Perioperative management of long-acting glucagon-like peptide-1 (GLP-1) receptor agonists: concerns for delayed gastric emptying and pulmonary aspiration

Br J Anaesth. 2024 Apr;132(4):644-648. doi: 10.1016/j.bja.2024.01.001. Epub 2024 Jan 29.

Abstract

Prescriptions and use of glucagon-like peptide-1 (GLP-1) receptor agonists are increasing dramatically, as indications are expanding from the treatment of diabetes mellitus to weight loss for people with obesity. As GLP-1 receptor agonists delay gastric emptying, perioperative healthcare practitioners could be concerned about an increased risk for pulmonary aspiration during general anaesthesia. We summarise relevant medical literature and provide evidence-based recommendations for perioperative care for people taking GLP-1 receptor agonists. GLP-1 receptor agonists delay gastric emptying; however, ongoing treatment attenuates this effect. The risk of aspiration during general anaesthesia is unknown. However, we advise caution in patients who recently commenced on GLP-1 receptor agonists. After over 12 weeks of treatment, standard fasting times likely suffice to manage the risk of pulmonary aspiration for most otherwise low-risk patients.

Keywords: diabetes mellitus; gastric emptying; glucagon-like peptide-1 receptor agonists; obesity; pulmonary aspiration.

Publication types

  • Editorial

MeSH terms

  • Diabetes Mellitus, Type 2*
  • Gastric Emptying
  • Gastroparesis* / chemically induced
  • Glucagon-Like Peptide 1 / agonists
  • Glucagon-Like Peptide 1 / therapeutic use
  • Humans
  • Hypoglycemic Agents / adverse effects

Substances

  • Hypoglycemic Agents
  • Glucagon-Like Peptide 1