Perioperative management of patients taking glucagon-like peptide 1 receptor agonists: Society for Perioperative Assessment and Quality Improvement (SPAQI) multidisciplinary consensus statement

Oprea, Adriana D.; Ostapenko, Laura J.; Sweitzer, BobbieJean; Selzer, Angela; Irizarry-Alvarado, Joan M.; Hurtado Andrade, Maria D.; Mendez, Carlos E.; Kelley, Kristen D.; Stewart, Erin; Fernandez Robles, Claudia R.; Chadha, Ryan M.; Camilleri, Michael; Mathur, Ruchi; Umpierrez, Guillermo E.; Hepner, David L.

doi:10.1016/j.bja.2025.04.001

Cited by 104Enhanced Recovery After SurgeryDiabetes Treatment and ManagementCardiac, Anesthesia and Surgical Outcomes

Perioperative management of patients taking glucagon-like peptide 1 receptor agonists: Society for Perioperative Assessment and Quality Improvement (SPAQI) multidisciplinary consensus statement

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Oprea, Adriana D., Ostapenko, Laura J., Sweitzer, BobbieJean, Selzer, Angela, Irizarry-Alvarado, Joan M., Hurtado Andrade, Maria D., Mendez, Carlos E., Kelley, Kristen D. +7 more·2025·British Journal of Anaesthesia

DOI 10.1016/j.bja.2025.04.001PMC PMC12597468

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Abstract

The perioperative management of patients using glucagon-like peptide 1 receptor agonists remains a topic of debate. While several multisociety statements have been published recently, the recommendations vary significantly in terms of medication management and preoperative fasting protocols for these patients. This document represents a multidisciplinary consensus statement led by the Society for Perioperative Assessment and Quality Improvement (SPAQI). It provides updated recommendations based on a modified Delphi process and supported by a systematic review of the current literature. The recommendations address management of the glucagon-like peptide 1 receptor agonists perioperatively, and preoperative fasting times for both solids and liquids. SYSTEMATIC REVIEW PROTOCOL: PROSPERO (CRD42023438624).

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The consensus recommends patients with significant gastrointestinal symptoms receive individualized management.
“Patients with significant gastrointestinal symptoms should receive individualized management”
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 [54]
The most recent multidisciplinary consensus statement [54] recommends that patients without significant gastrointestinal symptoms (severe nausea, vomiting, or intolerance to oral intake) should continue GLP-1 RA therapy regardless of agent, with modified fasting protocols.
“The most recent multidisciplinary consensus statement [54] recommends that patients without significant gastrointestinal symptoms—defined as severe nausea, vomiting, or intolerance to oral intake—should continue GLP-1 RA therapy regardless of the specific agent, with modifications to fasting protocols.”
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 [54]
The consensus recommends that in emergency procedures, all patients be treated as having a full stomach.
“in emergency procedures, all patients should be treated as having a full stomach.”
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 [54]
The consensus recommends solid foods be discontinued 24 hours before surgery, high-carbohydrate clear liquids (≥10% glucose) permitted up to 8 hours before, and low-carbohydrate clear liquids (<10% glucose) permitted up to 4 hours before.
“Solid foods should be discontinued 24 hours before surgery, high-carbohydrate clear liquids (≥ 10% glucose) permitted up to 8 hours before surgery, and low-carbohydrate clear liquids (< 10% glucose) permitted up to 4 hours before surgery.”
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 [54]
The consensus underscores that ensuring adequate fasting duration is paramount.
“The consensus underscores that ensuring an adequate fasting duration is paramount.”
