Updated Review Outlines Perioperative Management Strategies for Patients on GLP-1 Receptor Agonists to Mitigate Aspiration Risk

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prescribed for type 2 diabetes, obesity, and other cardiometabolic conditions. Their widespread use means more surgical patients are on these medications. A critical concern is the known side effect of delayed gastric emptying, which can lead to retained gastric contents and significantly elevate the risk of pulmonary aspiration during anesthesia. Current standard-of-care perioperative protocols often do not adequately address this specific risk, necessitating updated guidelines to ensure patient safety.

This updated review synthesized recent evidence and best practice strategies for managing perioperative patients receiving GLP-1RA therapy. The authors systematically reviewed existing literature concerning the history, mechanism of action, and perioperative implications of GLP-1RAs. They then focused on discussing current evidence and developing practical guidance statements to address the unique challenges posed by these medications during surgical procedures, particularly regarding anesthetic management and aspiration risk mitigation. The review also briefly touched upon Sodium-Glucose Co-transporter 2 (SGLT2) inhibitors, though the primary focus remained on GLP-1RAs.

The review highlighted that delayed gastric emptying is a consistent and significant risk factor for aspiration in surgical patients on GLP-1RAs. It emphasized the need for individualized perioperative plans, recommending specific adjustments to medication timing before surgery. Key recommendations included holding daily GLP-1RAs for 1 day and weekly GLP-1RAs for 7 days prior to elective procedures to allow for gastric emptying normalization. The review also underscored the importance of a thorough preoperative assessment for symptoms of delayed gastric emptying, such as nausea, vomiting, or bloating, even if medication holding protocols are followed. For emergency surgeries, the review suggested considering rapid sequence intubation and gastric decompression to minimize aspiration risk. It also noted that the evidence base for optimal management is still evolving, particularly for newer agents and diverse patient populations. > The review strongly recommends holding daily GLP-1RAs for 1 day and weekly GLP-1RAs for 7 days before elective surgery to reduce aspiration risk.