Perioperative Management of GLP-1 Receptor Agonists in Anesthesia: A Narrative Review

Glucagon like peptide 1 (GLP-1) receptor agonists, commonly known as GLP-1 receptor agonists, are increasingly used for type 2 diabetes, obesity, and cardiovascular risk reduction. Common examples include semaglutide, liraglutide, dulaglutide, and tirzepatide. Their rising use has created new concerns in anesthesia because these medications can delay gastric emptying, which may increase the risk of residual gastric contents, regurgitation, and pulmonary aspiration during sedation or general anesthesia. Early guidance recommended holding these medications before surgery, but newer multi-society guidance suggests that most patients can continue GLP-1 therapy before elective procedures, with individualized risk assessment for patients at higher risk. This narrative review discusses the mechanism of GLP-1 receptor agonists, perioperative aspiration concerns, evolving anesthesia guidelines, and practical clinical approaches for safe perioperative care.