Do I need to stop my GLP-1 before surgery?

The physiologic issue is simple: anesthesia assumes an empty stomach (hence fasting rules), and GLP-1s exist to keep stomachs from emptying fast. Food retained past standard fasting windows can be aspirated into the lungs during sedation — rare, serious, and exactly the kind of risk anesthesiology organizes itself around. How the guidance has moved: the ASA’s 2023 statement suggested holding weekly GLP-1s for a week (daily ones for a day) before elective procedures with sedation. Subsequent multi-society updates (2024–2025) softened toward individualized risk assessment — escalating doses, active GI symptoms, and heavy meals flag higher risk, while patients on stable doses without symptoms may proceed, commonly with a 24-hour clear-liquid diet before the procedure and/or point-of-care gastric ultrasound where available. Translation: practice genuinely varies by institution and case; there is no single rule to memorize. Your practical protocol: 1. Disclose at scheduling, not at check-in — “I take [drug], weekly, my last dose will be [day]” — for everything involving sedation: surgery, colonoscopy, endoscopy, dental sedation. The colonoscopy one gets missed constantly. 2. Follow their protocol, whatever it is — hold a dose, liquid diet, extended fast, or proceed-as-usual. If told to hold, that’s a planned skip (restart mechanics — one held weekly dose rarely needs re-titration). 3. Emergency surgery: teams manage it (rapid-sequence techniques exist) — your job is making sure the GLP-1 is on the med list they see. 4. Colonoscopy bonus note: some endoscopists report prep-quality and retained-food issues on GLP-1s; your GI may add prep modifications — ask when booking. Don’t self-hold for minor things: local-anesthetic dental work, skin biopsies, and imaging without sedation don’t require stopping. Pausing a working therapy “just in case” for a filling buys appetite return for nothing — the rule is tell the team and let them call it, not stop whenever medicine is nearby.