John Seitz, MDAnesthesiology
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GLP-1 Receptor Agonists Before Office Surgery: What a Practice Needs a Policy For

Two national guidance documents now address patients taking semaglutide and related drugs before anesthesia. What each recommends, where they diverge, and what an office should settle in writing.

Abstract ink and watercolor illustration: a navy crescent holding a small gold sphere above a fine line that breaks and resumes, suggesting delayed clearance and timing

About one in eight US adults now take a glucagon-like peptide-1 (GLP-1) receptor agonist — semaglutide, liraglutide, dulaglutide and related agents — for type 2 diabetes, weight loss or cardiovascular risk.1,3 In an office-based practice those drugs appear routinely in the medication list of patients presenting for aesthetic and other ambulatory procedures, and they change the preanesthesia assessment in one specific way: GLP-1 agonists delay gastric emptying, so a patient who has fasted as instructed may still have residual gastric contents, which raises the risk of regurgitation and aspiration during general anesthesia and deep sedation.1,2

Two guidance documents, two years apart

The ASA's 2023 consensus-based guidance, issued by its Task Force on Preoperative Fasting, advised considering holding daily-dosed agents on the day of the procedure and weekly-dosed agents for a week beforehand, and noted that gastrointestinal symptoms — nausea, vomiting, dyspepsia, abdominal distension — predict increased residual gastric contents.1 Where no symptoms were present and the drug had been held as advised, it advised proceeding as usual.

In October 2024, a multisociety clinical practice guidance written by the ASA with 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 started from a different assumption: most patients should continue the drug up to the day of the procedure, while patients at highest risk of significant gastrointestinal side effects should follow a liquid diet for 24 hours beforehand or take other measures depending on the circumstances.2,3 The societies describe the document as guidance rather than a formal evidence-based guideline, and state that the benefit of withholding must be weighed against the risks of doing so.2,3

What a practice should settle before the first case

Guidance does not write a practice's policy for it. These are the points a coverage arrangement should resolve in writing:

  • Agent, dose, daily or weekly formulation, and date of last dose, captured at booking and confirmed at preanesthesia evaluation rather than discovered on the day of the procedure.
  • A documented symptom screen, since gastrointestinal symptoms should change the plan.
  • A dated written holding and diet instruction consistent with whichever guidance the practice has adopted.
  • An explicit criterion for postponing an elective case, and the clinician who makes that decision.
  • Airway and aspiration preparedness proportionate to the possibility of residual gastric contents — for deep sedation, not only for general anesthesia.
  • The proceed-or-postpone decision documented in the medical record.

Where this meets technique choice

Both documents frame the concern around general anesthesia and deep sedation. A practice whose case mix is mostly monitored anesthesia care or regional technique with light sedation is not outside the question: depth can change during a case, and the ASA states that practitioners must be able to rescue a patient who reaches a deeper level than planned.4 The aspiration risk travels with the plan for depth, not with the label on the technique.

Dr. Seitz performs the preanesthesia evaluation for the office-based cases he covers, and makes and documents the discharge decision.

Sources

  1. American Society of Anesthesiologists Task Force on Preoperative Fasting. ASA Consensus-Based Guidance on Preoperative Management of Patients (Adults and Children) on Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists. June 29, 2023.
  2. Kindel TL, Wang AY, Wadhwa A, et al. Multisociety Clinical Practice Guidance for the Safe Use of Glucagon-like Peptide-1 Receptor Agonists in the Perioperative Period. Clin Gastroenterol Hepatol. Published online October 29, 2024.
  3. American Society of Anesthesiologists. New Multi-society Clinical Practice Guidance on GLP-1 Receptor Agonists. News release, October 29, 2024.
  4. American Society of Anesthesiologists. Statement on Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia. Original approval October 13, 1999; last amended October 23, 2024.
Portrait of Dr. John Seitz, MD

Dr. John Seitz, MD

Board-certified anesthesiologist

This article is for general educational purposes and is not a substitute for personalized medical advice. Always consult your physician for guidance specific to your health.

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