Avaliação ultrassonográfica gástrica point-of-care orientando anestesia segura em paciente em uso prolongado de semaglutida oral
relato de caso
DOI:
https://doi.org/10.63162/v66n68e25625Palavras-chave:
Agonistas GLP1, Ultrassonografia, Esvaziamento gástrico, Aspiração respiratória, AnestesiaResumo
Agonistas do receptor do peptídeo-1 semelhante ao glucagon (GLP-1 RA), como a semaglutida, retardam o esvaziamento gástrico, podendo aumentar o risco de broncoaspiração durante anestesia geral. Relatamos a aplicação da ultrassonografia gástrica point-of-care (USG-G) para estratificar esse risco em paciente usuária crônica de semaglutida oral. Relato do caso: Mulher de 40 anos, ASA II, diabetes mellitus persistente pós-gestação, em uso de semaglutida 7 mg/dia há 12 meses (orientada suspenção por 15 dias antes do procedimento cirúrgico). Jejum de 12 h confirmado. A USG-G demonstrou área antral de 5,81 cm² em decúbito dorsal e 4,94 cm² em decúbito lateral direito; volume estimado de 49 mL (0,72 mL/kg), abaixo do limiar de 1,5 mL/kg. Anestesia geral com sequência rápida modificada ocorreu sem intercorrências. A USG-G permitiu conduta anestésica segura, evitando cancelamento cirúrgico. O método fortalece a tomada de decisão individualizada em pacientes que utilizam GLP-1 RA.
Referências
Hayashi R, Maeda S, Hideki T, Higuchi H, Miyawaki T. Pulmonary Aspiration During Induction of General Anesthesia. Anesth Prog. 2020 Dec 1;67(4):214-218.
Freitas JC, Silvano J, Ribeiro C, Malheiro J, Pedroso S, Almeida M, Fonseca I, Martins LS. Glucagon like peptide 1 receptor agonists in kidney transplant recipients: a retrospective single center study. Braz J Transpl. 2024;27:e1224.
Souza Neto W, Oliveira Carballal IS. Tratamento de obesidade com uso de semaglutida: uma revisão de literatura. Revista ft. 2025;29(143).
Rocha CATD, Kamada LMK, Andrade Filho PH, Villaverde IA, Shiro JYB, Silva Junior JMD. Ultrasonographic evaluation of gastric content and volume: a systematic review. Rev Assoc Med Bras (1992). 2020 Dec;66(12):1725-1730.
Andrade DC, Horta HL, Alves LF, Tavares Júnior WC, Ferreira CS. Síndrome de Mendelson: relato de caso. Radiol Bras. 2005;38(4):309 11.
Lima CRR, Santos EA. Ventilação mecânica como estratégia protetora nos pacientes com SDRA: uma revisão integrativa. Res Soc Dev. 2024;13(1):e13013144839.
Imeryüz N, Yeğen BC, Bozkurt A, Coşkun T, Villanueva Peñacarrillo ML, Ulusoy NB. Glucagon like peptide 1 inhibits gastric emptying via vagal afferent mediated central mechanisms. Am J Physiol. 1997;273(4 Pt 1):G920 7.
Sodhi M, Rezaeianzadeh R, Kezouh A, Etminan M. Risk of Gastrointestinal Adverse Events Associated With Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss. JAMA. 2023 Nov 14;330(18):1795-1797.
Overgaard RV, Navarria A, Ingwersen SH, Bækdal TA, Kildemoes RJ. Clinical pharmacokinetics of oral semaglutide: analyses of data from clinical pharmacology trials. Clin Pharmacokinet. 2021;60(10):1335 48.
Jensen L, Kupcova V, Arold G, Pettersson J, Hjerpsted JB. Pharmacokinetics and tolerability of semaglutide in people with hepatic impairment. Diabetes Obes Metab. 2018;20(4):998 1005.
Michael A. Nauck, Guido Kemmeries, Jens J. Holst, Juris J. Meier; Rapid Tachyphylaxis of the Glucagon-Like Peptide 1–Induced Deceleration of Gastric Emptying in Humans. Diabetes 1 May 2011; 60 (5): 1561–1565.
Pan X, Chai J, Gao X, Li S, Liu J, Li L, Li Y, Li Z. Diagnostic performance of ultrasound in the assessment of gastric contents: a meta-analysis and systematic review. Insights Imaging. 2024 Mar 27;15(1):98.
Van de Putte P, Perlas A. Ultrasound assessment of gastric content and volume. Br J Anaesth. 2014 Jul;113(1):12-22.
Bouvet L, Cordoval J, Barnoud S, Berlier J, Desgranges FP, Chassard D. Diagnostic performance of qualitative ultrasound assessment for the interpretation of point-of-care gastric ultrasound to detect high gastric fluid volume: A prospective randomized crossover study. J Clin Anesth. 2022 Oct;81:110919.
Ushakumari DS, Sladen RN. ASA Consensus-based Guidance on Preoperative Management of Patients on Glucagon-like Peptide-1 Receptor Agonists. Anesthesiology. 2024 Feb 1;140(2):346-348.
Kindel TL, Wang AY, Wadhwa A, Schulman AR, Sharaiha RZ, Kroh M, Ghanem OM, Levy S, Joshi GP, LaMasters TL; American Gastroenterological Association; American Society for Metabolic and Bariatric Surgery; American Society of Anesthesiologists; International Society of Perioperative Care of Patients with Obesity; Society of American Gastrointestinal and Endoscopic Surgeons. Multisociety Clinical Practice Guidance for the Safe Use of Glucagon-like Peptide-1 Receptor Agonists in the Perioperative Period. Clin Gastroenterol Hepatol. 2024 Oct 29:S1542-3565(24)00910-8.
Czarnetzki C, Elia N, Frossard JL, Giostra E, Spahr L, Waeber JL, Pavlovic G, Lysakowski C, Tramèr MR. Erythromycin for Gastric Emptying in Patients Undergoing General Anesthesia for Emergency Surgery: A Randomized Clinical Trial. JAMA Surg. 2015 Aug;150(8):730-7.
Soto R, Jahr JS, Pavlin J, Sabo D, Philip BK, Egan TD, Rowe E, de Bie J, Woo T. Safety and Efficacy of Rocuronium With Sugammadex Reversal Versus Succinylcholine in Outpatient Surgery-A Multicenter, Randomized, Safety Assessor-Blinded Trial. Am J Ther. 2016 Nov/ Dec;23(6):e1654-e1662.
Park SK, Ko G, Choi GJ, Ahn EJ, Kang H. Comparison between supraglottic airway devices and endotracheal tubes in patients undergoing laparoscopic surgery: A systematic review and meta-analysis. Medicine (Baltimore). 2016 Aug;95(33):e4598.
Morales J, Shubrook JH, Skolnik N. Practical guidance for use of oral semaglutide in primary care: a narrative review. Postgrad Med. 2020 Nov;132(8):687-696.
Wang Y, Chen JDZ, Nojkov B. Diagnostic Methods for Evaluation of Gastric Motility-A Mini Review. Diagnostics (Basel). 2023 Feb 20;13(4):803.
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2025 Revista Goiana de Medicina
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
