Patients taking GLP-1 receptor agonists may have food remaining in their stomachs during surgery due to delayed gastric emptying, increasing the risk of pulmonary aspiration — prompting new recommendations for perioperative management.
Full stomach risk during surgeryGLP-1 receptor agonists delay gastric emptying as a core mechanism, meaning patients may retain food in their stomachs even after standard preoperative fasting — a potential aspiration hazard during anesthesia.
What the researchers found
The review establishes that GLP-1 receptor agonists delay gastric emptying as a key mechanism of action, which means patients may have retained gastric contents even after standard fasting periods before surgery. This creates a risk of pulmonary aspiration during anesthesia induction.
Recommendations include: careful preoperative assessment of GLP-1 RA medication details (drug type, dose, timing of last dose), pre-anesthesia gastric ultrasound to assess stomach contents, rapid sequence induction if gastric content retention is suspected, and additional monitoring during the perioperative period. The review emphasizes the need for thorough documentation of any GLP-1-related adverse events during anesthesia to build the evidence base for future guidelines.
Why it matters
With tens of millions of patients now taking GLP-1 drugs, every anesthesiologist and surgeon will encounter these patients regularly. The aspiration risk from delayed gastric emptying is a real and potentially life-threatening concern that wasn't part of traditional preoperative assessment. This review provides practical guidance for a rapidly evolving clinical scenario that existing anesthesia guidelines were not designed to address.
How the study worked
Narrative review of published literature on GLP-1 receptor agonist pharmacology (particularly gastric emptying effects), case reports and case series of perioperative complications, current anesthesia society guidelines, and expert recommendations for perioperative management.
What this study cannot tell us
As a narrative review, the evidence synthesis may be selective. The actual incidence of clinically significant aspiration in GLP-1 RA users undergoing surgery is not well quantified — most evidence comes from case reports rather than large prospective studies. The degree of gastric emptying delay varies between different GLP-1 drugs, doses, and individual patients. The recommendations are expert consensus rather than evidence-based guidelines from randomized trials.
How to read the evidence
This is a narrative review synthesizing pharmacological evidence, case reports, and expert consensus. No randomized trials or large prospective studies of aspiration risk in GLP-1 users have been conducted. The recommendations are prudent and based on known pharmacology but remain largely expert opinion.
When this study was published
Published in 2025, this is timely and addresses one of the most actively discussed topics in perioperative medicine. Guidelines are evolving rapidly as more data accumulates on GLP-1 drugs and surgical outcomes.
The bigger picture
The perioperative management of GLP-1 drug users has become one of the most urgent new issues in anesthesiology. The American Society of Anesthesiologists issued guidance in 2023 recommending GLP-1 drugs be held before elective surgery, but debate continues about timing, specific drugs, and whether the risk justifies delaying surgery. As GLP-1 drug use expands beyond diabetes into obesity, NASH, and potentially addiction and neurodegeneration, the number of surgical patients affected will only grow.
Questions still open
- Should specific GLP-1 drugs with shorter half-lives be held for different durations than long-acting agents like semaglutide before surgery?
- Does preoperative gastric ultrasound reliably identify patients at risk, and should it become standard for all GLP-1 users?
- Are the actual rates of aspiration significantly higher in GLP-1 users, or is the concern primarily theoretical based on the pharmacology?
Common questions
Should I stop taking my GLP-1 drug before surgery?
What is pulmonary aspiration and why is it dangerous?
Read the original research
Perioperative management of patients on GLP-1 receptor agonists: Risks, recommendations, and future directions-A narrative review.
Journal of clinical anesthesia, 104, 111871
Citation
Li, Xiao-Yu; Jin, Yun; Feng, Xiu-Ye; Wang, Rui-Chun; Chen, Jun-Ping; Lu, Bo. (2025). Perioperative management of patients on GLP-1 receptor agonists: Risks, recommendations, and future directions-A narrative review.. Journal of clinical anesthesia, 104, 111871. https://doi.org/10.1016/j.jclinane.2025.111871