What is it about?
This article reviews what happens when patients taking GLP-1 receptor agonists—medications need surgery or sedation. Because these medications slow stomach emptying, doctors have been worried that food might remain in the stomach and increase the risk of vomiting or aspiration during anaesthesia. The paper summarises: What the research shows: Studies involving more than 300,000 patients demonstrate that although GLP-1 medicines greatly increase the chance of finding food left in the stomach (5–10× higher), the actual risk of aspiration remains extremely low (0.1–0.2%). How guidelines have changed: Early advice in 2023 recommended stopping the medication before surgery. By 2024–2025, major international societies shifted to continuing GLP-1 medicines for most patients, using individualised risk assessment instead of blanket cessation. Practical strategies clinicians can use: 24-hour clear-liquid diets Gastric ultrasound (see decision algorithm in Figure 1 on page 6) Adjusted anaesthetic techniques Prokinetic medications Shared decision-making with patients Overall, the review shows that the real-world risk is lower than first feared, and stopping GLP-1 medications for everyone may do more harm than good.
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Why is it important?
1. Millions of people now take GLP-1 drugs More than 15 million people worldwide use GLP-1 receptor agonists for diabetes, obesity, or heart health. Many will require surgery or invasive procedures. 2. Stopping these medications can worsen patient outcomes Interrupting treatment can worsen: blood glucose control cardiovascular protection weight-related benefits For some patients, abrupt cessation may be unsafe. 3. Early warnings may have overestimated the danger Initial case reports created global concern. But large studies now show aspiration events are very rare, even when gastric contents are present. The review provides clarity by separating: theoretical risks (retained food) actual clinical outcomes (aspiration) 4. Guidelines are rapidly evolving and sometimes confusing The review summarises updates from: ASA (USA) Multi-society US guidance UK Association of Anaesthetists ANZCA (Australia/New Zealand) —helping clinicians navigate inconsistencies and make safe decisions. 5. It provides a practical, patient-centred approach Rather than using rigid rules, the article promotes risk-stratified care, shown clearly in the clinical decision algorithm (Figure 1).
Perspectives
Clinician Perspective Doctors face a dilemma: GLP-1 medications clearly increase stomach contents, but aspiration risk is low. The review helps clinicians balance these competing concerns, offering structured guidance on risk assessment, gastric ultrasound use, diet modification, and when (or when not) to postpone surgery. Patient Perspective Patients on GLP-1 medications often fear their procedure will be cancelled or delayed. The article reassures that most can proceed safely without stopping therapy. Using shared decision-making, clinicians can tailor fasting instructions and risk-reduction strategies while preserving the benefits of long-term treatment. Regulatory & Guideline Perspective The paper highlights how practice recommendations shifted between 2023 and 2025—from widespread cessation to continuation for most patients. It shows how emerging evidence drives policy updates, reducing unnecessary cancellations and improving consistency across hospitals. Anaesthesia & Perioperative Safety Perspective The review reinforces that aspiration—while serious—is rare, and that risk mitigation can be achieved through: - enhanced fasting protocols - point-of-care gastric ultrasound - regional anaesthesia - prokinetics - careful patient selection Rather than assuming every GLP-1 user has a “full stomach,” clinicians can assess risk more accurately.
Professor Chi Eung Danforn Lim
University of Technology Sydney
Read the Original
This page is a summary of: Perioperative Management of GLP-1 Receptor Agonists: Balancing Aspiration Risk with Therapeutic Benefit, SN Comprehensive Clinical Medicine, October 2025, Springer Science + Business Media,
DOI: 10.1007/s42399-025-02079-9.
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