GLP-1 receptor agonists / dual GIP-GLP-1 agonists
Perioperative management should be based on individual risk rather than routine withholding for every patient. Current multi-society guidance and ADA 2026 support continuing therapy in many low-risk elective patients. Factors informing that assessment include dose-escalation phase, higher doses, weekly formulations, GI symptoms and other conditions that delay gastric emptying. Measures described in the guidance for higher-risk patients include a 24-h liquid diet, gastric ultrasound where expertise exists, modification of the anaesthesia plan to address aspiration risk, or a delay when appropriate.
If withholding is chosen, the optimal duration is uncertain. The 2024 multisociety document notes that evidence for duration is unknown and references the older ASA suggestion of holding daily formulations on the day of surgery and weekly formulations for a week. ADA 2026 notes that even a one-week hold may be insufficient to eliminate residual gastric-content risk.