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 [54]

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Effects of Liraglutide on Myocardial Function After Cardiac Surgery: A Secondary Analysis of the Randomised Controlled GLOBE Trial
Hulst, A., Visscher, M., Cherpanath, T., van de Wouw, L., Godfried, M., Thiel, B., Gerritse, B., Scohy, T., Bouwman, R. A., Willemsen, M., et al. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9030673 · Cited by 21 · see citing works
Considerations of delayed gastric emptying with peri‐operative use of glucagon‐like peptide‐1 receptor agonists
Raven, L. M., Brown, C., & Greenfield, J. R. (2024) · Medical Journal of Australia · doi:10.5694/mja2.52170 · Cited by 21 · see citing works
Real-World Impact of GLP-1 Receptor Agonists on Endoscopic Patient Outcomes in an Ambulatory Setting: A Retrospective Study at a Large Tertiary Center
Gonzaga, E. R., Farooq, A., Mohammed, A., Chandan, S., Fawwaz, B. A. B., Singh, G., Malik, A., Zhang, Y., & Kadkhodayan, K. S. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13185403 · Cited by 21 · see citing works
Magnitude of slowing gastric emptying by glucagon‐like peptide‐1 receptor agonists determines the amelioration of postprandial glucose excursion in Japanese patients with type 2 diabetes
Suganuma, Y., Shimizu, T., Sato, T. K., Morii, T., Fujita, H., Sassa, M. H., & Yamada, Y. (2019) · Journal of Diabetes Investigation · doi:10.1111/jdi.13115 · Cited by 20 · see citing works
The GLP-1 receptor agonist lixisenatide reduces postprandial glucose in patients with diabetes secondary to total pancreatectomy: a randomised, placebo-controlled, double-blinded crossover trial
Juel, C. T., Lund, A., Andersen, M. M., Hansen, C. P., Storkholm, J. H., Rehfeld, J. F., van Hall, G., Hartmann, B., Albrechtsen, N. J. W., Holst, J. J., et al. (2020) · Diabetologia · doi:10.1007/s00125-020-05158-9 · Cited by 20 · see citing works
Association between Preoperative Glucose Dysregulation and Delirium after Non-Cardiac Surgery
Oh, A. R., Lee, D. Y., Lee, S. H., Lee, J.-H., Yang, K., Choi, B., & Park, J. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13040932 · Cited by 20 · see citing works
Tendency of Semaglutide to Induce Gastroparesis: A Case Report
Chaudhry, A., Buluku, G., Noor, J., Jawad, S., & Challa, S. R. (2024) · Cureus · doi:10.7759/cureus.52564 · Cited by 20 · see citing works
Effect of Glucagon-Like Peptide-1 Receptor Agonists Administration During Coronary Artery Bypass Grafting: A Systematic Review and Meta-Analysis of Randomized Control Trials
Watkins, A. R., Fialka, N. M., EL‐Andari, R., Kang, J. J. H., Bozso, S. J., & Nagendran, J. (2023) · Future Cardiology · doi:10.2217/fca-2022-0093 · Cited by 19 · see citing works
Point-of-Care Gastric Ultrasound to Identify a Full Stomach on a Diabetic Patient Taking a Glucagon-Like Peptide 1 Receptor Agonist
Girón-Arango, L., & Perlas, A. (2024) · A&A Practice · doi:10.1213/xaa.0000000000001751 · Cited by 19 · see citing works
Risk of pulmonary aspiration during semaglutide use and anesthesia in a fasting patient: a case report with tomographic evidence
Queiroz, V. N. F., Falsarella, P. M., Chaves, R. C. D. F., Takaoka, F., Socolowski, L. R., & Garcia, R. G. (2023) · Einstein (São Paulo) · doi:10.31744/einstein_journal/2023rc0628 · Cited by 17 · see citing works
Comparison of Glucose Control by Added Liraglutide to Only Insulin Infusion in Diabetic Patient Undergoing Cardiac Surgery
Sindhvananda, W., Poopuangpairoj, W., Jaiprasat, T., & Ongcharit, P. (2023) · Annals of Cardiac Anaesthesia · doi:10.4103/aca.aca_214_20 · Cited by 16 · see citing works
Should We Stop Glucagon-Like Peptide-1 Receptor Agonists Before Surgical or Endoscopic Procedures? Balancing Limited Evidence With Clinical Judgment
Umpierrez, G. E., Pasquel, F. J., Duggan, E. W., & Galindo, R. J. (2024) · Journal of Diabetes Science and Technology · doi:10.1177/19322968241231565 · Cited by 16 · see citing works
