What are the current preoperative guidelines for patients taking Glucagon-like peptide-1 (GLP-1) agonists?

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Last updated: February 19, 2025 • View editorial policy

From the Guidelines

Current Preoperative Guidelines for Patients Taking GLP-1 Agonists

For patients taking GLP-1 agonists, current preoperative guidelines recommend withholding the medication for at least three half-lives before surgery, depending on the specific medication and the patient's individual risk factors 1, 2, 3.

Medication-Specific Recommendations

  • For patients taking GLP-1 receptor agonists for weight loss, it is recommended to hold the medication for at least three half-lives ahead of the procedure to clear approximately 88% of the drug 1.
  • For patients taking GLP-1 receptor agonists for type 2 diabetes mellitus, consultation with the treating endocrinologist is advised to discuss the risks and benefits of holding the drug for at least three half-lives ahead of the procedure 1.

Key Considerations

  • Aspiration risk reduction strategies should be considered for patients who are unable to hold the GLP-1 receptor agonist for three half-lives before the procedure, those who have recently started the medication or increased their dose, and those experiencing nausea, vomiting, or abdominal distention 1.
  • Prokinetic drugs such as metoclopramide or erythromycin may be considered pre-operatively to reduce the risk of pulmonary aspiration 1.
  • Point-of-care gastric ultrasound may be used to inspect residual gastric contents and guide decision-making 1.
  • Rapid-sequence intubation may be considered to reduce the risk of pulmonary aspiration in high-risk patients 1.

Importance of Individualized Approach

It is essential to consider the patient's renal function, as GLP-1 agonists may need to be withheld for a longer period in patients with impaired renal function. Additionally, the anesthesiologist and surgeon should be informed of the patient's GLP-1 agonist use to ensure proper perioperative management. A shared decision-making approach with patients is recommended to openly discuss the risks and benefits of each option before the procedure 1.

From the Research

Preoperative Guidelines for Patients Taking GLP-1 Agonists

The current preoperative guidelines for patients taking Glucagon-like peptide-1 (GLP-1) agonists are as follows:

  • Patients taking GLP-1 receptor agonists should continue these drugs before surgery 4
  • Patients should have a full risk assessment and stratification 4
  • Peri-operative techniques that may mitigate the risk of pulmonary aspiration should be used before, during, and after sedation or general anesthesia 4
  • The risk of aspiration during general anesthesia is unknown, but caution is advised in patients who recently commenced on GLP-1 receptor agonists 5
  • After over 12 weeks of treatment, standard fasting times likely suffice to manage the risk of pulmonary aspiration for most otherwise low-risk patients 5

Key Considerations

  • GLP-1 receptor agonists delay gastric emptying, which may increase the risk of bronchoaspiration despite fasting intervals that comply with current guidelines 6
  • The use of GLP-1 receptor agonists may increase the risk of pre-procedural gastrointestinal symptoms and elevated residual gastric content 7
  • GLP-1 receptor agonists may improve glycemic control and decrease the rate of rescue insulin administration 7

Recommendations

  • Clinicians should be aware of the potential risks associated with the perioperative use of GLP-1 receptor agonists and follow the recommendations put forth by their respective Anesthesiology Societies 6
  • A shared decision-making approach should be used to discuss risks and mitigation strategies with patients 4

References

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.