Preoperative Strategies for Patients on Glucagon-like Peptide-1 Receptor Agonists Navigating Current Controversies and Future Directions

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as valuable therapeutic options for managing type 2 diabetes mellitus because they allow glycemic control without increasing the potential for hypoglycemia.^1,2  Also, they provide significant cardiovascular and renal benefits as well as lead to weight loss.^1–5  In addition to diabetes mellitus, they are being used extensively for managing obesity.¹  There is emerging evidence suggesting potential benefits of GLP-1RAs in the management of metabolic liver disease, obstructive sleep apnea, peripheral vascular disease, depression, addiction, and neurodegenerative disorders (e.g., Parkinson’s and Alzheimer’s disease).¹  With expanding indications, the clinical use of these drugs is expected to grow exponentially. Because GLP-1RAs can delay gastric emptying, they can potentially increase residual gastric volume despite recommended fasting duration.^2,6  This might increase the propensity for regurgitation and aspiration of gastric content during sedation and general anesthesia.² 

In this...