Self-citation
Frequency of GLP-1 receptor agonists use in diabetic patients diagnosed with delayed gastric emptying and their demographic profile
Kalas, M. A., Dang, T. Q., Galura, G. M., Alvarado, L. A., Dwivedi, A. K., Deoker, A., & McCallum, R. W. (2022) · Journal of Investigative Medicine · doi:10.1136/jim-2022-002480 · Cited by 16 · see citing works
No association between semaglutide and postoperative pneumonia in people with diabetes undergoing elective surgery
Welk, B., McClure, J. A., Carter, B., Clarke, C., Dubois, L., & Clemens, K. K. (2024) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.15711 · Cited by 16 · see citing works
Association between Glucagon-like Peptide-1 Receptor Agonists and Aspiration Pneumonia during Endoscopic Procedures
Peng, C.-Y., Chang, Y.-C., Gong, C., Chang, Y., Chi, K., Hsiao, C.-L., Chiang, C., & Chiang, C. (2024) · Anesthesiology · doi:10.1097/aln.0000000000005174 · Cited by 16 · see citing works
Differing effects of liraglutide on gastric emptying in Japanese patients with type 2 diabetes
Nagai, Y., Hashimoto, E., Oikawa, R., Asai, S., Terashima, Y., Nakamura, Y., Sasaki, Y., Tsukiyama, H., Fukuda, H., Ohshige, T., et al. (2013) · Diabetes Obesity and Metabolism · doi:10.1111/dom.12247 · Cited by 15 · see citing works
Liraglutide-induced Acute Gastroparesis
Rai, P., Madi, M. Y., & Dickstein, A. M. (2018) · Cureus · doi:10.7759/cureus.3791 · Cited by 15 · see citing works
Exenatide Delays Gastric Emptying in Patients with Type 2 Diabetes Mellitus but not in Those with Gastroparetic Conditions
Beti, C., Stratmann, B., Bokman, G., Dreier, J., Hauber, M., Lee-Barkey, Y., Fischer, M., Knabbe, C., & Tschoepe, D. (2019) · Hormone and Metabolic Research · doi:10.1055/a-0818-6374 · Cited by 15 · see citing works
Rates of glucagon-like peptide-1 receptor agonist use and aspiration events associated with anesthesia at a Canadian academic teaching centre
Milne, A. D., Berry, M. A., Ellis, M. W., & Dobson, G. R. (2024) · Canadian Journal of Anesthesia/Journal canadien d'anesthésie · doi:10.1007/s12630-024-02761-x · Cited by 14 · see citing works
Evaluation of gastric content in fasting patient during semaglutide use: an observational study
Queiroz, V. N. F., Falsarella, P. M., Chaves, R. C. D. F., Neto, M. J. F., Silva, J. M., Araújo, G. F., Takaoka, F., Pfeilsticker, F. J. D. A., Mendes, G. F., & Garcia, R. G. (2024) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2024.08.039 · Cited by 14 · see citing works
Liraglutide Effects on Upper Gastrointestinal Investigations: Implications Prior to Bariatric Surgery
Modi, R., Rye, P., Cawsey, S., Birch, D. W., & Sharma, A. M. (2018) · Obesity Surgery · doi:10.1007/s11695-018-3249-1 · Cited by 13 · see citing works
Lixisenatide Versus Insulin Glulisine on Fasting and Postbreakfast Systemic Hemodynamics in Type 2 Diabetes Mellitus Patients
Tonneijck, L., Muskiet, M. H. A., Twisk, J. W. R., Kramer, M. H. H., Danser, A. H. J., Joles, J. A., Smits, M. M., & van Raalte, D. H. (2018) · Hypertension · doi:10.1161/hypertensionaha.117.10740 · Cited by 13 · see citing works
Gastroparesis With the Initiation of Liraglutide: A Case Report
Almustanyir, S. A., Alhabeeb, H., Alhusseini, N., & Thow, M. A. (2020) · Cureus · doi:10.7759/cureus.11735 · Cited by 11 · see citing works
The impact of dehydration on short-term postoperative complications in total knee arthroplasty
Lung, B. E., Callan, K., McLellan, M., Kim, M. T., Yi, J. D., McMaster, W. C., Yang, S., & So, D. H. (2023) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-022-06118-7 · Cited by 11 · see citing works
A preoperative ultrasound-based protocol for optimisation of fluid therapy to prevent early intraoperative hypotension: a randomised controlled study
Szabó, M., Pleck, A. P., Soós, S. Á., Keczer, B., Varga, B., & Széll, J. (2023) · Perioperative Medicine · doi:10.1186/s13741-023-00320-4 · Cited by 11 · see citing works
