Perioperative anesthesia management of GLP-1 receptor agonists: a systematic review of potential risks

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) were initially developed for the management of type 2 diabetes, due to their role in enhancing insulin secretion, decreasing glucagon secretion, and delaying gastric emptying. Although these mechanisms have been exploited to facilitate weight loss, these medications have also been indicated for patients with cardiovascular or renal diseases, all of which have caused a recent drastic rise in prescribing GLP-1 RAs. However, the current American Society of Anesthesiologists (ASA) guidelines express concerns of an increased risk of aspiration in the perioperative setting due to the well-documented delayed gastric emptying. This systematic review evaluates the literature on the relationship between GLP-1 RA use and increased regurgitation and aspiration events to contextualize the existing, consensus-based guidelines put forth by the ASA in light of limited comparative evidence. A systematic search was conducted across PubMed, Google Scholar, SCOPUS, MEDLINE, and EMBASE from inception to January 17, 2025, yielding over 1.3 million articles. After a PRISMA analysis was completed on the initial search and articles were screened based on predefined eligibility criteria, 32 articles were selected for review and analysis. Although most of the studies reported an association between GLP-1 RA and increased residual gastric contents, evidence linking these medications to a statistically significant rise in regurgitation or aspiration events remains highly inconsistent. The variability in available studies, potential confounding factors, and the severe heterogeneity of conclusions all emphasize the need for more high-quality evidence-based primary research to optimize perioperative management of patients taking GLP-1 RAs.