Authors: Oprea AD et al.
British Journal of Anaesthesia, volume 135, issue 1, 2026
This multidisciplinary consensus statement from the Society for Perioperative Assessment and Quality Improvement (SPAQI) addresses the increasingly common perioperative challenge of managing patients taking glucagon-like peptide-1 receptor agonists (GLP-1 RAs). With widespread use for diabetes mellitus, obesity, and cardiovascular risk reduction, these medications pose unique anesthetic considerations because of their effects on gastric emptying and aspiration risk.
Using a systematic review and a structured modified Delphi process, the panel developed evidence-based recommendations for perioperative continuation of GLP-1 RAs and for preoperative fasting of both solids and liquids. The authors emphasize that delayed gastric emptying can occur in patients taking GLP-1 RAs regardless of drug type, dose, treatment duration, or the presence of gastrointestinal symptoms. Importantly, asymptomatic patients may still have significant residual gastric contents.
The consensus recommends continuing GLP-1 RAs perioperatively in patients without significant gastrointestinal symptoms, given the clear metabolic and cardiovascular benefits of these agents and the lack of evidence that routine discontinuation reduces aspiration events. However, standard fasting guidelines are considered insufficient. For patients without significant symptoms, the panel recommends a clear liquid diet with fasting from solids for 24 hours prior to procedures requiring anesthesia. Additional distinctions are made between low-calorie and high-calorie liquids, with longer fasting intervals advised for carbohydrate-containing fluids.
For patients with significant gastrointestinal symptoms such as severe nausea, vomiting, or inability to tolerate oral intake, elective procedures should be delayed and managed in conjunction with the prescribing clinician to allow dietary modification, dose de-escalation, or medication interruption. On the day of surgery, patients who have not followed dietary instructions or who are within weeks of dose initiation or escalation should be treated as having a full stomach, with anesthetic planning adjusted accordingly. Point-of-care gastric ultrasound is highlighted as a useful adjunct when uncertainty exists.
The statement also addresses postoperative management, recommending that both inpatients and outpatients restart GLP-1 RAs once they resume their usual diets, balancing glycemic control, cardiovascular protection, and tolerability.
Overall, this consensus provides a structured, physiology-driven approach that departs from prior inconsistent society guidance by focusing on fasting modification rather than routine medication discontinuation, aiming to reduce aspiration risk while preserving the perioperative benefits of GLP-1 RAs.
Key Points
GLP-1 receptor agonists delay gastric emptying and may increase aspiration risk even in asymptomatic patients.
Routine discontinuation of GLP-1 RAs before surgery is not recommended in patients without significant gastrointestinal symptoms.
Standard fasting guidelines are inadequate; a 24-hour fast from solids with clear liquids is advised for most patients on GLP-1 RAs.
High-carbohydrate liquids require longer fasting than low- or no-calorie clear liquids.
Patients with significant gastrointestinal symptoms should have elective procedures deferred and medications adjusted.
Gastric ultrasound can help guide anesthetic decision-making when fasting adherence or gastric status is uncertain.
This article has not been done before and is not a duplicate of any prior summaries we have cataloged.
Thank you to the British Journal of Anaesthesia for allowing us to summarize and discuss this article.