Effect of lixisenatide on liquid gastric emptying in type 2 diabetes – Implications for the use of GLP-1 receptor agonists before procedures
Kovoor, J. G., Rayner, C. K., Wu, T., Jalleh, R. J., Maddern, G. J., Horowitz, M., & Jones, K. L. (2024) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2024.108793 · Cited by 11 · see citing works
Continuous Glucose Monitoring and the Effect of Liraglutide in Cardiac Surgery Patients: A Substudy of the Randomized Controlled GLOBE Trial
Oosterom-Eijmael, M. J. P., Hermanides, J., van Raalte, D. H., Kouw, I. W. K., DeVries, J. H., & Hulst, A. H. (2024) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2024.06.015 · Cited by 11 · see citing works
Suspected Gastroparesis With Concurrent Gastroesophageal Reflux Disease Induced by Low-Dose Liraglutide
Ishihara, Y., Nishiguchi, S., Branch, J., & Tanaka, E. (2022) · Cureus · doi:10.7759/cureus.26916 · Cited by 11 · see citing works
Acute Administration of the GLP-1 Receptor Agonist Lixisenatide Diminishes Postprandial Insulin Secretion in Healthy Subjects But Not in Type 2 Diabetes, Associated with Slowing of Gastric Emptying
Marathe, C. S., Pham, H., Wu, T., Trahair, L. G., Rigda, R. S., Buttfield, M., Hatzinikolas, S., Lange, K. M., Rayner, C. K., Mari, A., et al. (2022) · Diabetes Therapy · doi:10.1007/s13300-022-01258-4 · Cited by 9 · see citing works
Gastroparesis with bezoar formation in patients treated with glucagon-like peptide-1 receptor agonists: potential relevance for bariatric and other gastric surgery
Preda, V. A., Khoo, S. S.-Y., Preda, T. C., & Lord, R. V. (2023) · BJS Open · doi:10.1093/bjsopen/zrac169 · Cited by 9 · see citing works
Point-of-Care Ultrasound Aids in the Management of Patient Taking Semaglutide Before Surgery: A Case Report
Hodgson, J. A., Rivera-Rodriguez, H., Wu, P. E., Udani, J., & Weiss, J. (2024) · A&A Practice · doi:10.1213/xaa.0000000000001762 · Cited by 7 · see citing works
Preoperative Dehydration Predicts Adverse Events Following Anterior Cervical Discectomy and Fusion
Ghali, A. N., Prabhakar, G., Momtaz, D., Ahmad, F., Abbas, A., Shamim, M., Issa, M., Bora, V., & Chaput, C. D. (2023) · The International Journal of Spine Surgery · doi:10.14444/8544 · Cited by 6 · see citing works
Preoperative Dehydration Increases the Risk of Extended Length of Hospital Stay Following Total Ankle Arthroplasty
Quan, T., Magruder, M. L., Chen, F. R., Tabaie, S. A., Best, M. J., & Aiyer, A. A. (2023) · Foot & Ankle Specialist · doi:10.1177/19386400231169367 · Cited by 4 · see citing works

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Semaglutide therapy for metabolic dysfunction–associated steatohepatitis: November 2025 updates to AASLD Practice Guidance
Bansal, M. B., Patton, H. M., Morgan, T. R. M., Carr, R. M., Dranoff, J. A., & Allen, A. M. (2025) · Hepatology · doi:10.1097/hep.0000000000001608 · Cited by 136 · see citing works
16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, M., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Briggs Early, K., ChallaSivaKanaka, S., et al. (2026) · Diabetes Care · doi:10.2337/dc26-s016 · Cited by 80 · see citing works
Glucagon-like peptide-1 receptor agonists in arthritis: current insights and future directions
Karacabeyli, D., & Lacaille, D. V. (2025) · Nature Reviews Rheumatology · doi:10.1038/s41584-025-01302-0 · Cited by 31 · see citing works
Gastric ultrasound in patients receiving semaglutide: a prospective, multicentre, matched control study
Vlaeminck, N., de Putte, P. B. C. V., Dekeyser, M., Baert, N., Wallyn, A., Vernieuwe, L., Smitz, C. J., Wouters, K., Cauwenberghe, J. V., & Saldien, V. (2026) · Anaesthesia · doi:10.1111/anae.70129 · Cited by 20 · see citing works
Pharmacological Treatment for Patients with Obesity and Heart Failure: Focus on Glucagon-Like Peptide-1 Receptor Agonists. European Journal of Heart Failure Expert Consensus Document
