Guidelines for Managing Patients on GLP-1 Receptor Agonists Undergoing General Anaesthesia

Medication Management

• The Association of Anaesthetists recommends continuing GLP-1 receptor agonists before surgery rather than stopping them, as part of a multidisciplinary consensus 1
• For non-diabetic patients using GLP-1 RAs for weight loss, the American College of Physicians suggests holding semaglutide for at least 3 weeks before elective surgery 2
• For diabetic patients, the European Association for the Study of Diabetes recommends consulting with endocrinology to weigh glycemic control benefits against aspiration risk 2

Risk Assessment and Stratification

• The American Society of Anesthesiologists suggests documenting medication details, gastrointestinal symptoms, co-prescribed medications, and recent recreational drug use in preoperative assessment 2
• The Association of Anaesthetists recommends considering the duration since starting or dose escalation of GLP-1 RAs, as patients who recently started or increased dose require extra caution 2

Risk Mitigation Strategies

• The American College of Surgeons recommends considering postponement and rescheduling of the procedure to allow adequate medication clearance 2
• The Society of Critical Care Medicine suggests using point-of-care gastric ultrasound pre-operatively to assess for residual gastric contents 2
• The American Society of Anesthesiologists recommends administering prokinetic drugs such as metoclopramide or erythromycin pre-operatively to enhance gastric emptying 2

Intraoperative Techniques

• The Association of Anaesthetists recommends implementing rapid-sequence intubation with full airway protection 2
• The American College of Surgeons suggests choosing endotracheal intubation over supraglottic airways, as case reports show aspiration with supraglottic devices 2

Special Considerations

• The National Kidney Foundation recommends no dose adjustment for semaglutide, liraglutide, or dulaglutide across all stages of chronic kidney disease 4
• The European Association for the Study of the Liver suggests that patients with liver impairment can safely receive GLP-1 RAs, as these medications may improve metabolic dysfunction-associated steatotic liver disease 4