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Featuring Dr. Andrew Albert, MD, MPH, Medical Staff President – Advocate Illinois Masonic Medical Center.
The Pre-Surgery Conversation That Changed Everything
I walked into my colonoscopy appointment feeling remarkably confident. I had followed every instruction to the letter. I survived the prep and the evacuation procedures. I had not eaten since the previous morning. I had only sipped water in the morning, stopping precisely when instructed. I felt like the gold-star student of preparation, ready to receive praise for my exceptional ability to follow rules.
The care team reviewed my paperwork, nodding along to my responses about medications, allergies, and previous surgeries. Then my doctor paused, looked up, and asked with casual curiosity, “Are you currently taking any GLP-1 medications?”
“Yes,” I answered proudly, as if I had just correctly answered a quiz question. “Mounjaro. Why?”
The atmosphere in the room shifted immediately. The nurse and anesthesiologist exchanged one of those meaningful looks that healthcare providers share when they know something you do not yet understand. The anesthesiologist set down his clipboard with deliberate care, the way you might set down a glass when you realize you need to have a serious conversation.
“Okay,” he said slowly. “So that changes things significantly.”
My confidence evaporated like morning fog. My inner monologue immediately spiraled: What do you mean it changes things? I followed all the rules. I have been a perfect patient. What did I do wrong? Am I going to die? Is this going to be on my permanent record?
What followed was an incredibly educational discussion about something I had never considered: GLP-1 medications do not just reduce appetite and support weight loss. They fundamentally change how quickly your digestive system processes food and liquid. And when you are about to undergo anesthesia, that matters more than I ever imagined.
Dr. Andrew Albert, MPH, who is the Medical Staff President with Advocate Illinois Masonic Medical Center, states, “GLP-1 receptor agonists slow gastric emptying in a dose-dependent manner. Many patients, especially those recently titrated or on higher doses, retain food in the stomach much longer than expected, even after following standard fasting instructions. This isn’t intuitive to patients, because the medication’s digestive effects can feel subtle.”
That day, I learned that being a responsible patient is not just about following the standard instructions. It is about understanding how your specific medications interact with surgical procedures and communicating that information clearly to your entire care team.
Let me share what I learned so you can walk into your surgical preparations with knowledge and confidence rather than the mild panic I experienced.
Why GLP-1 Medications and Anesthesia Have Become a Critical Discussion
Over the past few years, as GLP-1 medications like Ozempic, Wegovy, Mounjaro, and Zepbound have become increasingly prescribed for weight management and diabetes control, anesthesiologists and surgeons have had to adapt their pre-operative protocols significantly.
The issue centers on a fundamental mechanism of how GLP-1 medications work. These drugs are glucagon-like peptide-1 receptor agonists, which means they mimic a hormone your body naturally produces after eating. This hormone does several things, including slowing gastric emptying (the rate at which food moves from your stomach into your small intestine).
Slower gastric emptying is actually beneficial in many contexts. It helps you feel fuller longer, reduces blood sugar spikes after meals, and contributes to the appetite-suppressing effects that make these medications effective for weight management.
However, during surgery, slower gastric emptying creates a specific safety concern that surgical teams must carefully manage.
Understanding Aspiration Risk During Anesthesia
To understand why delayed gastric emptying matters during surgery, you need to understand what happens to your body under anesthesia and what anesthesiologists work to prevent.
How Anesthesia Affects Your Protective Reflexes
When you are awake, your body has multiple protective mechanisms that prevent food or liquid from entering your lungs. Your gag reflex, cough reflex, and the coordinated action of muscles in your throat all work together to ensure that anything you swallow goes down your esophagus toward your stomach, not down your trachea toward your lungs.
General anesthesia temporarily disables these protective reflexes. This is necessary for surgery, but it also means your body cannot protect your airway the way it normally would. Anesthesiologists manage this by inserting a breathing tube (endotracheal intubation) or using other airway management devices that protect your lungs during the procedure.
What Happens When Gastric Contents Enter the Lungs
The concern that keeps surgical teams vigilant is called pulmonary aspiration. This occurs when stomach contents (food, liquid, or even stomach acid) travel backward up the esophagus and enter the lungs. Aspiration can cause several serious complications:
- Aspiration pneumonia: Stomach contents introduce bacteria and irritating substances into the lungs, potentially causing infection and inflammation.
- Chemical pneumonitis: Stomach acid is highly corrosive. If it enters the lungs, it can cause severe chemical burns to lung tissue.
- Airway obstruction: Solid food particles can block airways, making it difficult or impossible to ventilate the patient properly.
- Respiratory failure: In severe cases, aspiration can lead to acute respiratory distress syndrome (ARDS), a life-threatening condition.