Monzo, L., Savarese, G., Müllens, W., Abdin, A., Bozkurt, B., Chioncel, O. D., Hadidi, S. E., Gorter, T. M., Inciardi, R. M., Petrie, M. C., et al. (2025) · European Journal of Heart Failure · doi:10.1002/ejhf.70082 · Cited by 14 · see citing works
GLP-1 Receptor Agonists and Gastrointestinal Endoscopy: A Narrative Review of Risks, Management Strategies, and the Need for Clinical Consensus
Crespo, J., Rodríguez-Duque, J. C., Iruzubieta, P., Cerda, E. C. M., & Velasco, J. A. V.-R. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14155597 · Cited by 8 · see citing works
GLP-1 receptor agonists for kidney transplant recipients
Schmitz, S. H., & Orandi, B. J. (2025) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfaf199 · Cited by 6 · see citing works
Adjunctive Treatment with GLP-1 and Dual GLP-1/GIP Receptor Agonists for People with Type 1 Diabetes: Consensus Report and Practical Guidelines for Safe Use
Garg, S. K., Aktürk, H. K., Garg, S., Beck, R. W., Bellini, N. J., Bjornstad, P., Carlson, A. L., Carroll, J., Close, K., Block, C., et al. (2026) · Diabetes Technology & Therapeutics · doi:10.1177/15209156261449879 · Cited by 6 · see citing works
Multimodal Prehabilitation for Hernia Repair: Linking Metabolic Modulation and Mechanical Methods
Paduraru, D. N., Palcău, A. C., Daniel, I., & Seicaru, R. (2025) · Biomedicines · doi:10.3390/biomedicines13123117 · Cited by 5 · see citing works
Prevalence and predictors of residual gastric content in patients with type 2 diabetes on GLP ‐1 receptor agonists: A prospective observational study
Li, X., Jin, Y., Feng, X., Wang, R., Zeng, F., Qin, J., Li, J., Xia, J., Mo, Y., Zhai, X., et al. (2026) · Diabetes Obesity and Metabolism · doi:10.1111/dom.70537 · Cited by 4 · see citing works
The Role of GLP1 Receptor Agonists and Multi-agonist Incretin Therapies for Specific Obesity-related Health Conditions: Evidence and Rationale for Prioritisation
Albor, C., Anyiam, O., Boyle, L., Makaronidis, J., Tan, R. J. L., Iftikhar, S., Burzić, A., Lajeunesse‐Trempe, F., Stanley, M., Bhatti, A. I., et al. (2026) · Current Obesity Reports · doi:10.1007/s13679-026-00707-6 · Cited by 5 · see citing works
Perioperative management of glucagon-like peptide-1 receptor agonists: international guidance and variability in recommendations
Lam, C., Thiruvenkatarajan, V., Nanjappa, N., Endlich, Y., & Lin, D. (2026) · British Journal of Anaesthesia · doi:10.1016/j.bja.2026.01.028 · Cited by 3 · see citing works
Perioperative management of patients taking glucagon-like peptide-1 receptor agonists: a restrictive fasting regimen is not necessary. Comment on Br J Anaesth 2025; 135: 48–78
Khandaker, R., Jahantighi, A. B., Schwarz, J. N., Himes, C. P., Isono, S., Eikermann, M., & Fassbender, P. J. (2025) · British Journal of Anaesthesia · doi:10.1016/j.bja.2025.09.027 · Cited by 2 · see citing works
Perioperative management of patients taking glucagon-like peptide-1 receptor agonists: implementation of complex fasting recommendations. Comment on Br J Anaesth 2025; 135: 48–78
Frank, C., El‐Boghdadly, K., & Dhesi, J. K. (2025) · British Journal of Anaesthesia · doi:10.1016/j.bja.2025.09.028 · Cited by 2 · see citing works
Clarifying the Guidelines and Decoding the Enigma: Strategies for Anesthetic Management of Patients on Glucagon-Like Peptide-1 Receptor Agonists
Joshi, G. P. (2025) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000007921 · Cited by 2 · see citing works
Impact of Glucagon-like Peptide-1 Receptor Agonists on Bowel Preparation for Colonoscopy: A Large, Matched Regional Cohort
Cole, J. L., & Stark, J. E. (2025) · Annals of Pharmacotherapy · doi:10.1177/10600280251349583 · Cited by 2 · see citing works
Delayed gastric emptying induced by glucagon-like peptide-1 receptor agonists and its implications for perioperative risk during anesthesia
Kang, D., & Choi, D. (2026) · The Korean Journal of Internal Medicine · doi:10.3904/kjim.2025.277 · Cited by 1 · see citing works
