GLP-1 + anesthesia (preoperative)

Every GLP-1 label now carries a warning titled Pulmonary Aspiration During General Anesthesia or Deep Sedation. The reasoning is short: these drugs delay gastric emptying, so a stomach that should be empty after an overnight fast may still hold food. If that content comes up while you are sedated and your airway reflexes are suppressed, it can go into the lungs. That is aspiration, and it is dangerous.

The American Society of Anesthesiologists issued guidance in June 2023 that is specific enough to act on. For elective procedures, it suggests holding a GLP-1 agonist on the day of the procedure for patients dosing daily, and holding it a week before the procedure for patients dosing weekly. On the day itself, it suggests considering a delay if the patient has severe nausea, vomiting, retching, bloating or abdominal pain; proceeding if there are no symptoms and the drug was held as advised; and, if it was not held, treating the patient as having a full stomach or using gastric ultrasound to check.

The concern is not hypothetical. A 2025 study of 598 outpatient upper endoscopies found roughly four times the odds of solid residual gastric contents among GLP-1 users, with more procedures aborted — though hypoxia rates were similar and no aspiration occurred.

The misconception that causes real problems is assuming the surgical team already knows. They frequently do not. A GLP-1 may not appear on a medication list you filled out months ago, a compounded product may be recorded under an unfamiliar name, and a dentist or a fertility clinic offering sedation may never think to ask.

So volunteer it — to the surgeon, the anesthesiologist, the endoscopy unit, the dentist and the IVF clinic — and ask each one how far in advance they want the drug held. If you are managing diabetes with it, ask who is covering your glucose during the hold. Our pre-op stop-date calendar and ASA guidance summary handle the timing.