Perioperative Management of Patients Receiving GLP‑1 Receptor Agonists: An Updated Clinical Review

Abstract

Glucagon‑like peptide‑1 receptor agonists (GLP‑1 RAs) are increasingly prescribed for type 2 diabetes, obesity, and cardiometabolic risk reduction. Their pharmacologic actions include delayed gastric emptying, appetite suppression, and improved glycaemic control, which have important implications for perioperative care. Recent multi‑society guidance suggests that most patients can safely continue GLP‑1 RAs before elective surgery, while those at highest risk for gastrointestinal side effects may benefit from a pre‑procedural liquid diet and individualized planning.(1) Multidisciplinary consensus statements from the UK, Australia, and international societies emphasize risk stratification rather than routine discontinuation, integrating factors such as treatment phase, dose, gastrointestinal symptoms, and procedural risk. (2), (3), (4) This narrative review synthesizes current evidence and guidelines to provide a practical framework for anaesthesiologists and perioperative teams. Key elements include structured preoperative assessment, selective use of gastric ultrasound, full‑stomach precautions in high‑risk patients, and timely postoperative resumption of therapy. A patient‑centred, risk‑based approach can minimize aspiration risk while preserving metabolic stability and continuity of chronic disease management. (1), (3), (5)

Keywords: GLP‑1 receptor agonists; semaglutide; perioperative management; anaesthesia; gastric emptying; aspiration risk; diabetes; obesity