Turkish journal of anaesthesiology and reanimationJun 23, 2026

Managing Surgery in Patients Taking GLP-1 Medicines: Current Evidence, Risks, and Practical Advice

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Jun 24, 2026

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may impair solid-phase gastric emptying and increase residual gastric contents (RGCs).

GLP-1 RAs are increasingly prescribed for diabetes and obesity, leading to more surgical patients using these agents.
Mechanistic studies and clinical investigations indicate that GLP-1 therapies consistently delay gastric emptying, particularly during early treatment and dose increases.
Reports suggest that RGCs can persist despite standard fasting and short-term interruption of GLP-1 therapy.
While clinically apparent aspiration events are uncommon, there have been multiple accounts of perioperative regurgitation and unexpected solid gastric contents.
Recent recommendations advocate for continuing GLP-1 therapy in asymptomatic patients while implementing enhanced perioperative strategies.
An individualized, risk-adapted approach to GLP-1 therapy and perioperative management is supported, with further studies needed to clarify aspiration risk.

Simplified

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual glucose-dependent insulinotropic polypeptide GLP-1 RAs are increasingly prescribed for diabetes and obesity, leading to a growing number of surgical patients receiving these agents. Their ability to delay gastric emptying has raised concerns about residual gastric contents (RGCs) and potential aspiration during anaesthesia. Available evidence from mechanistic studies, clinical investigations, and case reports indicates that GLP-1-based therapies consistently impair solid-phase gastric emptying and may increase RGC, particularly during early treatment and dose escalation, with effects that can persist despite standard fasting and short-term drug interruption. Although clinically apparent aspiration events remain uncommon, multiple reports have described perioperative regurgitation or unexpected solid gastric contents at induction. Early guidance favoured routine preoperative drug interruption; however, more recent multisociety recommendations increasingly support continuation of therapy in most asymptomatic patients and endorse enhanced perioperative mitigation strategies, such as dietary modification, strict adherence to fasting, selective use of point-of-care gastric ultrasound, preference for regional anaesthesia when feasible, and tailored airway management. Overall, current data support an individualised, risk-adapted approach rather than uniform interruption of GLP-1 therapy. Continuation of structured mitigation appears reasonable for many patients, whereas heightened caution and full-stomach precautions remain appropriate in higher-risk situations. Further prospective studies are required to define true perioperative aspiration risk and to establish evidence-based management pathways.

Funding

Competing interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

PubMed

Managing Surgery in Patients Taking GLP-1 Medicines: Current Evidence, Risks, and Practical Advice

Abstract

Funding

Competing interests

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Abstract

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