DOI

10.21007/con.dnp.2026.0149

Faculty Advisor

Bobby Bellflower, DNSc, NNP-BC, FAAN, FAANP, FNAP

Subject Matter Expert

Jordan Isaac

Clinical Site

University of Tennessee Health Science Center

Document Type

Poster

Publication Date

Spring 5-3-2026

Disciplines

Investigative Techniques | Medicine and Health Sciences | Nursing | Quality Improvement

Abstract

Purpose/Background

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for diabetes and obesity due to their metabolic benefits; however, these medications delay gastric emptying, raising concern for increased residual content (RGC) and aspiration risk during anesthesia. Current perioperative fasting and medication management guidelines for patients taking GLP-1 RAs remain inconsistent, creating uncertainty for anesthesia providers. This scoping review aimed to synthesize current evidence on the relationship between GLP-1 RA use and perioperative gastric safety, with particular focus on fasting duration and aspiration risk.

Methods

A scoping review was conducted in accordance with PRISMA-ScR guidelines. Searches were performed using the University of Tennessee Health Science Center Online Library in PubMed, CINHAL, Embase, Cochrane Library, ScienceDirect, and Google Scholar between August 2024 and November 2025. Inclusion criteria consisted of peer-reviewed, English-language, full-text studies published between 2023 and 2025 involving adult patients prescribed GLP-1 RAs undergoing surgical, procedural, or endoscopic anesthesia. Fifteen articles were screened for eligibility; after exclusion of studies unrelated to perioperative outcomes or of poor quality, ten articles were included for synthesis.

Results

Across systematic reviews, retrospective cohort studies, case series, and guideline comparisons, GLP-1 RA use was consistently associated with delayed gastric emptying and increased RGC. One study reported increased RGC in 56% of GLP-1 RA users compared with 19% of non-users, while meta-analyses demonstrated up to a sixfold increase in RGC and gastrointestinal symptoms. Despite these physiological effects, no study demonstrated a corresponding increase in aspiration, postoperative ileus, or mortality. Studies evaluating modified fasting strategies, including a 24-hour liquid-only diet, reported low complication rates without the need for routine medication discontinuation.

Implications for Nursing Practice

Findings suggest that while GLP-1 RAs reliably increase residual gastric content, their clinical impact on aspiration risk appears limited when appropriate perioperative management strategies are employed. An individualized, risk-based approach emphasizing extended liquid fasting rather than routine medication cessation may support both metabolic stability and perioperative safety. These results highlight the need for standardized, evidence-based fasting guidelines and support the development of institutional protocols to guide anesthesia providers in managing patients taking GLP-1 receptor agonists.

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