The February 2024 issue of Oral Health printed an article titled “Anesthetic Considerations for Patients Taking Glucagon-Like Peptide-1 Agonists” co-authored by Dr. Lucia Santos, Dr. Bruce Pynn, and me. At that time, the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs), like Ozempic® and Wegovy™ for weight loss, as opposed to its original indication of the management of type 2 diabetes mellitus (T2DM), was gaining tremendous popularity. The central issue discussed in that article was how the delayed gastric emptying affected the management of sedation and anesthesia in dentistry. The short answer was that we would need to wait longer than the conventional eight-hour fasting period and/or alter the GLP-1RA dose schedule.
The popularity of GLP-1RAs has not abated and more data has been gathered. Over the past year, something else continued to gain popularity and more data has been gathered – namely, generative artificial intelligence (GenAI). ChatGPT and Microsoft Co-Pilot are two popular products in a field that affects many facets of our lives from art (e.g., DALL-E) to music (e.g., Jukebox) to scientific research (e.g., Research Rabbit) to the development of self-driving vehicles. GenAI is so significant in today’s world that Geoffrey Hinton, the “godfather of AI” and a Professor Emeritus in computer science at the University of Toronto, won the 2024 Nobel Prize for Physics for his foundational discoveries in artificial intelligence.
In December 2024, the American Society for Metabolic and Bariatric Surgery (ASMBS) published a guidance article formulated by a multidisciplinary group on the perioperative management of patients using GLP-1RAs.1 While the author has more than passing interest in patient safety in anesthesia, he is new to the personal and professional uses of GenAI. After the author read the guidance article, both ChatGPT and Co-Pilot were asked to create a synopsis of the ASMBS guidance in the context of anesthesia. This update article is a review of the statement as well as a comparison of what GenAI saw compared to the author. The goal is to provide something of a “consensus” to enhance the safety for patients receiving sedation/anesthesia for their dentistry. Credit for the source of each consensus item has been noted.
GLP-1RAs are indicated for use in the treatment of T2DM, obesity, and heart failure.2,3 The main concern for patients using GLP-1RAs who are also receiving sedation/anesthesia for their dentistry is the delay in gastric emptying, which increases the risk of pulmonary aspiration intraoperatively.2,3,4
The ASMBS statement had two broad recommendations.2 Recommendation 1 was for shared decision-making involving the patient and the teams providing care (e.g., physicians, dentists, and anesthesiologists [if separate]).2,3 Specific variables that increased aspiration risk included: patients in the escalation phase of dosing versus maintenance dosing;2,4 higher GLP-1RA dosing;2,3,4 weekly dosing;2,3,4 the presence of gastrointestinal symptoms suggestive of delayed gastric emptying;2,3,4 and co-morbidities that can delay gastric emptying (e.g., Parkinson’s disease).2,3,4 If no elevated risks were present, then the use of the GLP-1RA can continue without alteration.2,4 If it is decided to hold the GLP-1RA, the current (speculative) suggestion comes from the American Society of Anesthesiologists; that is to hold the drug on the day of surgery for the daily formulations, and for a week prior to surgery for the weekly formulations.1,2,4
Recommendation 2 concentrated on reducing aspiration risk by altering the preoperative diet and/or altering the anesthetic plan. Preoperative diet changes suggested a liquid diet for 24 hours, similar to patient preparation for colonoscopies.2,3,4 The other suggestions for point-of-care ultrasound and rapid-sequence intubation were not as applicable for most dental settings.2
As of the time of writing this report, the best practices for the management of patients using GLP-1RAs and receiving sedation/anesthesia for dentistry include:
- Careful consultation with your patient and with the multiple disciplines involved in your patient’s care.
- Consideration of holding a dose or at least booking the appointment at the end of the weekly cycle if your patient is taking weekly formulations.
- Changing the preoperative fasting requirement to a liquid diet for 24 hours.
As more evidence is gathered, these recommendations will be updated.
The increased use of GLP-1RAs has potentially significant implications for anesthesia for dentistry. The increased use of GenAI has significant implications for…well, everything in modern society. To this point we are still gathering evidence on both. Both are important, though not on the same scale, and both will require our ongoing attention. As an end note, the author found GenAI helpful in reviewing this article, but he is not prepared to have it make diagnoses from radiographs or create treatment plans yet. That day may still be coming. On a cautionary note, it is worthy of mentioning that your specific tasks that used GenAI may enter the public domain, whether you intend them to or not, so be aware and beware; caveat emptor or more correctly, cave usor. 
Oral Health welcomes this original article.
References
- Kindel TL, Wang AY, Wadhwa A, Schulman AR, Sharaiha RZ, Kroh M, Ghanem OM, Levy S, Joshi GP, and LaMasters TL. Multisociety clinical practice guidance for the safe use of glucagon-like peptide-1 receptor agonists in the perioperative period. Surgery for Obesity and Related Diseases, 20(12): 1183-1186, 2024. doi: 10.1016/j.soard.2024.08.033.
- Nkansah P.
- ChatGPT. Accessed January 12, 2025.
- Microsoft Co-Pilot. Accessed January 12, 2025.
About the author
Dr. Peter Nkansah is a Dental-Anesthesiologist with a private practice in Toronto. He is an editorial board member for Oral Health, an Assistant Professor at the University of Toronto’s Faculty of Dentistry and past president of the Canadian Academy of Dental Anesthesia.