“The most recent multidisciplinary consensus statement [54] recommends that patients without significant gastro-intestinal symptoms—defined as severe nausea, vomiting, or intolerance to oral intake—should continue GLP-1 RA therapy regardless of the specific agent, with modifications to fasting…”
Glucagon-Like Peptide-1 Receptor Agonists in Gynecologic Surgery
Hsu, R. C., Han, E., Swartz, S., & Pacis, M. (2025) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000006035 · Cited by 1 · see citing works
Risk of periprocedural regurgitation of gastric contents in patients on glucagon-like peptide-1 receptor agonists: a two-centre nested case–control study
van Klei, W. A., Bartoszko, J. M., Andrusiak, J., Santema, M., & Marsman, M. (2026) · British Journal of Anaesthesia · doi:10.1016/j.bja.2025.12.033 · Cited by 1 · see citing works
Unexpected Residual Gastric Contents in a Patient After Holding Semaglutide After Standard Fasting Guidelines: A Case Report
Ando, K., Takenoshita, M., & Wei, M. T. (2026) · A&A Practice · doi:10.1213/xaa.0000000000002161 · Cited by 1 · see citing works
Preoperative management algorithm for endoscopic or surgical interventions in patients receiving incretin mimetics
Салухов, В. В., Щеголев, А. В., Kryukov, E. V., Surzhikov, P. V., Apostolidi, E. V., & Prochik, Y. E. (2026) · Meditsinskiy sovet = Medical Council · doi:10.21518/ms2026-161 · Cited by 1 · see citing works
Balancing the evidence with the SPAQI recommendations: from perioperative discontinuation towards continuation of SGLT2 inhibitors
Garcia, B., Dixit, A. A., & Legrand, M. M. (2026) · British Journal of Anaesthesia · doi:10.1016/j.bja.2026.05.005 · Cited by 1 · see citing works
Effect of a liberal fluid fasting policy before surgery on the incidence of aspiration: a single centre retrospective observational study
Marsman, M., Derksen, M., Helbach, M. V., van Waes, J. A. R., Kappen, T. H., van der Hout, E. C., Pouw, M. E., & van Klei, W. A. (2026) · BJA Open · doi:10.1016/j.bjao.2026.100578 · Cited by 1 · see citing works
Perioperative Glucagon-like Peptide-1 Receptor Agonist Use and Postoperative Outcomes in Adults with Obesity Undergoing Elective Non-Bariatric Surgery: A Systematic Review
Al‐Majmuei, A., Alatoom, M., Abdullahi, F., Marza, L., Murjan, N. A., Qasmi, R. A., Al-Rahbi, T., AlOmar, H., Alsherooqi, R., & Arekat, D. Z. (2026) · SN Comprehensive Clinical Medicine · doi:10.1007/s42399-026-02671-7 · Cited by 1 · see citing works
NPO at midnight: A historical rule in need of evidence-based reform
Kramer, E. F., Pepine, C. J., & Winchester, D. E. (2025) · American Heart Journal Plus Cardiology Research and Practice · doi:10.1016/j.ahjo.2025.100603
Full stomach and gastric ultrasound: Debunking some myths
Sastre, J. A., & Vaquero, M. Á. F. (2025) · Journal of Clinical Anesthesia · doi:10.1016/j.jclinane.2025.111998
Beyond “nil per mouth”: towards evidence-based fasting and medication practices
Nethathe, G. D. (2025) · Southern African Journal of Anaesthesia and Analgesia · doi:10.36303/sajaa.3426
Executive Summary of the American College of Cardiology/American Heart Association Joint Committee (2024) on Clinical Practice for Cardiac Evaluation and Management of Patients Having Noncardiac Surgeries
Sweitzer, B., Thompson, A., & Blitz, J. D. (2025) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000007857
Self-citation
GLP-1 agonists: A hidden challenge for airway management
Vaquero, M. Á. F., Puga-Carrasco, C. A., & Sastre, J. A. (2025) · Revista Española de Anestesiología y Reanimación (English Edition) · doi:10.1016/j.redare.2025.501991
Análogos GLP-1: el nuevo reto silencioso en la seguridad de la vía aérea
Fernández-Vaquero, M. A., Puga-Carrasco, C. A., & Sastre, J. A. (2025) · Revista Española de Anestesiología y Reanimación · doi:10.1016/j.redar.2025.501991
A restrictive fasting regimen is not necessary in patients taking glucagon-like peptide-1 receptor agonists. Response to Br J Anaesth 2025; 135: 1816-8.
