Preoperative GLP-1 RA considerations

fasting glp-1ras safety Jul 09, 2025

A weighty update - GLP-1 RA surgical guidelines

Here at PC, we have discussed GLP-1 receptor agonists at length already – however with the increasing popularity of these medications, and the introduction of new agents, it is expected that recommendations and guidelines pertaining to their use in surgical patients will be updated as new evidence emerges.

Firstly – let's recap some abbreviations!

🔹 GLP-1 RAs = glucagon-like peptide-1 receptor agonists
🔹 GLP-1/GIPRAs = dual glucagon-like peptide-1 / glucose-dependent insulinotrophic peptide receptor co-agonists

💉 ANZCA’s latest clinical practice recommendations were updated and released in April 2025 – here are the key changes you need to know!

🔸 All patients undergoing surgery or endoscopic procedures should be asked about the use of GLP-1 RA’s and GLP-1/GIPRAs

🔸 Patients should be involved in the discussion and planning regarding the risk of aspiration

🔸 Cessation of GLP-1 RA’s and GLP-1/GIPRAs is NOT recommended – due to the risk of hyperglycaemia and compromised weight control

🔸 Patients should be asked about the use of other medications and/or medical conditions that may exacerbate GI symptoms, such as bowel dysmotility, gastroparesis and Parkinson's disease 🫁

🔸 Pre-procedure diet recommendations are 24-hour clear fluid diet, followed by standard 6 hour fasting time

🔸 For patients who are not adequately fasted, risk mitigation should occur, including:
 ▪️ Point of care gastric ultrasound
 ▪️ Prokinetic agents such as metoclopramide and domperidone 💊
 ▪️ Modification of anaesthesia
 ▪️ Deferral of procedure where possible

❤️ For perioperative nurses, it is critical to stay up to date with the latest recommendations and guidelines in order to recognise and mitigate risks for our patients in the preoperative phase.

Build Knowledge ✅
Improve Safety ✅

References:

ANZCA (2025) Clinical practice recommendations regarding patients taking GLP-1 receptor agonists and dual GLP-1/GIP receptor agonists prior to anaesthesia or sedation for surgical and endoscopic procedures. https://www.anzca.edu.au/getContentAsset/0f35028e-e371-4220-a49a-ddee877051c8/80feb437-d24d-46b8-a858-4a2a28b9b970/Clinical-Practice-Recommendations-Periprocedural-GLP-1RA-use-Apr-2025.pdf 

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