The impact of glucagon-like peptide-1 receptor agonists in the patients undergoing anesthesia or sedation: systematic review and meta-analysis
Why this work is in the frame
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Bibliographic record
Abstract
Abstract Background Glucagon-like peptide-1 agonist receptors (GLP-1RAs), medications used for glycemic control and weight loss, are increasing worldwide. In the perioperative period, the major concern related to GLP-1RA is gastric emptying delay and risk of aspiration. This meta-analysis and systematic review compared the risks and benefits of using GLP-1 agonist receptors and control in surgical and nonsurgical procedures under anesthesia or sedation. Methods We systematically searched MEDLINE, Embase, and Cochrane for randomized controlled trials and observational studies involving patients > 18 years undergoing elective surgeries or procedures. Outcomes of interest were pre-procedural gastrointestinal (GI) symptoms, residual gastric content assessed by endoscopy, pulmonary aspiration during anesthesia/sedation, perioperative glycemic control, postoperative inotropic support, nausea/vomiting (PONV), atrial fibrillation, and 30-day mortality rate. We used a random effects model, with odds ratio and mean difference computed for binary and continuous outcomes, respectively. Results Fourteen randomized and observational studies with 2143 adult patients undergoing elective surgeries and procedures were included. GLP-1RA resulted in increased pre-procedural GI symptoms ( OR 7.66; 95% CI 3.42, 17.17; p < 0.00001; I 2 = 0%) and elevated residual gastric content ( OR 6.08; 95% CI 2.86, 12.94; p < 0.00001; I 2 = 0%). GLP-1RA resulted in lower glycemic levels ( MD − 0.73; 95% CI − 1.13, − 0.33; p = 0.0003; I 2 = 90%) and lower rate of rescue insulin administration ( OR 0.39; 95% CI 0.23, 0.68 p = 0.0009; I 2 = 35%). There was no significant difference in rate of perioperative hypoglycemia ( OR 0.60; 95% CI 0.29, 1.24; p = 0.17; I 2 = 0%), hyperglycemia ( OR 0.89; 95% CI 0.59, 1.34; p = 0.58; I 2 = 38%), need for postoperative inotropic support ( OR 0.57; 95% CI 0.33, 1.01; p = 0.05; I 2 = 0%), atrial fibrillation ( OR 1.02; 95% CI 0.52, 2.01; p = 0.95; I 2 = 16%), rate of PONV ( OR 1.35; 95% CI 0.82, 2.21; p = 0.24; I 2 = 0%), and 30-day mortality rate ( OR 0.54; 95% CI 0.14, 2.05; p = 0.25; I 2 = 0%). Conclusion Compared to control , pre-procedural GLP-1RA increased the rate of GI symptoms and the risk of elevated residual gastric content despite adherence to fasting guidelines. GLP-1RA improved glycemic control and decreased the rate of rescue insulin administration. There was no significant difference in the rates of perioperative hypo or hyperglycemia, postoperative inotropic support, PONV, atrial fibrillation, and 30-day mortality.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it