Oprea, A., Hepner, D. L., & Sweitzer, B. (2026) · British Journal of Anaesthesia · doi:10.1016/j.bja.2025.11.022
Self-citation
Perioperative Glucagon-Like Peptide-1 Receptor Agonist Therapy and Postoperative Outcomes in Adult Foot and Ankle Surgery: A Scoping Review
Zahed, M., Alesawy, A. F., Elkohail, A., Ghazi, A., Fell, A., & Hashem, M. (2026) · Cureus · doi:10.7759/cureus.101653
INTERNATIONAL GUIDELINES ON PERIOPERATIVE MANAGEMENT OF GLP-1 RECEPTOR AGONISTS: A NARRATIVE REVIEW
Grela, K., Grygorowicz, A., Baran, K., Ględa, M., Szyszka, M., Radecka, W., Kozak, W., Szreiber, A., Nowacka, K., Jabłoński, K., et al. (2025) · International Journal of Innovative Technologies in Social Science · doi:10.31435/ijitss.4(48).2025.4724
Perioperative management of patients taking glucagon-like peptide-1 receptor agonists: implementation of complex fasting recommendations. Response to Br J Anaesth 2025; 136: 375-6
Hepner, D. L., Oprea, A. D., & Sweitzer, B. J. (2026) · British Journal of Anaesthesia · doi:10.1016/j.bja.2025.12.022
Self-citation
Glucagon-like Peptide-1 Receptor Agonists
Kligman, M., & Holsten, S. B. (2026) · Surgical Clinics of North America · doi:10.1016/j.suc.2025.12.011
Still confusing? What should perioperative teams do when patients are taking GLP-1 medications?
Dost, B., & Turunç, E. (2026) · JCA advances. · doi:10.1016/j.jcadva.2026.100219
Applying the 2024 American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines for Cardiac Evaluation and Managment of Patients Having Noncardiac Surgeries in an Ambulatory Setting
Sweitzer, B. (2026) · Anesthesiology Clinics · doi:10.1016/j.anclin.2026.02.013
Self-citation
Perioperative Management of Glucagon-like Peptide-1 Receptor Agonists and Sodium-Glucose Co-transporter 2 Inhibitors
Lozada, G. A., Chen, R. B., Davoud, S. C., & Lee, G. S. (2026) · Anesthesiology Clinics · doi:10.1016/j.anclin.2026.02.002
Prise en charge du surpoids et de l’obésité en préopératoire
Pardo, E. (2026) · Le Praticien en Anesthésie Réanimation · doi:10.1016/j.pratan.2026.02.007
Perioperative anesthesia care for patients with diabetes mellitus: a review of current literature with focus on oral antidiabetic medication
Riesemann, S., Tenge, T., & Roth, S. (2026) · Current Opinion in Anaesthesiology · doi:10.1097/aco.0000000000001644
GLP-1 Receptor Agonists: Clinical Considerations and Risk Management for Patients Undergoing Ophthalmic Surgery
Baumal, C. R., Choi, S. H., Balonov, K., & Diana, V. (2026) · Ophthalmic surgery, lasers & imaging retina · doi:10.3928/23258160-20260310-01
AGONISTAS DO RECEPTOR DE GLP-1 E COAGONISTAS GIP/GLP-1 NO PERIOPERATÓRIO: RISCO DE ASPIRAÇÃO, JEJUM, ULTRASSOM GÁSTRICO E TOMADA DE DECISÃO ANESTÉSICA BASEADA EM RISCO
Esquirio, M. G. S., Barcia, M. E. A. C., de Alencar, M. L., & Alves, D. P. (2026) · International Journal of Health Management Review · doi:10.47172/ijhmreview.v12i1.483
Perioperative risks of glucagon-like peptide-1 receptor agonists and their implications in airway management using supraglottic airway devices
Oh, C.-S., Lee, S., & Hong, B. (2026) · Anesthesia and Pain Medicine · doi:10.17085/apm.26589
Incretin-Based Therapeutics: A Dual-Pronged Evaluation of Global Health Impact and Clinical Viability (Preprint)Preprint
Ortiz‐Prado, E., Vasconez-Gonzalez, J., Izquierdo‐Condoy, J. S., & López-Jaramillo, P. A. (2026) · doi:10.2196/preprints.99738
ETHER: a proposal for a European peri-operative data sharing and registry network
