Glucagon-like peptide-1 receptor agonists (GLP-1RAs) (Wegovy, Ozempic, Saxenda, Trulicity) have revolutionized the care of patients with metabolic disease such as obesity and diabetes due in part to the agonists’ unique combination of effects, including decreasing hyperglycemia and enhancement of satiety.

An increasing safety concern has developed amongst anesthesia providers regarding the perioperative use of GLP-1RA due to delayed gastric emptying and subsequent residual gastric contents on the day of the procedure despite traditional fasting. There have been reports of pulmonary aspiration of gastric contents in patients on GLP-1RAs undergoing procedural sedation and/or general anesthesia. Further, GLP-1RAs induce common side effects of nausea, vomiting, abdominal pain, and constipation, which may complicate the diagnosis and treatment of preoperative and postoperative disease states that share these symptoms.

Patients in the escalation phase of GLP-1 drugs (early in treatment) are more likely to have delayed stomach emptying. The escalation phase (when the patient is given increasing doses of the GLP-1 drug) typically lasts four to eight weeks, depending on the drug and the reason it has been prescribed. Elective surgery should be deferred and only proceed once the escalation phase has passed, and GI side effects have dissipated.

Patients who have GI symptoms, including nausea, vomiting, abdominal pain, shortness of breath or constipation should wait until their symptoms have dissipated before proceeding with elective surgery.

Patients on a higher dose or weekly dosing of the GLP-1 drug typically have more GI side effects and should follow a liquid diet for 24 hours before the procedure.

Patients with other medical conditions that slow stomach emptying, such as Parkinson’s disease or gastroparesis, may further modify the perioperative management plan.