Perioperative Management of Patients using GLP-1 Receptor Agonists Current Evidence, Risks, and Practical Recommendations-A Narrative Review.

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual glucose-dependent insulinotropic polypeptide GLP-1 RAs are increasingly prescribed for diabetes and obesity, leading to a growing number of surgical patients receiving these agents. Their ability to delay gastric emptying has raised concerns about residual gastric contents (RGCs) and potential aspiration during anaesthesia. Available evidence from mechanistic studies, clinical investigations, and case reports indicates that GLP-1-based therapies consistently impair solid-phase gastric emptying and may increase RGC, particularly during early treatment and dose escalation, with effects that can persist despite standard fasting and short-term drug interruption. Although clinically apparent aspiration events remain uncommon, multiple reports have described perioperative regurgitation or unexpected solid gastric contents at induction. Early guidance favoured routine preoperative drug interruption; however, more recent multisociety recommendations increasingly support continuation of therapy in most asymptomatic patients and endorse enhanced perioperative mitigation strategies, such as dietary modification, strict adherence to fasting, selective use of point-of-care gastric ultrasound, preference for regional anaesthesia when feasible, and tailored airway management. Overall, current data support an individualised, risk-adapted approach rather than uniform interruption of GLP-1 therapy. Continuation of structured mitigation appears reasonable for many patients, whereas heightened caution and full-stomach precautions remain appropriate in higher-risk situations. Further prospective studies are required to define true perioperative aspiration risk and to establish evidence-based management pathways.