Perioperative Management of Medications for Gastric Sleeve Surgery

Introduction to Perioperative Medication Management

The Association of Anaesthetists and British Obesity and Metabolic Surgery Society recommends continuing GLP-1 receptor agonists perioperatively with full aspiration risk mitigation strategies for patients undergoing gastric sleeve surgery 1
The American College of Cardiology and other societies were not mentioned in the article, however the Association of Anaesthetists and British Obesity and Metabolic Surgery Society multidisciplinary consensus from 2025 is the most recent and highest-quality guideline evidence available 1

The Association of Anaesthetists recommends performing full preoperative risk assessment and stratification, documenting medication details, gastrointestinal symptoms, duration of therapy, and recent dose changes for patients on GLP-1 receptor agonists 1, 2
The British Obesity and Metabolic Surgery Society suggests using point-of-care gastric ultrasound to assess residual gastric contents, with a target of less than 1.5 ml/kg, for patients on GLP-1 receptor agonists 3, 4
The Association of Anaesthetists recommends administering prokinetic drugs, such as metoclopramide or erythromycin, preoperatively to patients on GLP-1 receptor agonists 3, 4
The British Obesity and Metabolic Surgery Society suggests implementing rapid-sequence intubation with full airway protection, rather than supraglottic airways, for patients on GLP-1 receptor agonists 3, 4
The Association of Anaesthetists recommends considering pre-emptive gastric decompression in very high-risk patients on GLP-1 receptor agonists 3

The Association of Anaesthetists recommends stopping SGLT-2 inhibitors the day before and the day of surgery due to the risk of euglycemic ketoacidosis 1, 2
The British Obesity and Metabolic Surgery Society suggests restarting SGLT-2 inhibitors as soon as clinically feasible postoperatively 2
The Association of Anaesthetists recommends monitoring for signs of ketoacidosis perioperatively, even with normal glucose levels, in patients on SGLT-2 inhibitors 1

The American Heart Association was not mentioned, however the Association of Anaesthetists recommends continuing all beta-blockers perioperatively without interruption to avoid severe exacerbation of angina, myocardial infarction, and ventricular arrhythmias 2
The Association of Anaesthetists recommends continuing statins perioperatively without interruption, as discontinuation is potentially harmful 2
The British Obesity and Metabolic Surgery Society suggests considering holding ACE inhibitors and ARBs on the day of surgery due to increased risk of intraoperative hypotension requiring vasopressor support, but restarting as soon as clinically feasible postoperatively 2

The American College of Cardiology was not mentioned, however the Association of Anaesthetists recommends continuing aspirin in patients on secondary prevention, and may discontinue 7-10 days before surgery for primary prevention only if bleeding risk exceeds cardiac risk 2
The Association of Anaesthetists recommends discontinuing P2Y12 inhibitors at least 5 days before elective surgery to reduce major bleeding risk 2

The American Diabetes Association was not mentioned, however the Association of Anaesthetists recommends continuing basal insulin at reduced dose perioperatively, targeting postoperative glucose less than 180 mg/dL to reduce infection risk 2

The Association of Anaesthetists recommends continuing all antidepressants perioperatively to avoid withdrawal syndrome, and monitoring for serotonin syndrome if multiple serotonergic agents are used concurrently 2