Matthew Oh
Introduction
Glucagon-like peptide-1 (GLP-1) receptor agonists and dual GIP/GLP-1 agents are increasingly used for obesity and type 2 diabetes across NHS and independent healthcare settings. Within day-case surgery, a key concern is delayed gastric emptying, increasing risk of pulmonary aspiration under anaesthesia and sameday cancellations. This review examines current evidence and guidance to support peri-operative decision-making and provide recommendations on medication cessation and resumption.
Methods
A narrative review was performed incorporating international and UK guidance, including anaesthetic recommendations, NHS policy documents, NICE guidance, and clinical reviews. Key areas included pharmacological mechanisms, reported aspiration events, reliability of fasting protocols, and strategies for peri-operative risk stratification and pathway optimisation.
Results
Evidence demonstrates that GLP-1 and dual GIP/GLP-1 therapies delay gastric emptying and may result in retained gastric contents despite adherence to standard fasting guidance. Management is increasingly individualised, favouring continuation with risk stratification, enhanced pre-operative assessment, modified fasting or dietary measures, and adjustment of anaesthetic technique. Consensus supports treating higher-risk patients as having a “full stomach”, particularly those in the dose-escalation phase, with gastrointestinal symptoms or other risk factors for delayed gastric emptying. Increasing private prescribing raises concern regarding incomplete drug histories and inconsistent perioperative advice, contributing to avoidable day-of-surgery disruption.
Conclusions
GLP-1 therapies present a growing challenge for safe and efficient day-case surgery. Pre-assessment screening, clear medication disclosure, and standardised cessation and resumption protocols are essential. Proactive identification and management of GLP-1 use can reduce aspiration risk, minimise same-day
cancellations, and support safe ambulatory surgical pathways within an evolving prescribing landscape.
Authors
Matthew Oh, Tamer Hasablla, Basim Al-Robaie, Shameen Jaunoo
East Sussex Healthcare NHS Trust, Hastings, United Kingdom