Perioperative management of patients taking glucagon-like peptide 1 receptor agonists: Society for Perioperative Assessment and Quality Improvement (SPAQI) multidisciplinary consensus statement

Affiliations

¹ Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA. Electronic address: adriana.oprea@yale.edu.
² Department of Anesthesiology and Perioperative Medicine, Maine Health-Maine Medical Center, Portland, ME, USA.
³ Department of Anesthesiology and Surgical Services, Inova Health, Falls Church, VA, USA; Department of Medical Education, University of Virginia, Charlottesville, VA, USA.
⁴ Department of Anesthesiology, University of Colorado, Denver, CO, USA.
⁵ Division of General Internal Medicine, Jacksonville, FL, USA.
⁶ Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA; Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
⁷ Department of Medicine, Medical College of Wisconsin and Zablocki Veteran Affairs Medical Center, Milwaukee, WI, USA.
⁸ Department of Internal Medicine, University of California at Davis School of Medicine, Sacramento, CA, USA.
⁹ Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, CA, USA.
¹⁰ Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA.
¹¹ Department of Anesthesiology, Mayo Clinic, Jacksonville, FL, USA.
¹² Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
¹³ Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
¹⁴ Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
¹⁵ Department of Anesthesiology, Mass General Brigham, Harvard Medical School, Boston, MA, USA.

PMID: 40379536
DOI: 10.1016/j.bja.2025.04.001

Perioperative management of patients taking glucagon-like peptide 1 receptor agonists: Society for Perioperative Assessment and Quality Improvement (SPAQI) multidisciplinary consensus statement

Adriana D Oprea et al. Br J Anaesth. 2025 Jul.

. 2025 Jul;135(1):48-78.

doi: 10.1016/j.bja.2025.04.001. Epub 2025 May 16.

Authors

Affiliations

¹ Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA. Electronic address: adriana.oprea@yale.edu.
² Department of Anesthesiology and Perioperative Medicine, Maine Health-Maine Medical Center, Portland, ME, USA.
³ Department of Anesthesiology and Surgical Services, Inova Health, Falls Church, VA, USA; Department of Medical Education, University of Virginia, Charlottesville, VA, USA.
⁴ Department of Anesthesiology, University of Colorado, Denver, CO, USA.
⁵ Division of General Internal Medicine, Jacksonville, FL, USA.
⁶ Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA; Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
⁷ Department of Medicine, Medical College of Wisconsin and Zablocki Veteran Affairs Medical Center, Milwaukee, WI, USA.
⁸ Department of Internal Medicine, University of California at Davis School of Medicine, Sacramento, CA, USA.
⁹ Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, CA, USA.
¹⁰ Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA.
¹¹ Department of Anesthesiology, Mayo Clinic, Jacksonville, FL, USA.
¹² Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
¹³ Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
¹⁴ Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
¹⁵ Department of Anesthesiology, Mass General Brigham, Harvard Medical School, Boston, MA, USA.

PMID: 40379536
DOI: 10.1016/j.bja.2025.04.001

Abstract

The perioperative management of patients using glucagon-like peptide 1 receptor agonists remains a topic of debate. While several multisociety statements have been published recently, the recommendations vary significantly in terms of medication management and preoperative fasting protocols for these patients. This document represents a multidisciplinary consensus statement led by the Society for Perioperative Assessment and Quality Improvement (SPAQI). It provides updated recommendations based on a modified Delphi process and supported by a systematic review of the current literature. The recommendations address management of the glucagon-like peptide 1 receptor agonists perioperatively, and preoperative fasting times for both solids and liquids. SYSTEMATIC REVIEW PROTOCOL: PROSPERO (CRD42023438624).

Keywords: diabetes mellitus; gastric emptying; glucagon-like peptide 1 receptor agonists; major adverse cardiovascular events; obesity; perioperative care.

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Conflict of interest statement

Declarations of interest GEU receives grant support from Novo Nordisk, Merck, Insulcloud, Dexcom, Abbott, AstraZeneca, and Bayer. BJS receives funding from UpToDate, IARS, and Medtronic, DLH receives funding from Pharmacosmos and UpToDate. HA receives research funding from Phenomix Sciences and the USA National Institute of Health (K12AR084222). She also participates in advisory boards for Novo Nordisk. All other authors declare that they have no conflicts of interest.

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Perioperative management of patients taking glucagon-like peptide 1 receptor agonists: Society for Perioperative Assessment and Quality Improvement (SPAQI) multidisciplinary consensus statement

Affiliations

Perioperative management of patients taking glucagon-like peptide 1 receptor agonists: Society for Perioperative Assessment and Quality Improvement (SPAQI) multidisciplinary consensus statement

Authors

Affiliations

Abstract

Conflict of interest statement

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LinkOut - more resources

Full Text Sources

Medical