Clinical Guidelines for Managing GLP-1 Receptor Agonist Patients Before Surgery and Procedures | Research

The takeaway

New Australian/NZ guidelines recommend continuing GLP-1 receptor agonists before surgery but require a 24-hour clear liquid diet and standard fasting to reduce aspiration risk from delayed gastric emptying.

24-hour liquid diet
Recommended pre-procedural preparation for all patients taking GLP-1 receptor agonists or dual GLP-1/GIP agonists to reduce aspiration risk

What the researchers found

The multi-society expert panel recommends:

1. All patients should be asked about GLP-1RA and GLP-1/GIPRA use before any procedure requiring sedation or anesthesia

2. These medications should be continued in the peri-procedural period (not stopped)

3. A 24-hour clear fluid diet followed by standard 6-hour fasting is recommended for all patients on these drugs

4. If the liquid diet was not completed, gastric ultrasound or minimally sedated gastroscopy should assess stomach contents, and intravenous erythromycin may be used

5. The absence of gastrointestinal symptoms cannot be relied upon for risk assessment

6. No adequate cessation period can currently be recommended to ensure gastric emptying returns to baseline

Why it matters

With millions of patients now using GLP-1 receptor agonists for diabetes and obesity, the surgical safety implications are a growing clinical concern. These are among the first formal multi-society guidelines addressing this issue, providing practical recommendations for a situation that surgeons, anesthesiologists, and gastroenterologists encounter with increasing frequency.

How the study worked

An expert panel was assembled from four professional societies (Australian Diabetes Society, Australian and New Zealand College of Anaesthetists, Gastroenterological Society of Australia, and the National Australian Committee on Obesity Surgery) to review current evidence and develop consensus-based clinical practice recommendations.

What this study cannot tell us

The guidelines are based on limited evidence, as there are few large studies specifically examining aspiration risk with GLP-1RAs during procedures. Recommendations are consensus-based rather than derived from randomized controlled trials. The guidelines are tailored for Australian and New Zealand practice and may not directly apply to other healthcare settings. The panel acknowledges they cannot yet recommend a safe cessation period.

How to read the evidence

These are expert consensus guidelines from four professional societies, developed based on available evidence which is currently limited. While they represent best available clinical practice, they are not based on randomized controlled trials specifically addressing this clinical question.

When this study was published

Published in 2025, these are among the most current guidelines addressing the increasingly important question of GLP-1RA management around surgical procedures.

The bigger picture

These guidelines highlight an important real-world consequence of the GLP-1 receptor agonist revolution: as these peptide drugs become some of the most prescribed medications worldwide, their effects on gastric emptying create practical challenges across medicine. This is one of several guideline efforts globally attempting to standardize safe surgical practices for the growing population of patients on incretin-based therapies.

Questions still open

How long do different GLP-1 receptor agonists delay gastric emptying, and does this vary by dose and duration of use?
Will future evidence support a specific pre-procedure washout period for these medications?
Do next-generation incretin therapies (like retatrutide, a triple agonist) carry even greater peri-procedural gastric retention risk?

Common questions

Why do GLP-1 receptor agonists matter for surgery?

GLP-1 receptor agonists slow stomach emptying as part of how they help with blood sugar control and weight loss. This means food or liquid may remain in the stomach longer than normal. During surgery under anesthesia, retained stomach contents can be aspirated (inhaled) into the lungs, which is a serious and potentially life-threatening complication.

Should I stop my GLP-1 medication before surgery?

According to these guidelines, no — the medications should be continued. Instead, patients should follow a 24-hour clear liquid diet before the procedure, then fast for 6 hours. If the liquid diet wasn't completed, doctors should check stomach contents with ultrasound before proceeding. Always discuss medication management with your surgical and medical team.

Read the original research

2025 ADS/ANZCA/GESA/NACOS clinical practice recommendations on the peri-procedural use of GLP-1/GIP receptor agonists.

Anaesthesia and intensive care, 53(5), 300-306

View on PubMed ↗Publisher’s paper ↗

Citation

Hocking, Samantha L; Scott, David A; Remedios, Matthew L; Horowitz, Michael; Story, David A; Greenfield, Jerry R; Boussioutas, Alex; Devereaux, Benedict; Andrikopoulos, Sofianos; Shaw, Jonathan E; Olesnicky, Benjamin L. (2025). 2025 ADS/ANZCA/GESA/NACOS clinical practice recommendations on the peri-procedural use of GLP-1/GIP receptor agonists.. Anaesthesia and intensive care, 53(5), 300-306. https://doi.org/10.1177/0310057X251355288