Glucagon-like polypeptide-1 (GLP-1) agonists are being increasingly used for their effectiveness in enhancing glycemic control in type 2 diabetes mellitus as well as weight loss in obesity. Their potential for gastroparesis, retained gastric contents, perioperative regurgitation, and pulmonary aspiration syndrome is a very real concern for anesthesiologists. The guidance recently published in the American Society of Anesthesiologists (ASA) Newsroom provides timely recommendations for the preoperative management of patients taking GLP-1 agonists. However, we have concerns and questions about two of the recommendations.

The first states, “For patients on daily dosing consider holding GLP-1 agonists on the day of the procedure/surgery. For patients on weekly dosing consider holding GLP-1 agonists a week prior to the day of the procedure/surgery. If the patient has no GI symptoms, and the GLP-1 agonists have been held as advised, proceed as usual.”

Is there evidence that the risk of gastroparesis or residual gastric...

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