1 April 2025 Clinical Practice Recommendations regarding patients taking GLP-1 receptor agonists and dual GLP-1/GIP receptor co-agonists prior to anaesthesia or sedation for surgical and endoscopic procedures. A consensus clinical practice recommendation endorsed by the Australian Diabetes Society (ADS), National Association of Clinical Obesity Services (NACOS), Gastroenterological Society of Australia (GESA) and Australian and New Zealand College of Anaesthetists (ANZCA). Purpose of this document To provide recommendations for managing patients taking glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual GLP-1/glucose-dependent insulinotrophic peptide receptor co-agonists (GLP-1/GIPRAs) prior to anaesthesia or sedation for surgical and endoscopic procedures. Scope This advice applies to all practitioners providing moderate to deep procedural sedation or anaesthesia. Although focused on surgical and endoscopic procedures, the principles should apply to any procedures requiring anaesthesia or sedation. Background In response to case reports and large case series of retained gastric contents and pulmonary aspiration during sedation for endoscopic procedures or general anaesthesia in people with diabetes and/or obesity treated with GLP-1RAs or GLP-1/ GIPRAs, a clinical practice recommendation regarding the periprocedural use of GLP-1RAs and GLP-1/GIPRAs has been co-authored and updated by representatives from ADS, NACOS, GESA and ANZCA. The below represents a consensus based on review of currently available evidence and expert opinion. Although the current level of evidence remains limited, new data and other multidisciplinary clinical guidelines [1, 2] have been considered. This document was written to mitigate the risk of pulmonary aspiration with the periprocedural use of GLP-1RAs and GLP-1/GIPRAs which, although rare, is high-risk and potentially fatal. Recommendations relating to GLP-1RAs and GLP-1/GIPRAs and sedation or anaesthesia: • All patients should be asked about the use of GLP-1RAs and GLP-1/GIPRAs prior to anaesthesia or sedation for surgical and endoscopic procedures and be involved in discussion and planning regarding the risk of aspiration. • Elective preprocedural cessation of GLP-1RAs and GLP-1/GIPRAs is not recommended, and risks hyperglycaemia in people with diabetes and may compromise weight control where patients are taking GLP-1RAs and GLP-1/GIPRAs for this indication. • Patients should be asked about the use of other medications and medical conditions which may exacerbate gastrointestinal symptoms and delay gastric emptying, such as, but not limited to bowel dysmotility, gastroparesis, and Parkinson’s disease. • Preprocedural diet modification with 24-hour clear fluid diet, followed by standard 6-hour fasting, should be recommended for all patients receiving GLP-1 RAs and GLP-1/GIPRAs. • Risk mitigation options should be undertaken for those who have not withheld solids for 24 hours. These include detection of residual gastric contents, prokinetic agents, modification of anaesthesia, or deferral of procedure (see figure and explanatory notes).
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