GLP-1 Receptor Agonists in the Perioperative Period: Risks, Management, and Surgical Outcomes

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1) have gained increasing importance in the treatment of type 2 diabetes mellitus and obesity, raising concerns regarding their implications for the safety of patients undergoing surgical procedures. This study aimed to critically analyze the scientific literature on perioperative risks associated with the use of these medications, clinical management strategies, and their potential impact on surgical outcomes. This is a narrative literature review with a qualitative, descriptive, and analytical approach, based on searches conducted in the PubMed/MEDLINE, Virtual Health Library (VHL), and SciELO databases. Clinical studies, observational research, systematic reviews, meta-analyses, and clinical practice guidelines addressing the use of these drugs in the perioperative setting were considered. The reviewed literature indicates that delayed gastric emptying and the possibility of residual gastric contents are relevant concerns for anesthetic safety because of the potential risk of regurgitation and pulmonary aspiration. However, the available evidence does not consistently demonstrate that these mechanisms lead to an increase in clinically significant respiratory complications. Regarding perioperative management, current recommendations emphasize individualized risk assessment, taking into account gastrointestinal symptoms, the dose-escalation phase, the pharmacological characteristics of the medication, and the patient's clinical condition. It is concluded that the perioperative management of patients receiving GLP-1 receptor agonists should balance anesthetic safety with the maintenance of metabolic control, prioritizing shared decision-making, appropriate fasting protocols, and individualized preventive strategies. Prospective studies are needed to clarify the risks associated with different formulations and establish more consistent and safer management strategies.