Aspiration risk under anaesthesia: difference between revisions
Diff·revision 3 → 4·16:51, 16 Nov 2024
Difference between revision 3 and revision 4 of Aspiration risk under anaesthesia. 3 lines changed; the page grew by 387 bytes.
| Revision 3 — 08:58, 28 Oct 2024 MTC_Marisol (talk) state whether the figure is from a trial or from post-marketing reporting 2,259 bytes ±0 | Revision 4 — 16:51, 16 Nov 2024 AnalyticalAnnie (talk) clarify that dose-dependence is reported for some effects and not others 2,646 bytes +387 | ||
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| 10 | The evidence is largely case reports and imaging series showing residual gastric contents on ultrasound after standard fasting in people taking these agents, rather than trials demonstrating an increased aspiration rate. Aspiration is rare enough that a randomised demonstration is impractical.{{r|joshi2023}} | 10 | The evidence is largely case reports and imaging series showing residual gastric contents on ultrasound after standard fasting in people taking these agents, rather than trials demonstrating an increased aspiration rate. Aspiration is rare enough that a randomised demonstration is impractical.{{r|joshi2023}} |
| 11 | 11 | ||
| + | 12 | Professional guidance has been issued and revised more than once, moving from broad recommendations to withhold treatment before procedures towards a more individualised assessment. This article describes the position; it is not medical advice.{{r|ada2024}} | |
| + | 13 | ||
| 12 | == The mechanism and its magnitude == | 14 | == The mechanism and its magnitude == |
| 13 | The gastric-emptying delay is largest during escalation and with short-acting agents, and attenuates with continued exposure to a long-acting agonist.{{r|marathe2013}} A person established on a weekly agent for months has a smaller delay than one in the first weeks of treatment.{{r|drucker2018}} | 15 | The gastric-emptying delay is largest during escalation and with short-acting agents, and attenuates with continued exposure to a long-acting agonist.{{r|marathe2013}} A person established on a weekly agent for months has a smaller delay than one in the first weeks of treatment.{{r|drucker2018}} |
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| 19 | <ref name="joshi2023">Joshi GP, Abdelmalak BB, Weigel WA, et al. "American Society of Anesthesiologists consensus-based guidance on preoperative management of patients on glucagon-like peptide-1 receptor agonists." (2023).</ref> | 21 | <ref name="joshi2023">Joshi GP, Abdelmalak BB, Weigel WA, et al. "American Society of Anesthesiologists consensus-based guidance on preoperative management of patients on glucagon-like peptide-1 receptor agonists." (2023).</ref> |
| 20 | <ref name="drucker2018">Drucker DJ. "Mechanisms of action and therapeutic application of glucagon-like peptide-1." ''Cell Metabolism'' 27(4):740–756 (2018). PMID 29617641.</ref> | 22 | <ref name="drucker2018">Drucker DJ. "Mechanisms of action and therapeutic application of glucagon-like peptide-1." ''Cell Metabolism'' 27(4):740–756 (2018). PMID 29617641.</ref> |
| + | 23 | <ref name="ada2024">American Diabetes Association. "Standards of Care in Diabetes." ''Diabetes Care'' 47(Suppl 1) (2024).</ref> | |
| 21 | <ref name="marathe2013">Marathe CS, Rayner CK, Jones KL, Horowitz M. "Relationships between gastric emptying, postprandial glycemia, and incretin hormones." ''Diabetes Care'' 36(5):1396–1405 (2013). PMID 23613599.</ref> | 24 | <ref name="marathe2013">Marathe CS, Rayner CK, Jones KL, Horowitz M. "Relationships between gastric emptying, postprandial glycemia, and incretin hormones." ''Diabetes Care'' 36(5):1396–1405 (2013). PMID 23613599.</ref> |
| 22 | 25 |