Perioperative management of long-acting glucagon-like peptide-1 (GLP-1) receptor agonists: concerns for delayed gastric emptying and pulmonary aspiration
Open accessAbstract
Prescriptions and use of glucagon-like peptide-1 (GLP-1) receptor agonists are increasing dramatically, as indications are expanding from the treatment of diabetes mellitus to weight loss for people with obesity. As GLP-1 receptor agonists delay gastric emptying, perioperative healthcare practitioners could be concerned about an increased risk for pulmonary aspiration during general anaesthesia. We summarise relevant medical literature and provide evidence-based recommendations for perioperative care for people taking GLP-1 receptor agonists. GLP-1 receptor agonists delay gastric emptying; however, ongoing treatment attenuates this effect. The risk of aspiration during general anaesthesia is unknown. However, we advise caution in patients who recently commenced on GLP-1 receptor agonists. After over 12 weeks of treatment, standard fasting times likely suffice to manage the risk of pulmonary aspiration for most otherwise low-risk patients.
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Initial guidance from multiple societies advocated a conservative strategy of temporary discontinuation for safety considerations.
“the initial guidance for preoperative management of GLP-1 RAs advocated a conservative strategy, recommending temporary discontinuation for safety considerations.”
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 [5]
The Abstract (page unavailable) reports guidance to hold once-daily GLP-1 receptor agonists for one day and once-weekly agents for one week before elective surgery, based on case reports of pulmonary aspiration. The References identify American Society of Anesthesiologists guidance, but the passages do not establish that multiple societies issued the initial guidance. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe ASA and BJA published clinical recommendations in 2023 and 2024 addressing the perioperative management of patients treated with GLP-1 RAs.
“The ASA and the British Journal of Anaesthesia (BJA) published clinical recommendations in 2023 and 2024, respectively, addressing the perioperative management of patients treated with GLP-1 RAs [4,5].”
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 [5]
In the gastrointestinal tract, GLP-1 acts on myoenteric neurons and inhibits vagal activity, thereby delaying gastric emptying and lowering gastric acid secretion, which promotes satiety and reduces caloric intake.
“In the GI tract, GLP-1 acts on myoenteric neurons and inhibits vagal activity, thereby delaying gastric emptying and lowering gastric acid secretion, which further promotes satiety and reduces caloric intake [38,39]”
From Nutritional Approaches to Enhance GLP-1 Analogue Therapy in Obesity: A Narrative Review (2025) · cites this paper as [39]
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- Authors
- van Zuylen, M. L., Siegelaar, S. E., Plummer, M. P., Deane, A. M., Hermanides, J., & Hulst, A. H.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- The University of Adelaide (AU)
- The Royal Melbourne Hospital (AU)
- Corresponding author
- Siegelaar, Sarah E.
- Plummer, Mark P.
- Deane, Adam M.
- Hermanides, Jeroen
- Hulst, Abraham H.
- Venue
- British Journal of Anaesthesia
- Publisher
- Elsevier BV
- Published
- 2024-04
- Volume
- 132
- Issue
- 4
- Pages
- 644-648
- ISSN
- 0007-0912 (ISSN-L)
- OpenAlex
- W4391303884
- Cited by
- 132
- References
- 38
- Citations by year
- 2026: 52 · 2025: 53 · 2024: 27
- FWCI
- 55.33
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- British Journal of Anaesthesia (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (acceptedVersion, other-oa)
- Funders
- Horizon 2020
- H2020 Marie Skłodowska-Curie Actions (101024833)
- Topics
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Keywords
- GLP-1 receptor agonists, perioperative care, gastric emptying, pulmonary aspiration, general anesthesia, preoperative fasting, diabetes mellitus, obesity, weight loss
- MeSH terms
- Diabetes Mellitus, Type 2, Gastric Emptying, Humans, Hypoglycemic Agents, Gastroparesis, Glucagon-Like Peptide 1
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