What to Know if Your Child Takes a GLP-1 Agonist and Needs Surgery

GLP-1 agonist medications, such as Trulicity ^Ⓡ (dulaglutide), Victoza ^Ⓡ (liraglutide), Wegovy ^Ⓡ (semaglutide) and Saxenda ^Ⓡ (liraglutide), are increasingly used to treat type 2 diabetes and obesity in children and adolescents. Over the past 2 years, medical organizations, such as the American Society of Anesthesiologists, have recommended additional precautions for anyone on these medications who is scheduled for surgery. 

GLP-1 agonists for children and adolescents

While metformin and sometimes insulin are frequently the first medications used to treat type 2 diabetes in children and adolescents, GLP-1 agonists can be added as another medication to control blood sugar (glucose) levels. Most children can      tolerate the daily or weekly injections required to take these medications, and many benefit not only from the effects on blood glucose but also from the associated weight loss and metabolic effects. 

“Type 2 diabetes in pediatrics is very different from adult type 2 diabetes, as it tends to be more aggressive and associated with earlier cardiovascular complications and comorbidities, including high cholesterol, high blood pressure, kidney disease, nerve disease, etc. National and international pediatric type 2 diabetes guidelines recommend adding GLP-1 agonists if initial medications (metformin with or without insulin) aren’t enough to meet glycemic goals,” said Grace Kim, MD, diabetes specialist and endocrinologist at Texas Children’s Hospital. 

Use of GLP-1 agonists exclusively for obesity in children without type 2 diabetes is also increasing, but still not their most common use. 

How can GLP-1 agonists affect anesthesia and surgery?

One effect of taking a GLP-1 agonist is that it slows the movement of food through the stomach, called delayed gastric emptying. Slower digestion is helpful for people with diabetes because sugar is introduced to the blood more gradually, and it helps obesity by making a person feel full longer. But delayed gastric emptying can also result in some of the negative side effects of GLP-1 agonists, such as nausea and stomach upset. 

“Because the stomach doesn’t empty as quickly as we would otherwise expect, this increases the risk of aspiration. The biggest issue that we are concerned about in anesthesia related to GLP-1 agonists is aspiration, meaning that anything that’s in the stomach can come up and end up in the lungs, which can cause pneumonia and other complications,” said Megha Karkera Kanjia, MD, pediatric anesthesiologist at Texas Children’s. Aspiration pneumonia and similar complications may require additional treatment and pose other risks in the perioperative time period, so Texas Children’s has implemented new recommendations, starting with a visit to the Pre-Anesthesia Screening Service for children who are on a GLP-1 agonist and planning for surgery.

Take advantage of the Pre-Anesthesia Screening Service

The Texas Children’s Anesthesiology, Perioperative & Pain Medicine Department recommends that all children who are planning an elective surgery and taking a GLP-1 agonist visit the Pre-Anesthesia Screening Service (PASS) before surgery. 

“If a child has type 2 diabetes and their medications are stopped for too long, there is concern about poor blood glucose control,” said Dr. Kim.

At this appointment, a nurse practitioner or physician assistant will make recommendations based on your child’s medical history and current medications so that complications and surprises on the day of surgery are minimal, and blood glucoses remain at a safe level. 

“The PASS providers ensure that we understand a child’s medical history before surgery, and I think it speaks to the complexity of the patients that we care for here. Some families travel from out of town and see multiple specialists, so ensuring that we can gather all the correct information in advance is really critical for planning,” said Dr. Kanjia. “Additionally, families have an opportunity to have a lot of their questions answered, and so they have a bit of an overview of what to expect as well.”

Preparing for surgery is more than medication management. PASS providers work closely with child life specialists to minimize pre-surgical anxieties and accommodate children’s special needs or concerns. For complex medical management, behavioral concerns or coordination of care, Texas Children’s works hard to make a family’s surgical experience as efficient and successful as possible, and the PASS clinic is just one example of innovation to this end on behalf of our patients. 

Learn more about the specialty programs offered by Texas Children’s Department of Anesthesiology, Perioperative & Pain Medicine.