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. 2025 Jul;135(1):48-78.
doi: 10.1016/j.bja.2025.04.001. Epub 2025 May 16.

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  1 , Laura J Ostapenko  2 , BobbieJean Sweitzer  3 , Angela Selzer  4 , Joan M Irizarry-Alvarado  5 , Maria D Hurtado Andrade  6 , Carlos E Mendez  7 , Kristen D Kelley  8 , Erin Stewart  9 , Claudia R Fernandez Robles  10 , Ryan M Chadha  11 , Michael Camilleri  12 , Ruchi Mathur  13 , Guillermo E Umpierrez  14 , David L Hepner  15
Affiliations

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.

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.

Figures

Fig 1
Fig 1
PRISMA flow diagram. GLP--1 RA, glucagon-like peptide-1 receptor agonist; PRISMA, Preferred Reporting Items for Systematic reviews and Meta-Analyses.
Fig 2
Fig 2
Preoperative recommendations for patients taking glucagon-like peptide 1 receptor agonists. GLP-1 RA, glucagon-like peptide-1 receptor agonist. ∗Significant symptoms include severe nausea, vomiting or inability to tolerate oral intake.
See this image and copyright information in PMC

References

    1. Nauck M.A., Mirna A.E.A., Quast D.R. Meta-analysis of head-to-head clinical trials comparing incretin-based glucose-lowering medications and basal insulin: an update including recently developed glucagon-like peptide-1 (GLP-1) receptor agonists and the glucose-dependent insulinotropic polypeptide/GLP-1 receptor co-agonist tirzepatide. Diabetes Obes Metab. 2023;25:1361–1371. - PubMed
    1. Michos E.D., Lopez-Jimenez F., Gulati M. Role of glucagon-like peptide-1 receptor agonists in achieving weight loss and improving cardiovascular outcomes in people with overweight and obesity. J Am Heart Assoc. 2023;12 - PMC - PubMed
    1. Stefanou M.I., Theodorou A., Malhotra K., et al. Risk of major adverse cardiovascular events and stroke associated with treatment with GLP-1 or the dual GIP/GLP-1 receptor agonist tirzepatide for type 2 diabetes: a systematic review and meta-analysis. Eur Stroke J. 2024;9:530–539. - PMC - PubMed
    1. American Diabetes Association Professional Practice Committee. 9 Pharmacologic approaches to glycemic treatment: standards of care in diabetes-2024. Diabetes Care. 2024;47:S158–S178. - PMC - PubMed
    1. Samson S.L., Vellanki P., Blonde L., et al. American Association of Clinical Endocrinology consensus statement: comprehensive type 2 diabetes management algorithm - 2023 update. Endocr Pract. 2023;29:305–340. - PubMed

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