Delayed gastric emptying induced by glucagon-like peptide-1 receptor agonists and its implications for perioperative risk during anesthesia

Kang, Donghee; Choi, Dughyun

doi:2026.41.3.384

Korean J Intern Med > Volume 41(3); 2026 > Article

REVIEW

Endocrinology-metabolism

Korean J Intern Med. 2026;41(3):384-395. doi: https://doi.org/10.3904/kjim.2025.277

Delayed gastric emptying induced by glucagon-like peptide-1 receptor agonists and its implications for perioperative risk during anesthesia

Donghee Kang¹

, and Dughyun Choi²

¹Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
²Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea

Corresponding Author: Donghee Kang , Tel: +82-51-990-6474, Fax: +82-51-980-6283, Email: lorien@kosin.ac.kr
Dughyun Choi , Tel: +82-32-621-5781, Fax: +82-32-621-5018, Email: realgreen82@schmc.ac.kr

Received: August 8, 2025; Revised: December 16, 2025; Accepted: February 12, 2026.

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for managing type 2 diabetes mellitus and obesity because of their glucose-lowering, weight-reducing, and cardiovascular benefits. However, their potential to delay gastric emptying has raised growing concern in perioperative care, particularly regarding the risk of pulmonary aspiration during general anesthesia. Recent studies have shown that patients treated with GLP-1 RAs may retain considerable gastric contents even after standard preoperative fasting, thereby increasing the likelihood of regurgitation and aspiration during anesthesia induction or emergence. Short-acting GLP-1 RAs cause more pronounced delays in gastric emptying, whereas long-acting agents may exert residual effects depending on dose and treatment duration. Several international anesthesia societies have issued updated guidance to mitigate these risks, yet available evidence remains limited and sometimes inconsistent. This review summarizes the pharmacological mechanisms and clinical implications of GLP-1 RA–induced delayed gastric emptying, evaluates current literature on perioperative aspiration risk, and emphasizes the importance of interdisciplinary collaboration between endocrinologists and anesthesiologists to ensure safe and individualized perioperative management.

Keywords: Glucagon-like peptide 1 receptor agonists ; Gastric emptying ; Anesthesia, general ; Pulmonary aspiration ; Perioperative care