Regurgitation under anesthesia in a fasted patient prescribed semaglutide for weight loss: a case report
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Purpose Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as semaglutide are a class of medications prescribed to treat type 2 diabetes mellitus, and more recently, as an adjunct for weight loss because of its effects of delaying gastric emptying and suppressing appetite. Semaglutide is a long-acting agent with a half-life of approximately one week, and there are currently no guidelines that address the perioperative management of such agents. Clinical features We describe an unexpected case of regurgitation of a large volume of gastric contents upon induction of general anesthesia in a nondiabetic, nonobese patient despite a long preoperative fasting period (20 hr for solids and eight hours for clear fluids). This patient had no traditional risk factors for regurgitation or aspiration but was taking the GLP-1 RA semaglutide for weight loss and had last taken the medication two days before their scheduled procedure. Conclusions Patients taking long-acting GLP-1 RAs such as semaglutide may be at risk of pulmonary aspiration under anesthesia. We propose strategies to mitigate this risk including holding the medication four weeks prior to a scheduled procedure when feasible and considering full stomach precautions.
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Gulak and Murphy reported a 48-year-old female using semaglutide for weight loss who regurgitated and aspirated a large volume of liquid gastric contents during induction.
“Similarly, Gulak and Murphy [44] reported a 48-year-old female patient using semaglutide for weight loss who regurgitated and aspirated a large volume of liquid gastric contents during induction.”
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 [44]
The Clinical features section identifies a 48-year-old woman prescribed semaglutide for weight loss and reports regurgitation of more than 200 mL of clear gastric contents shortly after induction. It does not report that she aspirated the fluid; bronchoscopy found no liquid or particulate matter in the major bronchi. (LLM, conf=0.93)
Experimental — accuracy not yet measuredThere have been recent case reports of patients taking glucagon-like peptide-1 receptor agonists before surgery having pulmonary aspiration or increased residual gastric contents despite appropriate fasting.
“there have been recent case reports of patients who are taking these drugs before surgery having pulmonary aspiration or increased residual gastric contents despite appropriate fasting [5, 6, 7, 8, 9, 10, 11, 12, 13, 14].”
From Association between glucagon-like peptide-1 receptor agonist use and peri-operative pulmonary aspiration: a systematic review and meta-analysis (2025) · cites this paper as [7]
Case reports describe delayed gastric emptying in appropriately starved patients undergoing sedation or general anaesthesia for elective procedures or endoscopy.
“However, case reports describing clinically relevant evidence for delayed gastric emptying in appropriately starved patients either undergoing sedation or general anaesthesia for elective procedures [9, 11, 12, 64, 65, 66] or endoscopy [10, 67] (see online Supporting Information Table S1) have been published.”
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“Similarly, Gulak and Murphy [44] reported a 48-year-old female patient using semaglutide for weight loss who regurgitated and aspirated a large volume of liquid gastric contents during induction.”
Semaglutide in Patients Undergoing Anesthesia for Otolaryngologic Procedures
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GLP-1 agonists: a new hope for patients, a new challenge for anaesthetists
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- Authors
- Gulak, M. A., & Murphy, P.
- Affiliations
- University of Toronto (CA)
- University Health Network (CA)
- Corresponding author
- Gulak, Michael A.
- ORCID
- Gulak, Michael A.
- Venue
- Canadian Journal of Anesthesia/Journal canadien d'anesthésie
- Published
- 2023-06-06
- Volume
- 70
- Issue
- 8
- Pages
- 1397-1400
- ISSN
- 0832-610X (ISSN-L)
- 1496-8975
- OpenAlex
- W4379522676
- Cited by
- 153
- References
- 16
- Citations by year
- 2026: 32 · 2025: 54 · 2024: 56 · 2023: 11
- FWCI
- 40.99
- 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 › Surgery › Enhanced Recovery After Surgery
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Keywords
- semaglutide, GLP-1 receptor agonists, gastric regurgitation, pulmonary aspiration, general anesthesia, preoperative fasting, anti-obesity drugs, perioperative care
- MeSH terms
- Glucagon-Like Peptide-1 Receptor, Glucagon-Like Peptide-1 Receptor Agonists, Semaglutide, Anesthesia, General, Diabetes Mellitus, Type 2, Fasting, Humans, Hypoglycemic Agents, Weight Loss, Glucagon-Like Peptide 1
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