The DOI matches its Crossref record; 16 of the 16 references it cites were found in a registry or an index.
Regurgitation under anesthesia in a fasted patient prescribed semaglutide for weight loss: a case report
Open accessAbstract
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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“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]
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“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]
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“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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Cites
Once-Weekly Semaglutide in Adults with Overweight or Obesity
Wilding, J. P. H., Batterham, R. L., Calanna, S., Davies, M., Van Gaal, L. F., Lingvay, I., McGowan, B. M., Rosenstock, J., Tran, M. T. D., Wadden, T. A., et al. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2032183 · Cited by 5,205
Tirzepatide Once Weekly for the Treatment of Obesity
Jastreboff, A. M., Aronne, L. J., Ahmad, N. N., Wharton, S., Connery, L., Alves, B., Kiyosue, A., Zhang, S., Liu, B., Bunck, M. C., et al. (2022) · New England Journal of Medicine · doi:10.1056/nejmoa2206038 · Cited by 3,838
GLP-1 receptor agonists in the treatment of type 2 diabetes - state-of-the-art
Nauck, M. A., Quast, D. R., Wefers, J., & Meier, J. J. (2021) · Molecular Metabolism · doi:10.1016/j.molmet.2020.101102 · Cited by 1,647 · cited 1×
“Thus, GLP-1 RAs reduce postprandial hyperglycemia and promote weight loss through increased satiety.(9)”
Background(2017) · Anesthesiology · doi:10.1097/aln.0000000000001452 · Cited by 1,114
Physiology of Proglucagon Peptides: Role of Glucagon and GLP-1 in Health and Disease
Sandoval, D. A., & D'Alessio, D. A. (2015) · Physiological Reviews · doi:10.1152/physrev.00013.2014 · Cited by 498
GLP-1 Receptor Activation Modulates Appetite- and Reward-Related Brain Areas in Humans
van Bloemendaal, L., IJzerman, R. G., ten Kulve, J. S., Barkhof, F., Konrad, R. J., Drent, M. L., Veltman, D. J., & Diamant, M. (2014) · Diabetes · doi:10.2337/db14-0849 · Cited by 427
Meloni, A. R., DeYoung, M. B., Lowe, C., & Parkes, D. G. (2013) · Diabetes, Obesity and Metabolism · doi:10.1111/j.1463-1326.2012.01663.x · Cited by 407
Nauck, M. A., Kemmeries, G., Holst, J. J., & Meier, J. J. (2011) · Diabetes · doi:10.2337/db10-0474 · Cited by 392
Silveira, S. Q., da Silva, L. M., de Campos Vieira Abib, A., de Moura, D. T. H., de Moura, E. G. H., Santos, L. B., Ho, A. M.-H., Nersessian, R. S. F., Lima, F. L. M., Silva, M. V., et al. (2023) · Journal of Clinical Anesthesia · doi:10.1016/j.jclinane.2023.111091 · Cited by 259
Sikirica, M., Martin, A., Wood, R., Leith, A., Piercy, J., & Higgins, V. (2017) · Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy · doi:10.2147/dmso.s141235 · Cited by 223
Cited by
Sorted by citations
Glucagon-Like Peptide-1 Receptor Agonist Use and Residual Gastric Content Before Anesthesia
Sen, S., Potnuru, P. P., Hernandez, N., Goehl, C., Praestholm, C., Sridhar, S., & Nwokolo, O. O. (2024) · JAMA Surgery · doi:10.1001/jamasurg.2024.0111 · Cited by 202
Kindel, T. L., Wang, A. Y., Wadhwa, A. N., Schulman, A. R., Sharaiha, R. Z., Kroh, M., Ghanem, O. M., Levy, S. M., Joshi, G. P., & LaMasters, T. L. (2024) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2024.08.033 · Cited by 152
El‐Boghdadly, K., Dhesi, J., Fabb, P., Levy, N., Lobo, D. N., McKechnie, A., Mustafa, O., Newland‐Jones, P., Patel, A., Pournaras, D. J., et al. (2025) · Anaesthesia · doi:10.1111/anae.16541 · Cited by 147
Gastrointestinal effects of GLP-1 receptor agonists: mechanisms, management, and future directions
Jalleh, R. J., Rayner, C. K., Hausken, T., Jones, K. L., Camilleri, M., & Horowitz, M. (2024) · The Lancet Gastroenterology & Hepatology · doi:10.1016/s2468-1253(24)00188-2 · Cited by 144
Ghusn, W., & Hurtado, M. D. (2024) · Obesity Pillars · doi:10.1016/j.obpill.2024.100127 · Cited by 122
Metadata
- 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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