Pulmonary aspiration of gastric contents in two patients taking semaglutide for weight loss

Semaglutide is a new weight loss treatment that has received substantial media attention in recent years. Anaesthetists must be aware of a potentially dangerous side effect of the drug: decreased gastric emptying. This is caused by effects on gastric smooth muscle, mediated by the vagal afferent nerves. This is especially relevant in the peri-operative setting where pulmonary aspiration of gastric contents is a recognised complication. Here, we report two cases of peri-operative regurgitation of gastric contents in patients taking semaglutide. A patient taking semaglutide may have a full stomach despite compliance with routine pre-operative fasting guidelines. We consider how to manage patients receiving glucagon-like peptide-1 agonist therapy in the peri-operative period, including identifying those at high risk of regurgitation. Precautions such as rapid sequence induction and tracheal intubation can be used, but gastric ultrasound may also be useful in the pre-operative environment to help identify patients at high risk of aspiration.