Perioperative Management of GLP-1 Receptor Agonists in Anesthesia: A Narrative Review
Article Sidebar
Main Article Content
Abstract
Glucagon like peptide 1 (GLP-1) receptor agonists, commonly known as GLP-1 receptor agonists, are increasingly used for type 2 diabetes, obesity, and cardiovascular risk reduction. Common examples include semaglutide, liraglutide, dulaglutide, and tirzepatide. Their rising use has created new concerns in anesthesia because these medications can delay gastric emptying, which may increase the risk of residual gastric contents, regurgitation, and pulmonary aspiration during sedation or general anesthesia. Early guidance recommended holding these medications before surgery, but newer multi-society guidance suggests that most patients can continue GLP-1 therapy before elective procedures, with individualized risk assessment for patients at higher risk. This narrative review discusses the mechanism of GLP-1 receptor agonists, perioperative aspiration concerns, evolving anesthesia guidelines, and practical clinical approaches for safe perioperative care.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Holst JJ. The physiology of glucagon-like peptide 1. Physiological Reviews. 2007;87(4):1409-1439. doi:10.1152/physrev.00034.2006.
Hjerpsted JB, Flint A, Brooks A, Axelsen MB, Kvist T, Blundell J. Semaglutide improves postprandial glucose and lipid metabolism and delays first-hour gastric emptying in subjects with obesity. Diabetes, Obesity and Metabolism. 2018;20(3):610-619. doi:10.1111/dom.13120.
Halawi H, Khemani D, Eckert D, et al. Effects of liraglutide on weight, satiation, and gastric functions in obesity: a randomized, placebo-controlled pilot trial. The Lancet Gastroenterology & Hepatology. 2017;2(12):890-899. doi:10.1016/S2468-1253(17)30285-6.
Maselli DB, Camilleri M. Effects of GLP-1 and its analogs on gastric physiology in diabetes mellitus and obesity. Advances in Therapy. 2021;38(10):5261-5274. doi:10.1007/s12325-021-01886-8.
American Society of Anesthesiologists Task Force on Preoperative Fasting. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures. Anesthesiology. 2017;126(3):376-393. doi:10.1097/ALN.0000000000001452.
Perlas A, Van de Putte P, Van Houwe P, Chan VWS. Point-of-care gastric ultrasound: an aspiration risk assessment tool. Canadian Journal of Anesthesia. 2018;65(4):437-444. doi:10.1007/s12630-017-1031-9.