Study: GLP-1 drugs heighten risk of gastric residue but not perioperative pulmonary aspiration

Editor's Note

Taking GLP-1 receptor agonists before anesthesia increases the risk of residual gastric contents, but evidence is lacking for a corresponding increase in perioperative pulmonary aspiration risk, according research published April 15 in the journal Anaesthesia.

The systematic review and meta-analysis analyzed 28 observational studies involving over 466,000 patients to evaluate whether pre-operative GLP-1 receptor agonist (GLP-1 RA) use is associated with pulmonary aspiration or increased residual gastric content in fasted patients undergoing procedures with anesthesia or sedation.  Key findings include:

• Pulmonary aspiration: Among 304,060 patients across nine studies, there was no significant association between GLP-1 RA exposure and pulmonary aspiration (OR 1.04; 95% CI 0.87–1.25), though the certainty of this evidence was low.
• Residual gastric contents: Across 18 studies with 165,522 patients, GLP-1 RA use was strongly associated with the presence of residual gastric contents despite appropriate fasting (OR 5.96; 95% CI 3.96–8.98), although the certainty of evidence was also low due to study design limitations and heterogeneity.
• Withholding medication: In five studies including 1,706 patients, skipping at least one GLP-1 RA dose prior to a procedure was associated with lower odds of residual gastric contents (OR 0.51; 95% CI 0.33–0.81), but this estimate was based on very low-certainty evidence.

Although the incidence of pulmonary aspiration was low, residual gastric contents could complicate procedures like gastroscopy, increasing the likelihood of aborted procedures and unnecessary anesthesia exposure, authors write. They emphasize that tailored pre-operative guidance may be warranted for patients on GLP-1 RAs, particularly when procedures require a clear stomach.

Ultimately, while current evidence does not support a broad recommendation to withhold GLP-1 RAs before surgery, further high-quality research—especially randomized controlled trials—is needed, researchers conclude. Until then, the decision to withhold these medications should be made collaboratively based on situational considerations.