Authors: Boudreau B et al.
Cureus 17(11): e95986, November 2025. DOI: 10.7759/cureus.95986
This qualitative survey captured practicing anesthesiologists’ experiences with GLP-1 receptor agonists (GLP-1 RAs) in elective surgery and their views on the ASA’s 2023 consensus guidance. The instrument was developed via expert focus groups, iterative validation, cognitive interviews, and pretesting, then deployed nationally via Qualtrics and snowball sampling. In total, 277 clinicians responded to one or more items; 233 completed the full survey. Respondents spanned career stages, and most reported seeing GLP-1 RA patients at least weekly.
Knowledge and adoption were high: 66% had read the 2023 ASA guidance, 72% reported following it (often alongside local policies), and 66% agreed/strongly agreed it preserves patient safety. Yet free-text comments repeatedly cited limited evidence, confusion about when to hold weekly vs daily agents, and uncertainty around the role and practicality of gastric point-of-care ultrasound (POCUS). Reported barriers included inconsistent hospital instructions, productivity and satisfaction pressures, surgeon resistance, and variable interpretations of the guidance.
When patients had not held a GLP-1 RA appropriately, symptoms most likely to trigger case cancellation were vomiting, nausea, fullness, and bloating; many respondents also favored treating such patients as “full stomach” or using gastric POCUS when available. Interest in gastric POCUS was substantial (about 70% somewhat/very interested or already training), though some questioned feasibility, access, and interpretive reliability.
The discussion acknowledges the subsequent October 2024 multi-societal update that allows continuation of GLP-1 RAs in low-risk patients and recommends a 24-hour liquid diet, selective POCUS, or reversion to 2023 “hold” guidance for higher-risk scenarios—underscoring the field’s evolving, still evidence-limited state. The authors call for rigorous studies to quantify aspiration risk, standardize POCUS use, and refine hold/continuation strategies.
What You Should Know:
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Most anesthesiologists in this sample see GLP-1 RA patients frequently and report general alignment with the 2023 ASA guidance, despite perceived evidence gaps.
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Practical friction points include inconsistent institutional messaging, surgeon pressure, and uncertainty about holding intervals and gastric POCUS utility.
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Cancellation triggers when meds aren’t held commonly include vomiting, nausea, fullness, and bloating; many adopt full-stomach precautions.
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Interest in gastric POCUS is high, but access, training, and decision thresholds vary; standardized pathways are needed.
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The 2024 multi-societal update supports continuation in low-risk cases with a liquid diet strategy, highlighting a shift toward individualized risk stratification pending stronger evidence.
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