Semaglutide, delayed gastric emptying, and intraoperative pulmonary aspiration: a case report
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Purpose We report a case in which the use of semaglutide for weight loss was associated with delayed gastric emptying and intraoperative pulmonary aspiration of gastric contents. Clinical features A 42-yr-old patient with Barrett's esophagus underwent repeat upper gastrointestinal endoscopy and ablation of dysplastic mucosa. Two months earlier, the patient had started weekly injections of semaglutide for weight loss. Despite having fasted for 18 hr, and differing from the findings of prior procedures, endoscopy revealed substantial gastric content, which was suctioned before endotracheal intubation. Food remains were removed from the trachea and bronchi using bronchoscopy. The patient was extubated four hours later and remained asymptomatic. Conclusion Patients using semaglutide and other glucagon-like peptide 1 agonists for weight management may require specific precautions during induction of anesthesia to prevent pulmonary aspiration of gastric contents.
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GLP-1 RAs and dual GIP/GLP-1 RAs may be associated with risk of peri-operative pulmonary aspiration.
“These drugs may be associated with risks of peri‐operative pulmonary aspiration or euglycaemic ketoacidosis.”
The Case presentation reports gastric material in the airway of a patient taking semaglutide, and the Discussion treats this as a perioperative safety concern while acknowledging that causation is not established. Semaglutide supports the claim for one GLP-1 receptor agonist, but this case report does not establish an aspiration risk for GLP-1 receptor agonists as a class or address dual GIP/GLP-1 receptor agonists. The indexed passages do not specify individual page numbers (article pp. 1394–1396). (LLM, conf=0.86)
Experimental — accuracy not yet measuredKlein et al. described a 42-year-old male receiving once-weekly semaglutide for weight loss who aspirated a substantial amount of solid and liquid gastric contents during anesthesia induction despite an 18-hour fasting period.
“For instance, Klein et al. [43] described a 42-year-old male patient receiving once-weekly semaglutide for weight loss who aspirated a substantial amount of solid and liquid gastric contents during anesthesia induction despite an 18-hour fasting period.”
From Delayed gastric emptying induced by glucagon-like peptide-1 receptor agonists and its implications for perioperative risk during anesthesia (2026) · cites this paper as [43]
The Case presentation (pp. 1394–1396) describes a 42-year-old man taking weekly semaglutide for weight loss who had fasted for over 18 hours and experienced pulmonary aspiration during the procedure. It reports large quantities of solid and liquid material in his stomach, but only a moderate quantity in his airway; the claim overstates the amount aspirated. (LLM, conf=0.88)
Experimental — accuracy not yet measuredGLP-1-based medications may be associated with nausea, vomiting, and delayed gastric emptying, and there have been case reports of pulmonary aspiration during general anesthesia and deep sedation.
“These medications may be associated with nausea, vomiting, and delayed gastric emptying, and there have been case reports of pulmonary aspiration during general anesthesia and deep sedation (154).”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [154]
The Discussion identifies nausea and vomiting as prevalent GLP-1 agonist side effects and describes delayed gastric emptying associated with semaglutide in this patient. The Case presentation reports pulmonary aspiration during a procedure initiated under deep sedation. This paper presents one case; it does not report a separate case of aspiration during general anesthesia. (LLM, conf=0.88)
Experimental — accuracy not yet measuredCase reports document aspiration events occurring during procedural anesthesia in patients administered GLP-1 RAs.
“The correlation between delayed gastric emptying and GLP-1 RAs raises concerns about the possible negative effects in the periprocedural setting, as evidenced by case reports of aspiration events occurring during procedural anesthesia in patients administered GLP-1 RAs [14,15].”
From Exploring the Side Effects of GLP-1 Receptor Agonist: To Ensure Its Optimal Positioning (2025) · cites this paper as [15]
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Self-citationGlucagon-like peptide-1 receptor agonists: What ophthalmologists need to know
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- Authors
- Klein, S. R., & Hobai, I. A.
- Affiliations
- Massachusetts General Hospital (US)
- Harvard University (US)
- Corresponding author
- Hobai, Ion A.
- ORCID
- Hobai, Ion A.
- Venue
- Canadian Journal of Anesthesia/Journal canadien d'anesthésie
- Published
- 2023-03-28
- Volume
- 70
- Issue
- 8
- Pages
- 1394-1396
- ISSN
- 0832-610X (ISSN-L)
- 1496-8975
- OpenAlex
- W4361212412
- Cited by
- 207
- References
- 12
- Citations by year
- 2026: 55 · 2025: 58 · 2024: 70 · 2023: 24
- FWCI
- 68.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Canadian Journal of Anesthesia/Journal canadien d anesthésie (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- semaglutide, delayed gastric emptying, GLP-1 receptor agonists, weight loss, Barrett's esophagus, upper gastrointestinal endoscopy, anesthesia induction, endotracheal intubation, bronchial aspiration, bronchoscopy
- MeSH terms
- Semaglutide, Diabetes Mellitus, Type 2, Glucagon-Like Peptides, Humans, Weight Loss, Endoscopy, Gastrointestinal, Gastroparesis
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