Perioperative medicine: what you need to know about new hypoglycemic medicines?

Rationale. In recent years, glucagon-like peptide-1 (GLP-1) receptor agonists, glucose-dependent insulinotropic polypeptide (GIP) receptor agonists, and sodium-glucose cotransporter 2 inhibitors (SGLT2Is) have been increasingly used to treat diabetes mellitus, heart failure, and obesity. Their use is associated with the development of gastrostasis, which significantly increases the risk of perioperative aspiration and explains the increased attention anesthesiologists pay to this problem. Euglycemic or diabetic ketoacidosis may also develop. Methods. We searched PubMed, Web of Science, and eLibrary for the period 2016-2026 using the keywords "GLP-1 receptor agonists," "GLP-1 and GIP receptor agonists," "SGLT2Is," "anesthesia," "aspiration," and "regurgitation." Results. The programmed slowing of gastric motility caused by medications must be taken into account during anesthesia. A large body of clinical data has demonstrated that the medicines in question significantly increase the risk of aspiration and regurgitation. However, the timing of medicine withdrawal before anesthesia, the regimens for resuming treatment, and the conditions for emergency anesthesia remain unclear. Current international guidelines recommend varying timing of medicine withdrawal before anesthesia, recommend paying attention to characteristic dyspeptic symptoms, justify the need for gastric ultrasound if a large residual volume is suspected, and recommend a "full stomach" protocol during emergency interventions. Currently, there are no current guidelines for the perioperative care of such patients in the Russian Federation. Conclusion. The steady increase in the number of patients receiving new hypoglycemic agents requires an individualized approach to anesthesia, as well as the development of Russian clinical guidelines for the perioperative care of this patient population. Our proposed algorithm could form the basis for such guidelines, improving the safety of general anesthesia.