Glucagon-like peptide-1 receptor agonists and aspiration risk

Glucagon-like peptide-1 (GLP-1) receptor agonists, which can slow gastric emptying and increase the risk of retained gastric contents, are increasingly prescribed for the treatment of diabetes and obesity, as well as emerging indications for cardiovascular and renal disease.1234 Many clinicians providing anaesthesia or sedation, however, are concerned about an increased risk of aspiration in patients using GLP-1 receptor agonists, owing to their mechanism of action. Unfortunately, whether, and to what extent, GLP-1 receptor agonists increase the risk of aspiration remains uncertain. Current evidence is limited to case reports and single centre observational studies at risk of confounding biases and that are focused on the presence of retained gastric contents and not whether aspiration occurs more frequently in those taking GLP-1 receptor agonists. This uncertainty is reflected in opinions and clinical practice guidelines that provide highly variable recommendations, spanning from conservative and precautionary guidance to the withholding of GLP-1 receptor agonists for three weeks before a procedure—including consideration for cancellation of a procedure owing to inadequate cessation of the drug to continuation of a procedure despite the drug not having …