The Australian and New Zealand College of Anaesthetists (ANZCA) and peak diabetes, obesity and gastroenterological bodies have updated recommendations, frequently asked questions (FAQs) and patient information for clinicians when talking to patients using GLP-1/GIP receptor agonists.

The Australian and New Zealand College of Anaesthetists (ANZCA), the Gastroenterological Society of Australia, the Australian Diabetes Society, and the National Association of Clinical Obesity Services and Australian and New Zealand Metabolic and the Obesity Surgery Society have developed revised recommendations for patients taking GLP-1 receptor agonists and dual GLP-1/GIP receptor co-agonists prior to anaesthesia or sedation.

The guidance is in response to recent case reports and large case series that have shown a risk of retained gastric contents and cases of pulmonary aspiration during sedation for endoscopic procedures or general anaesthesia in individuals treated with GLP-1RAs or GLP-1/GIPRAs.

Although rare, pulmonary aspiration is a high-risk and potentially fatal complication. Given the popularity of and rapid rise in the use of this class of receptor agonists, the need for this guidance has become increasingly urgent. These recommendations aim to mitigate the risks for patients undergoing procedures requiring anaesthesia or sedation.

The guidance outlines five key recommendations relating to GLP-1RAs and GLP-1/GIPRAs and sedation or anaesthesia:

• All patients should be asked about the use of GLP-1RAs and GLP-1/GIPRAs before anaesthesia or sedation for surgical and endoscopic procedures and be involved in discussion and planning regarding the risk of aspiration. 
• Elective preprocedural cessation of GLP-1RAs and GLP-1/GIPRAs is not recommended, and risks hyperglycaemia in people with diabetes. It may compromise weight control where patients are taking GLP-1RAs and GLP-1/GIPRAs for this indication. 
• Patients should be asked about the use of other medications and medical conditions, which may exacerbate gastrointestinal symptoms and delay gastric emptying, such as, but not limited to bowel dysmotility, gastroparesis, and Parkinson’s disease.
• Preprocedural diet modification with 24-hour clear fluid diet, followed by standard 6-hour fasting, should be recommended for all patients receiving GLP-1 RAs and GLP-1/GIPRAs. 
• Risk mitigation options should be undertaken for those who have not withheld solids for 24 hours. These include detection of residual gastric contents, prokinetic agents, modification of anaesthesia, or deferral of procedure (see figure and explanatory notes).

A diagram of clinical practice recommendations for patients taking GLP-1 receptor agonists and dual GLP-1 and GIP receptor co-agonists before anaesthesia or sedation for surgical and endoscopic procedures is included with the updated recommendations and guidance (see Figure 1). 

ANZCA have also established a dedicated webpage for GLP-1 receptor agonists - clinical practice recommendations which includes links to:

• The guidance document Clinical Practice Recommendations regarding patients taking GLP-1 receptor agonists and dual GLP-1/GIP receptor co-agonists prior to anaesthesia or sedation for surgical and endoscopic procedures.
• FAQs for clinicians.
• A patient information sheet.
• A patient information form. 

These patient information resources are for clinicians and their staff to give to patients. They can be adapted to the requirements of facilities or procedures. The patient information documents complement the recommendations in the guidance document.