{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T14:21:41Z","timestamp":1793715701983,"version":"4.6.1"},"reference-count":51,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Anaesth Intensive Care"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:p>Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used for the treatment of type 2 diabetes and\/or obesity. The physiological actions of endogenous GLP-1, and synthetic GLP-1RAs include inhibition of gastric emptying. This has peri-procedural implications due to the potential increased risk of retained gastric contents which may result in pulmonary aspiration. There is a need for local evidence-based guidelines to best manage patients on GLP-1RAs and dual GLP-1 and glucose-dependent insulinotropic polypeptide receptor co-agonists (GLP-1\/GIPRAs) presenting for surgical and medical procedures requiring sedation or anaesthesia. A panel of experts was formed to consider the peri-procedural implications of GLP-1RA and GLP-1\/GIPRA use and establish best practice recommendations based on the current evidence.<\/jats:p>\n                  <jats:p>We recommend that all patients should be asked about glucagon-like peptide-1 receptor agonist (GLP-1RA) and dual GLP-1 and glucose-dependent insulinotropic polypeptide receptor co-agonist (GLP-1\/GIPRA) use prior to anaesthesia or sedation for surgical and endoscopic procedures and be informed of the benefits and risks. We also recommend that GLP-1RAs and GLP-1\/GIPRAs be continued in the peri-procedural period. Preprocedural diet modification with a 24-h clear fluid diet, followed by standard 6-h fasting, should be recommended for all patients receiving GLP-1RAs or GLP-1\/GIPRAs. In patients who have not completed or are unable to have a 24-h liquid diet, risk stratification using gastric ultrasound or minimally sedated gastroscopy to assess gastric contents is recommended, as is the use of intravenous erythromycin. We cannot currently recommend using the absence of gastrointestinal symptoms for risk stratification, nor can we recommend an adequate cessation period for GLP-1RAs and GLP-1\/GIPRAs to ensure gastric emptying has returned to baseline levels. This clinical guideline, developed by multiple professional bodies, outlines current best practice recommendations for patients taking GLP-1RAs and combined GLP-1\/GIPRAs who require general anaesthesia, sedation and\/or endoscopic procedures. The guide provides a structure for Australian and New Zealand primary health practitioners, gastroenterologists, surgeons, endocrinologists, anaesthetists and perioperative physicians to support clinical decisions in these patients.<\/jats:p>","DOI":"10.1177\/0310057x251355288","type":"journal-article","created":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T03:26:30Z","timestamp":1755228390000},"page":"300-306","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":52,"title":["2025 ADS\/ANZCA\/GESA\/NACOS clinical practice recommendations on the peri-procedural use of GLP-1\/GIP receptor agonists"],"prefix":"10.1177","volume":"53","author":[{"given":"Samantha L","family":"Hocking","sequence":"first","affiliation":[{"name":"Charles Perkins Centre, University of Sydney, Camperdown, Australia"},{"name":"Faculty of Medicine and Health, University of Sydney, Camperdown, Australia"},{"name":"Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A","family":"Scott","sequence":"additional","affiliation":[{"name":"Department of Critical Care, University of Melbourne, Melbourne, Australia"},{"name":"Department of Anaesthesia and Acute Pain Medicine, St Vincent\u2019s Hospital, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew L","family":"Remedios","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Wesley Hospital, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Horowitz","sequence":"additional","affiliation":[{"name":"Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia"},{"name":"Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6479-1310","authenticated-orcid":false,"given":"David A","family":"Story","sequence":"additional","affiliation":[{"name":"Department of Critical Care, University of Melbourne, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerry R","family":"Greenfield","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, St Vincent\u2019s Hospital, Sydney, Australia"},{"name":"Clinical Diabetes, Appetite and Metabolism Laboratory, Garvan Institute of Medical Research, Sydney, Australia"},{"name":"School of Clinical Medicine, UNSW Medicine &amp; Health, St Vincent\u2019s Healthcare Clinical Campus, University of New South Wales, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Boussioutas","sequence":"additional","affiliation":[{"name":"Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia"},{"name":"Department of Gastroenterology, The Alfred, Monash University, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedict","family":"Devereaux","sequence":"additional","affiliation":[{"name":"School of Medicine, The University of Queensland, Brisbane, Australia"},{"name":"Department of Gastroenterology and Hepatology, Royal Brisbane and Women\u2019s Hospital, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofianos","family":"Andrikopoulos","sequence":"additional","affiliation":[{"name":"Australian Diabetes Society, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan E","family":"Shaw","sequence":"additional","affiliation":[{"name":"Baker Heart and Diabetes Institute, Melbourne, Australia"},{"name":"School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2650-7593","authenticated-orcid":false,"given":"Benjamin L","family":"Olesnicky","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, University of Sydney, Camperdown, Australia"},{"name":"Department of Anaesthesia, Pain, and Perioperative Medicine, Royal North Shore Hospital, St Leonards, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"Woodrow L. \u2018Turbocharged\u2019 $160bn market for obesity drugs by 2030 https:\/\/www.medicalrepublic.com.au\/turbocharged-160bn-market-for-obesity-drugs-by-2030\/1068252024 (accessed 16 June 2025)."},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01316798"},{"key":"e_1_3_3_4_2","first-page":"E981","article-title":"Glucagon-like peptide 1 inhibition of gastric emptying outweighs its insulinotropic effects in healthy humans","volume":"273","author":"Nauck MA","year":"1997","unstructured":"Nauck MA, Niedereichholz U, Ettler R, et\u00a0al. 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