GLP-1 AND DUAL GIP/GLP-1 AGONISTS IN PERIOPERATIVE CARE RISK STRATIFICATION AND INDIVIDUALIZED MANAGEMENT

Abstract

The use of GLP-1 receptor agonists and dual GIP/GLP-1 agonists raises questions about the balance between anesthetic safety and continuity of metabolic treatment. This critical narrative review examines the management of adults undergoing elective procedures under general anesthesia or deep sedation. The literature search consulted PubMed, Europe PMC, scientific society documents, and regulatory agencies, with updates through October 4, 2026, and selection guided by clinical relevance. The synthesis distinguishes delayed gastric emptying, residual gastric contents, and pulmonary aspiration, comparing American, British, Australian, and Brazilian recommendations. Observational studies show an association with residual contents, whereas findings on respiratory complications vary with study design and outcome definitions. A 2026 randomized trial favors withholding one dose to reduce clinically significant residual contents during endoscopy, without demonstrating prevention of aspiration. A recent prospective cohort identifies a higher frequency of regurgitation or aspiration, requiring separate interpretation of its components. Recommendations converge on individualized assessment but differ regarding medication withholding and fasting for solids and liquids. The analysis proposes integrating treatment phase, symptoms, comorbidities, dietary preparation, anesthetic technique, and metabolic consequences. It concludes that no single intervention ensures an empty stomach and that decision-making should combine risk reduction, shared planning, and reassessment on the day of the procedure.