Ahmed FAKRI, Maha SEKKAL, Mourad ABABOU, Marouane JIDAL, Youssef HALHOUL, Mustapha BENSGHIR
Journal: Medpeer Publisher
ISSN: 3066-2737
Volume: 3
Issue: 10
Date of Publication: 2026/10/16
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), including the dual agonist tirzepatide, slow gastric emptying, and their growing use has raised concern about residual gastric content and pulmonary aspiration during anesthesia and procedural sedation. Recommendations have shifted since 2023 from routine interruption toward continued treatment with individualized risk assessment. We conducted a narrative review based on a systematic search of PubMed and Scopus for studies published from 2023 to October 2026 and synthesized 106 studies, including one randomized trial, 14 prospective studies and 20 systematic reviews, across five themes. GLP-1 RAs delay solid gastric emptying by approximately 36 to 74 minutes, with only partial tachyphylaxis. Despite standard fasting, residual gastric content is consistently more frequent in users, with pooled odds ratios of 3.95 to 6.30 at endoscopy and a full stomach in 40% to 56% of users on preoperative gastric ultrasound. Large databases and meta-analyses show no increase in coded pulmonary aspiration (pooled odds ratio close to 1.0), whereas studies based on direct reporting by anesthesiologists found an approximately tenfold higher incidence of regurgitation or aspiration (1.41% vs. 0.12% in a national prospective cohort, in which about half of the events occurred at emergence). Withholding one dose reduced clinically significant residual content from 25.0% to 3.1% in the only randomized trial, but interruptions of seven to 10 days still left a full stomach in 40% to 49% of patients in prospective ultrasound studies, whereas no residual content occurred in either trial arm among patients who had followed a clear-liquid diet the day before. Routine interruption is therefore neither reliably effective nor necessary for most patients. We propose an individualized strategy: continue treatment, prescribe a 24-hour clear-liquid diet, screen for high-risk features, use gastric ultrasound when doubt persists, and apply full-stomach precautions through emergence when risk remains. The certainty of the evidence is low, and trials under general anesthesia are needed.
GLP-1 receptor agonists, semaglutide, tirzepatide, pulmonary aspiration, residual gastric content, gastric ultrasound, preoperative fasting, procedural sedation
Download PDF