Residual gastric content and aspiration-related outcomes in perioperative patients treated with semaglutide: A systematic review and meta-analysis

Table 4 Comparative recommendations for perioperative management of glucagon-like peptide-1 receptor agonists

Guideline/source	Suspension timing	Dietary measures	Use of gastric ultrasound	Risk stratification/other notes
Multisociety Clinical Practice Guidance (ASA and others, 2024)[5]	No universal discontinuation. If high-risk: Daily formulations - hold on day of surgery; weekly formulations - hold 7 days prior. Duration beyond these intervals unknown	Consider ≥ 24 hours liquid diet if concern for delayed emptying	May be used when retained gastric content is a concern	High-risk factors: Dose escalation, high doses, weekly formulations, active gastrointestinal symptoms, comorbid dysmotility. Avoid discontinuation only in obesity (bias concern)
Brazilian Position Statement (SBD/SBA/ABESO, 2025)[34]	7 days for long-acting; 1 day for short-acting, in patients at increased aspiration risk or within 12 weeks of dose escalation/instability	Liquid diet 24 hours before + 8-12 hours fasting	POCUS is recommended whenever available	Emphasis on selective suspension plus diet + ultrasound
ESAIC Guideline (2025)[35]	≥ 7 days for weekly; ≥ 14 days if for obesity. Hold daily formulations on day of surgery	24 hours clear-fluid diet	Strongly encouraged; treat all GLP-1RA users as “full stomach” if content present	More conservative: Notes 1-week hold may not normalize gastric emptying; RSI if urgent

ASA: American Society of Anesthesiologists; ABESO: Brazilian Association for the Study of Obesity and Metabolic Syndrome; ESAIC: European Society of Anaesthesiology and Intensive Care; POCUS: Point-of-care ultrasound; RSI: Rapid-sequence induction; SBA: Brazilian Society of Anesthesiology; SBD: Brazilian Diabetes Society.