.

All I have to say is good luck. This is a big paradigm shift that your surgeon or proceduralist will have to buy into

 

[deleted87051]

I do appreciate the salient anecdote in driving practice (it does for me in many cases). The current evidence on the topic is well described in these podcasts if you or others might be interested 😊

Do LMAs increase the risk of aspiration compared to ETTs? – Part I of II – Depth of Anesthesia

depthofanesthesia.com

Do LMAs increase the risk of aspiration compared to ETTs? – Part II of II – Depth of Anesthesia

depthofanesthesia.com

Thanks. I know it’s not scientific to let complications drive our practice but I’m only human.

I am a bit of an LMA enthusiast. I do prone and sitting LMAs in low risk patients. But with the development of VL and sugammadex, I have moved back a bit toward ETTs.

 

[Mehd School]

FYI LMAs don't really increase aspiration risk. Idk if it holds up in court but it's pretty much a disproven myth at this point

Is there any recent data to support his? I wasn't able to find much. My experience contradicts this enormously.

 

[coffeebythelake]

The newer generation SGA create better separation of the airway and alimentary canal and presumably have lower risk for aspiration vs older models. If the article is from 2009 that is probably 2 generations of SGA ago. And even that study was quite positive..

 

[HalO'Thane]

Depends on what recent is, but here’s one from 2009

Bernardini A, Natalini G. Risk of pulmonary aspiration with laryngeal mask airway and tracheal tube: analysis on 65 712 procedures with positive pressure ventilation. Anaesthesia. 2009 Dec;64(12):1289-94. doi: 10.1111/j.1365-2044.2009.06140.x. Epub 2009 Oct 23. PMID: 19860753.

Risk of pulmonary aspiration with laryngeal mask airway and tracheal tube: analysis on 65 712 procedures with positive pressure ventilation - PubMed

We compared the risk of pulmonary aspiration in patients whose lungs were mechanically ventilated through a laryngeal mask airway (35 630 procedures) or tracheal tube (30 082 procedures). Three cases of pulmonary aspiration occurred with the laryngeal mask airway and seven with the tracheal...

pubmed.ncbi.nlm.nih.gov

I would keep in mind that this study, along with some of the other LMA studies, are retrospective in which the anesthesiologist had already selected an ETT when they felt that an LMA would be unsafe: non-fasted, bowel obstruction, etc. I don't know if you can extrapolate this data to say that an LMA would protect the airway if there was actual actual gastric contents, such as may occur with these GLP agonists.

 

[Mehd School]

I would keep in mind that this study, along with some of the other LMA studies, are retrospective in which the anesthesiologist had already selected an ETT when they felt that an LMA would be unsafe: non-fasted, bowel obstruction, etc. I don't know if you can extrapolate this data to say that an LMA would protect the airway if there was actual actual gastric contents, such as may occur with these GLP agonists.

This is an excellent point. I don't put a lot of LMA's in the "in-between" kind of patient. They're either safe for an LMA or not. A large portion of my patient population (probably like most of yours) fall into the "not" category, even on low risk ambulatory stuff.