Perioperative Management of a Breastfed Child Whose Mother Was Receiving Injectable Semaglutide: A Case Report Outlining Use of Gastric Point-of-Care Ultrasound

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), including semaglutide, are increasingly used for the treatment of type 2 diabetes mellitus and for weight management. Although generally effective, specific end-organ effects, including delayed gastric emptying, may impact the perioperative care of patients receiving these agents. Given these concerns, guidelines have been suggested for the perioperative care of patients receiving GLP-1 RAs. However, these recommendations do not specifically address the increasingly encountered scenario in which a breastfeeding mother is taking a GLP-1 RA and the breastfed infant or young child is presenting for anesthetic care. We present a 15-month-old breastfed child who presented for surgery and whose mother was receiving once-weekly injectable semaglutide. Given limited evidence-based medicine to guide perioperative care in this clinical scenario, preoperative gastric point-of-care ultrasound (POCUS) was used to evaluate gastric volume before induction of anesthesia. Perioperative care of breastfed children of mothers receiving GLP-1 RAs is discussed, the role of gastric POCUS is presented, and options for perioperative care are reviewed.