By Thomas Davis, DNAP, MAE, CRNA
The use of GLP-1 drugs has increased exponentially over the past decade and, according to information provided by the Gallup organization, 11% of the US population take this medication for the purpose of weight control/loss. In addition, GLP-1 drugs have provided a significant breakthrough for glycemic control in diabetic patients. GI procedures typically require heavy sedation/general anesthesia with an unprotected airway and, if you work in a busy GI center, it is likely that every day you will have several patients on this medication.
The anesthetic implication of GLP-1 drugs on anesthesia safety are well known. Almost from the introduction of this family of drugs, anesthesia providers were aware of delayed gastric emptying and the increased risk for aspiration. Strict guidelines were established recommending discontinuing the medication 7 days prior to the procedure, a clear liquid diet 24 hours prior to procedure and NPO for liquids 4 hours preop rather than the usual 2 hours.
The first GLP-1 drug, exenatide (Byetta) was FDA approved for release in 2005 for the treatment of type 2 diabetes. Along with glycemic control, it quickly became obvious that the drug also facilitated weight loss. Now, two decades later, GLP-1 drugs are highly prescribed for both diabetic patients and the general population who desire weight loss.
As with COVID, healthcare providers responded to the situation at hand and learned the nuances of the disease and modified treatment protocols over time as more information became available. Likewise, our knowledge of GLP-1 drugs has evolved over time. Because we frequently have patients who take this medication, an update/refresher is appropriate.
A review published by the Mayo Clinic in 2026 noted several considerations related to GLP-1 drugs beyond the obvious delay in gastric emptying. The review notes that weight loss does not come from fat alone, rather, there is also a loss of lean body mass including skeletal muscle, organs, bone, body water, and connective tissue. In addition, there is a reduction in the basal metabolic rate which reduces the metabolism of drugs and makes the patient susceptible to rapid weight gain when the drugs are discontinued.
Should GLP-1 drugs be discontinued prior to receiving anesthesia. The Mayo Clinic offers some leeway and suggests that patients should be evaluated individually when making the decision. Why is the patient taking the drug, how long have they been on it, and does it cause symptoms? If the patient is on a GLP-1 drug for glycemic control, coordination with endocrinology is appropriate before discontinuing the drug. If the patient has been on a steady dose of the medication for weight loss and they do not have symptoms, then it may be OK to continue the drug and enforce strict liquid diet 24 hours prior to surgery. Those who take a daily dose should hold the dose on the day of the procedure.
Patients who are relatively new to taking GLP-1 drugs for weight control or increasing the dose should have the drug stopped a week prior to the procedure. In addition, any patient taking GLP1 drugs for any reason and who experience nausea, vomiting, or bloating after taking the drug should have the drug held for a week prior to the procedure. When in doubt, a point of care gastric ultrasound to assess gastric content is recommended.
The bottom line is that we must continue to be vigilant and anticipate the potential for residual gastric content when dealing with patients on GLP-1 drugs however stopping the drug one week prior to the procedure is not an absolute requirement for all patients. That said, clear liquids for 24 hours pre-op and longer pre-op NPO for liquids is recommended.
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