Implications of GLP-1 Agonists on Office-Based Sedation and General Anesthesia for Dentistry

Incretin hormones, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), are produced in the gut and play critical roles linking the processes of eating and digestion with the release of insulin from the pancreas and glucose homeostasis. GLP-1 receptor agonist and combination GLP-1/GIP receptor agonist medications are exogenous incretins that mimic their endogenous counterparts, but their significantly longer half-lives allow them to be clinically useful for managing diabetes mellitus type 2 (DMT2) and obesity. Recently, their use for weight loss has grown exponentially, increasing the potential that a provider of sedation or general anesthesia for dentistry will encounter a patient taking a GLP-1 or GLP-1/GIP combination receptor agonist. One of the clinical effects produced by these medications is decreased gastric emptying which increases satiety and decreases oral intake. While these medications are effective in the management of DMT2 and obesity, delayed gastric emptying can cause concerns for sedation and general anesthesia providers. Retained gastric contents can increase risks for emesis and subsequent pulmonary aspiration in the perioperative period. In 2024, a multisociety guidance document was published to provide recommendations for the management of these patients in the perioperative period. Recommendations emphasized risk stratification of individual patients and weighing the risks vs the benefits of holding or continuing GLP-1 and GLP-1/GIP combination receptor agonist medications. The recommendations also suggested shared decision making between the sedation or general anesthesia provider, the prescribing physician, and the patient should be used when developing a plan regarding the preoperative use of these medications.