Summary: New Perioperative Recommendations for GLP-1 RA Users
Summary:
New Perioperative Recommendations for GLP-1 RA Users
Source: Medscape June 5 / British Journal of Anaesthesia, June 2025 .
1. Key Update:
• Patients on GLP-1 receptor agonists (GLP-1 RAs) should continue their medication before anesthesia but fast from solid foods for 24 hours to reduce aspiration risk.
2. Rationale:
• GLP-1 RAs delay gastric emptying, which may increase residual stomach content despite standard 8-hour fasting.
• Extended fasting time helps mitigate aspiration risk while preserving the benefits of GLP-1 RAs (e.g., glycemic control).
3. Background:
• 2023 ASA guidelines suggested holding GLP-1s for one half-life and following standard 8-hour fasting.
• New evidence shows delayed gastric emptying may persist beyond one half-life, especially with long-acting agents like semaglutide and tirzepatide.
4. Updated Consensus (2025):
• Continue GLP-1 RAs in patients without significant GI symptoms.
• Solid food fasting: 24 hours before anesthesia.
• Clear liquids only allowed during fasting period.
• No liquids at all within 4 hours of procedure.
• Avoid high-glucose clear liquids (>10% glucose) in the last 8 hours pre-op.
5. Patients at Higher Risk:
• Those in dose escalation phase, on weekly or high doses, or with GI symptoms (nausea, vomiting, bloating).
• Should adhere strictly to 24-hour liquid diet and be evaluated individually.
6. Postponing Procedures:
• Elective procedures should be delayed if patients exhibit severe GI symptoms.
• Physicians should assess and modify treatment or diet in such cases.
7. Criticism and Debate:
• Some experts argue there’s insufficient evidence to stratify patients by dose or phase.
• Absence of GI symptoms doesn’t guarantee an empty stomach.
8. Basis of Recommendation:
• Derived from a systematic review of 112 studies and a modified Delphi consensus process.
• Endorsed by: Society for Perioperative Assessment and Quality Improvement & American Association of Clinical Endocrinology.
9. Clinical Implication:
• Aims to balance safety and continuity of care, especially in diabetic patients where stopping GLP-1s may worsen outcomes or trigger side effects on reinitiation.
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