Guidelines for Perioperative GLP-1 Receptor Agonist Management

This manuscripy details the perioperative management of patients taking glucagon-like peptide-1 receptor agonists (GLP-1 RAs). GLP-1 RAs are medications primarily used to treat type 2 diabetes and obesity by improving blood sugar control and promoting weight loss. The authors aimed to develop evidence-based recommendations for managing these medications before and after surgical procedures, addressing concerns such as delayed gastric emptying and aspiration risks during anesthesia.

GLP-1 RAs are widely used due to their benefits for diabetes and obesity management, including reducing cardiovascular risks. However, their ability to slow gastric emptying raises concerns about the potential for perioperative pulmonary aspiration. With more patients taking GLP-1 RAs, clear guidelines are essential for ensuring patient safety during surgical procedures while maintaining the benefits of these medications.

The authors conducted a systematic review of existing studies and case reports, registered under PROSPERO, to analyze the effects of GLP-1 RAs on gastric emptying and perioperative outcomes. A multidisciplinary taskforce, including anesthesiologists, endocrinologists, and other specialists, used a Delphi consensus process to formulate recommendations. The taskforce reviewed literature, developed clinical scenarios, and voted on proposed management strategies.

GLP-1 RAs delay gastric emptying for both solids and liquids , increasing residual gastric contents. Standard ASA fasting guidelines are insufficient for patients taking these medications, and aspiration risk is not always correlated with reported symptoms. Evidence supports fasting for solids for 24 hours and clear liquids for 4 to 8 hours prior to anesthesia in patients taking GLP-1 RAs, depending on caloric content. Discontinuing long-acting GLP-1 RAs for less than four to five weeks may not fully restore normal gastric emptying.

This manuscript was developed by the Society for Perioperative Assessment and Quality Improvement (SPAQI) in collaboration with the American Association of Clinical Endocrinology (AACE). No funding was received for this project.