Perioperative Use of Glucagon-Like Peptide-1 Receptor Agonists and Risk of Regurgitation, Gastric Residual Volume, And Pulmonary Aspiration During Anesthesia: A Systematic Review

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs), widely prescribed for glycemic control and obesity, are increasing worldwide. In the perioperative period, GLP-1RAs lead primarily to delayed gastric emptying, along with suppression of glucagon release and enhancement of insulin secretion. This ultimately results in increased residual gastric content and increased risk of adverse gastrointestinal events, including regurgitation, vomiting, and gastroesophageal reflux. With the aim of informing clinical decision-making, guiding safe perioperative management strategies in patients receiving GLP-1 RA therapy, and improving patient and clinical outcomes, this systematic review synthesized existing research on the association between perioperative use of GLP-1 RAs and the risk of increased gastric residual volume and pulmonary aspiration during anesthesia.

Methods: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, searching PubMed, ScienceDirect, and Scopus for studies on perioperative use of GLP-1RAs and risk of regurgitation, gastric residual volume, and pulmonary aspiration during anesthesia. 14 eligible studies reported the association of perioperative use of GLP-1RAs and risk of gastric residual volume and pulmonary aspiration during anesthesia. Risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies.

Results: The included studies (n=14) demonstrated a significant association between perioperative use of GLP-1 RAs and increased gastric residual volume. However, this risk does not translate into significant aspiration-related complications.

Conclusion: The perioperative use of GLP-1 receptor agonists offers important safety insight for anesthesiologists and endoscopists, demonstrating a consistent increase in gastric residual volume and retained gastric contents without a correspondingly increased risk of pulmonary aspiration or aspiration-related respiratory complications compared with nonusers.