Multi-society guidance replaces the standalone anesthesia advice on GLP-1 drugs

Five medical organizations released joint clinical practice guidance in October 2024 on how to manage patients taking GLP-1 receptor agonists before surgery or procedures requiring anesthesia ^[1]. The guidance replaces earlier standalone advice and comes from the American Society of Anesthesiologists (ASA), the American Gastroenterological Association, the American Society for Metabolic and Bariatric Surgery, the International Society of Perioperative Care of Patients with Obesity, and the Society of American Gastrointestinal and Endoscopic Surgeons ^[1].

The central message is that most patients should keep taking their GLP-1 drugs before elective surgery ^[1]. Patients at highest risk for gastrointestinal side effects should follow a liquid-only diet for 24 hours before their procedure or take other precautions depending on their situation ^[1]. About one in eight U.S. adults use GLP-1 drugs, including Ozempic, Wegovy, Saxenda and Trulicity, for diabetes, weight loss or heart problems ^[1].

The concern behind the guidance is that GLP-1 drugs delay stomach emptying, which can leave food in the stomach and raise the risk of regurgitation and aspiration into the lungs during general anesthesia or deep sedation — a complication that can lead to potentially fatal aspiration pneumonia ^[1]. But the guidance also warns that withholding the medication carries its own risks, including higher blood sugar in people with diabetes, so the benefit of pausing treatment must be weighed against those risks ^[1].

The guidance identifies specific groups at higher risk. Patients in the escalation phase — when doses are still being increased, typically for four to eight weeks depending on the drug — are more likely to have delayed stomach emptying and should have elective surgery deferred until that phase passes and GI symptoms subside ^[1]. Patients with ongoing GI symptoms such as nausea, vomiting, abdominal pain, shortness of breath or constipation should wait until those symptoms resolve ^[1]. Those on higher doses, who tend to have more GI side effects, should follow the 24-hour liquid diet before their procedure ^[1]. Patients with other conditions that slow stomach emptying, such as Parkinson's disease, may need further adjustments to their anesthesia plan ^[1].

To manage risk without unnecessarily stopping treatment, the guidance suggests care teams can adjust the anesthesia plan itself or use point-of-care ultrasound right before a procedure to check stomach contents in high-risk patients ^[1]. In some cases, surgery should be delayed until risk decreases, according to the guidance and a related letter in the journal Anesthesiology by Dr. Girish P. Joshi, a coauthor of the guidance ^[1].

Why it matters for patients

For the roughly one in eight U.S. adults taking these medications, this guidance means a scheduled surgery does not automatically require stopping a GLP-1 drug ^[1]. Instead, the recommendation depends on individual risk factors — how long someone has been on the drug, their dose, and whether they have GI symptoms ^[1]. ASA President Dr. Donald E. Arnold said scheduling of elective procedures should account for when the risk of delayed stomach emptying is highest, such as during dose escalation or when GI symptoms are present, so risks can be minimized in advance ^[1].

The guidance also flags a fairness concern: withholding GLP-1 drugs only from patients who are obese or overweight could constitute bias and should be avoided ^[1]. It notes that pausing medication can be resource intensive, costly, or blocked by insurance rules, and stopping the drug carries its own downsides, such as effects on blood sugar control ^[1].

What this means in practice is that patients should expect their anesthesiologist, surgeon and prescribing provider to coordinate on a plan tailored to their situation rather than following a blanket rule ^[1]. It is not yet known from these sources how quickly hospitals and surgical centers nationwide will adopt the new guidance into their own protocols.