Perioperative Management of GLP-1 Receptor Agonists: Balancing Aspiration Risk with Therapeutic Benefit

Lim, ECN; Lim, CED

Perioperative Management of GLP-1 Receptor Agonists: Balancing Aspiration Risk with Therapeutic Benefit

Lim, ECN Lim, CED

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Publisher:: Springer Science and Business Media LLC
Publication Type:: Journal Article
Citation:: SN Comprehensive Clinical Medicine, 2025, 7, (1), pp. 313
Issue Date:: 2025-12-01

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Field	Value	Language
dc.contributor.author	Lim, ECN
dc.contributor.author	Lim, CED
dc.date.accessioned	2026-01-13T05:39:02Z
dc.date.available	2026-01-13T05:39:02Z
dc.date.issued	2025-12-01
dc.identifier.citation	SN Comprehensive Clinical Medicine, 2025, 7, (1), pp. 313
dc.identifier.issn	2523-8973
dc.identifier.issn	2523-8973
dc.identifier.uri	http://hdl.handle.net/10453/191741
dc.description.abstract	The prescribing of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has surged for the treatment of diabetes and obesity, with more than 15 million users worldwide. These medications also delay gastric emptying through neural mechanisms, increasing the risk for perioperative aspiration during anaesthesia and sedation. This narrative review aims to bridge the gap between evidence and clinical practice regarding the use of GLP-1 RAs in the perioperative period by critically evaluating changing clinical recommendations to inform a balance between the risks of aspiration and the potential surgical benefits. Important conclusions drawn from recent meta-analyses involving over 300,000 patients report that while the retained gastric contents are significantly increased (fivefold to tenfold increase; odds ratio 3.35–36.97), rates of pulmonary aspiration (0.1% to 0.2%) remain quite low, with no significant increase in comparison to control groups. Guidelines have evolved considerably from routine medication cessation in 2023 to GLP-1 RA continuation with individualised risk assessment in 2024–2025, illustrating increasing acknowledgment that certain theoretical risks may be underestimated. The evidence supports shared decision-making frameworks, where patient needs, procedure timeframes, and other management approaches, such as liquid diets, ultrasound evaluation of the stomach preoperatively, or anaesthetic modification tailored techniques, are considered primary drivers for care rather than rigid guidelines. The principle under which GLP-1 RAs should be managed has shifted to strategy layering—restoring calculator systems tailored to patients, rather than blanket medication cessation triggers that dominated prior models’ suspension approach.
dc.language	en
dc.publisher	Springer Science and Business Media LLC
dc.relation.ispartof	SN Comprehensive Clinical Medicine
dc.relation.isbasedon	10.1007/s42399-025-02079-9
dc.rights	info:eu-repo/semantics/openAccess
dc.subject.classification	3202 Clinical sciences
dc.subject.classification	4206 Public health
dc.title	Perioperative Management of GLP-1 Receptor Agonists: Balancing Aspiration Risk with Therapeutic Benefit
dc.type	Journal Article
utslib.citation.volume	7
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Science
pubs.organisational-group	University of Technology Sydney/Faculty of Science/School of Life Sciences
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/
dc.date.updated	2026-01-13T05:39:01Z
pubs.issue	1
pubs.publication-status	Published
pubs.volume	7
utslib.citation.issue	1

Abstract:

The prescribing of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has surged for the treatment of diabetes and obesity, with more than 15 million users worldwide. These medications also delay gastric emptying through neural mechanisms, increasing the risk for perioperative aspiration during anaesthesia and sedation. This narrative review aims to bridge the gap between evidence and clinical practice regarding the use of GLP-1 RAs in the perioperative period by critically evaluating changing clinical recommendations to inform a balance between the risks of aspiration and the potential surgical benefits. Important conclusions drawn from recent meta-analyses involving over 300,000 patients report that while the retained gastric contents are significantly increased (fivefold to tenfold increase; odds ratio 3.35–36.97), rates of pulmonary aspiration (0.1% to 0.2%) remain quite low, with no significant increase in comparison to control groups. Guidelines have evolved considerably from routine medication cessation in 2023 to GLP-1 RA continuation with individualised risk assessment in 2024–2025, illustrating increasing acknowledgment that certain theoretical risks may be underestimated. The evidence supports shared decision-making frameworks, where patient needs, procedure timeframes, and other management approaches, such as liquid diets, ultrasound evaluation of the stomach preoperatively, or anaesthetic modification tailored techniques, are considered primary drivers for care rather than rigid guidelines. The principle under which GLP-1 RAs should be managed has shifted to strategy layering—restoring calculator systems tailored to patients, rather than blanket medication cessation triggers that dominated prior models’ suspension approach.

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http://hdl.handle.net/10453/191741