GLP-1 and dual GIP/GLP-1 receptor agonists: potential risk of pulmonary aspiration during general anaesthesia and deep sedation

The Medicines and Healthcare products Regulatory Agency (MHRA) January 2025 Drug Safety Update highlights the potential risk of pulmonary aspiration during general anaesthesia or deep sedation in patients using GLP-1 or dual GIP/GLP-1 receptor agonists. The RCoA has endorsed the update.  

GLP-1 and dual GIP/GLP-1 receptor agonists are a class of medications that are used to treat type II diabetes mellitus and/or obesity. They are known to cause delayed gastric emptying, which may increase the risk of residual gastric contents despite preoperative fasting.  

The MHRA update includes advice for healthcare professionals and advice for healthcare professionals to provide to patients.  

The advice for healthcare professionals includes:  

• Anaesthetists should provide an individualised assessment of the aspiration risk, ensuring they ask patients if they take GLP-1 or dual GIP/GLP-1 receptor agonists. 
• Patients taking these medications who have underlying diabetic gastroparesis, as well as other comorbidities such as obesity or gastroesophageal reflux disease, and symptoms of delayed gastric emptying (such as nausea, vomiting, and abdominal pain) may be at higher risk of aspiration.
• Consider the possibility that patients may have purchased GLP-1 or dual GIP/GLP-1 receptor agonists for aesthetic weight loss and may not readily disclose this information unless directly asked. Private prescriptions may not always be included in the patient’s medical notes or drug history.
• Healthcare Professionals should also identify the increased risk of aspiration in patients as early as possible before surgery and specifically at pre-assessment clinic before surgery. Patients should be reminded to inform their healthcare team including the anaesthetist if they are taking GLP-1 or dual GIP/GLP-1 receptor agonists.  
• Suspected adverse drug reactions associated with GLP-1 and dual GIP/GLP-1 receptor agonists, aspiration and other surgical complications should be reported on a Yellow Card. 

Advice for healthcare professionals to provide to patients: 

• If you are taking a GLP-1 or dual GIP/GLP-1 receptor agonist, make sure you inform your healthcare team including the anaesthetist about this prior to your surgical procedure. 
• This medicine slows the emptying of your stomach, increasing the risk that stomach contents (e.g. food and drink) could enter into your airways and lungs during surgery or procedures whilst you are under general anaesthesia or deep sedation. This means that a modification to the pre-procedure instruction and anaesthetic technique may be required.
• Take your prescribed medicine(s) as usual and do not stop your treatment without first discussing this with your doctor. 

Consensus statement 

The MHRA also references clinical guidelines in the form of the multidisciplinary consensus statement on the elective perioperative management of adults taking  GLP-1 receptor agonists, dual GIP/GLP-1 receptor agonists and SGLT2 inhibitors. 

This statement advises taking the GLP-1 or dual GIP/GLP-1 receptor agonist as normal (irrespective of dosing schedule i.e. daily or weekly).