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Perioperative management of patients taking glucagon-like peptide-1 receptor agonists: implementation of complex fasting recommendations. Response to Br J Anaesth 2025; 136: 375-6
Hepner, D. L., Oprea, A. D., & Sweitzer, B. J. (2026) · British Journal of Anaesthesia · doi:10.1016/j.bja.2025.12.022
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Perioperative management of patients taking glucagon-like peptide-1 receptor agonists: a restrictive fasting regimen is not necessary. Comment on Br J Anaesth 2025; 135: 48–78
Khandaker, R., Jahantighi, A. B., Schwarz, J. N., Himes, C. P., Isono, S., Eikermann, M., & Fassbender, P. J. (2025) · British Journal of Anaesthesia · doi:10.1016/j.bja.2025.09.027 · Cited by 2 · see citing works
Perioperative Management of Patients Taking GLP-1 Receptor Agonists. A Mini-Review
Smilková, L. H., & Záhorec, R. (2026) · Bratislavské lekárske listy/Bratislava medical journal · doi:10.1007/s44411-026-00825-6
Perioperative management of patients taking glucagon-like peptide-1 receptor agonists: implementation of complex fasting recommendations. Comment on Br J Anaesth 2025; 135: 48–78
Frank, C., El‐Boghdadly, K., & Dhesi, J. K. (2025) · British Journal of Anaesthesia · doi:10.1016/j.bja.2025.09.028 · Cited by 2 · see citing works
Perioperative management of patients taking GLP-1 receptor agonists: A comparative review of international clinical guidelines
Moore, T., & Ramsahoye, B. (2026) · Saudi Journal of Anaesthesia · doi:10.4103/sja.sja_314_26

Authors: Oprea, A. D., Ostapenko, L. J., Sweitzer, B., Selzer, A., Irizarry-Alvarado, J. M., Hurtado Andrade, M. D., Mendez, C. E., Kelley, K. D., Stewart, E., Fernandez Robles, C. R., Chadha, R. M., Camilleri, M., Mathur, R., Umpierrez, G. E., & Hepner, D. L.
Affiliations: Yale University (US)
MaineHealth (US)
Inova Health System (US)
University of Colorado Denver (US)
Medical College of Wisconsin (US)
University of California Davis Medical Center (US)
Stanford Medicine (US)
Mayo Clinic (US)
Cedars-Sinai Medical Center (US)
Emory University (US)
Harvard University (US)
Corresponding author: Oprea, Adriana D.
ORCID: Oprea, Adriana D.
Ostapenko, Laura J.
Sweitzer, BobbieJean
Selzer, Angela
Irizarry-Alvarado, Joan M.
Mendez, Carlos E.
Kelley, Kristen D.
Chadha, Ryan M.
Camilleri, Michael
Mathur, Ruchi
Umpierrez, Guillermo E.
Hepner, David L.
Venue: British Journal of Anaesthesia
Publisher: Elsevier BV
Published: 2025-07
Volume: 135
Issue: 1
Pages: 48-78
ISSN: 0007-0912 (ISSN-L)
DOI: 10.1016/j.bja.2025.04.001
PMC: PMC12597468
OpenAlex: W4410386406
Cited by: 104
References: 166
Citations by year: 2026: 85 · 2025: 19
FWCI: 86.73
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 366 d)
Locations: British Journal of Anaesthesia (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed (publishedVersion)
Funders: Mayo Clinic
Topics: Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
Keywords: GLP-1 receptor agonists, perioperative care, preoperative fasting, fasting duration, medication management, consensus recommendations, Delphi method
MeSH terms: Glucagon-Like Peptide-1 Receptor Agonists, Delphi Technique, Fasting, Humans, Hypoglycemic Agents, Perioperative Care, Consensus, Quality Improvement

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Perioperative management of patients taking glucagon-like peptide 1 receptor agonists: Society for Perioperative Assessment and Quality Improvement (SPAQI) multidisciplinary consensus statement

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