• Michael A Gulak and Patricia Murphy.
• Department of Anesthesiology and Pain Medicine, University of Toronto, 12th Floor, 123 Edward Street, Toronto, ON, M5G 1E2, Canada. mike.gulak@mail.utoronto.ca.
• Can J Anaesth. 2023 Aug 1; 70 (8): 139714001397-1400.

PurposeGlucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as semaglutide are a class of medications prescribed to treat type 2 diabetes mellitus, and more recently, as an adjunct for weight loss because of its effects of delaying gastric emptying and suppressing appetite. Semaglutide is a long-acting agent with a half-life of approximately one week, and there are currently no guidelines that address the perioperative management of such agents.Clinical FeaturesWe describe an unexpected case of regurgitation of a large volume of gastric contents upon induction of general anesthesia in a nondiabetic, nonobese patient despite a long preoperative fasting period (20 hr for solids and eight hours for clear fluids). This patient had no traditional risk factors for regurgitation or aspiration but was taking the GLP-1 RA semaglutide for weight loss and had last taken the medication two days before their scheduled procedure.ConclusionsPatients taking long-acting GLP-1 RAs such as semaglutide may be at risk of pulmonary aspiration under anesthesia. We propose strategies to mitigate this risk including holding the medication four weeks prior to a scheduled procedure when feasible and considering full stomach precautions.© 2023. Canadian Anesthesiologists' Society.

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