These are not minor complications. Pulmonary aspiration can extend hospital stays, require intensive care treatment, and in the most severe cases, can be fatal. This is why surgical teams take fasting requirements so seriously and why they need to know about any medications that affect gastric emptying.
How GLP-1 Medications Change Gastric Emptying Dynamics
Research has shown that GLP-1 medications can significantly delay gastric emptying, sometimes for much longer than patients or even some healthcare providers realize.
The Timeline Problem
Standard pre-operative fasting guidelines were developed based on normal gastric emptying rates. For most people not taking medications that affect digestion, the stomach typically empties solid foods within 6 to 8 hours and clear liquids within 2 hours.
These timelines informed the traditional fasting recommendations:
Nothing to eat after midnight if surgery is in the morning, or at least 6 to 8 hours of fasting before the procedure. Clear liquids allowed up until 2 hours before anesthesia.
However, studies on patients taking GLP-1 medications have found that gastric emptying can be delayed far beyond these standard timeframes. Some research has documented food remaining in the stomach 24 hours or more after consumption in patients taking these medications. This means that even if you have followed traditional fasting guidelines perfectly, your stomach may still contain gastric residue that creates aspiration risk.
Factors That Increase Delayed Gastric Emptying
Not everyone on GLP-1 medications experiences the same degree of delayed gastric emptying. Several factors influence how much these medications slow your digestion:
Dose and duration: Higher doses and recent dose increases tend to cause more pronounced gastric emptying delays. Your body may adapt somewhat over time, but the effect remains present.
Individual variation: People metabolize medications differently. Some individuals experience more dramatic digestive slowing than others on the same medication and dose.
Type of GLP-1 medication: Different medications in this class have varying effects on gastric emptying. Some newer dual-agonist medications may have even more pronounced effects.
Existing gastrointestinal conditions: Dr. Albert says that “GLP-1 medications can worsen or trigger GERD symptoms. Because they slow gastric emptying, stomach contents and acid remain in place longer, increasing the likelihood of reflux, especially at higher doses or during dose escalation. Reflux symptoms signal even slower motility and increase aspiration risk, so anesthesia teams pay close attention to them.”
Current symptoms: If you are experiencing nausea, bloating, early satiety (feeling full quickly), or reflux, these are signals that gastric emptying is significantly slowed.
What Anesthesiologists and Surgeons Need You to Know
Having spoken with multiple anesthesiologists and surgical teams about this issue, several key points emerge consistently in their guidance to patients.
Communication is Absolutely Essential
“Communication is essential,” Dr. Andrew Albert emphasizes. “Even if it’s documented in your chart, repeat it. Electronic records don’t always communicate across departments, and anesthesia decisions depend on this information.”
The single most important thing you can do is inform every member of your surgical team that you are taking a GLP-1 medication. This includes your surgeon, their office staff, and the anesthesiologist.
Dr. Albert reiterated, “Please don’t assume anyone knows, even if you have talked about it with one team member. Medical records do not always communicate perfectly between departments. Each provider needs to hear directly from you about this medication.”
Standard Fasting Guidelines May Not Be Sufficient
Because of delayed gastric emptying, traditional fasting recommendations often need modification for patients on GLP-1 therapy. Your surgical team may implement enhanced protocols, which could include:
Extended fasting periods beyond the standard 8 hours for solid foods. Liquid-only diet for 24 to 48 hours before surgery. Instructions to hold your GLP-1 dose for a specific period before the procedure. Additional pre-operative testing such as gastric ultrasound to assess stomach contents.
These modifications are protective, not punitive. They exist solely to maximize your safety during anesthesia.
Pausing Your Medication May Be Recommended
Many surgical protocols now recommend temporarily holding GLP-1 medications before elective procedures. The specific timing depends on the medication’s half-life (how long it remains active in your body):
Weekly injectable GLP-1 medications (Ozempic, Wegovy, Mounjaro, Zepbound): Often held for 1 full week before surgery. Some protocols recommend holding for 2 weeks before major procedures.
Daily GLP-1 medications (like oral semaglutide or shorter-acting injectables): Typically held for 24 to 48 hours before the procedure.
However, this decision must be individualized. Factors your provider will consider include:
Whether the surgery is elective or urgent. Your diabetes control and whether pausing medication will destabilize your blood sugar. The type and duration of your procedure. Your history of gastrointestinal symptoms on the medication.
Never stop your medication without explicit guidance from your healthcare provider. The decision to pause and the specific timing should be made collaboratively with your care team.
You Are Not in Trouble
This point deserves emphasis because I have witnessed many patients (myself included) feel embarrassed or worried when this issue comes up. Let me be absolutely clear: you have not done anything wrong if your surgical team needs to modify plans because of your GLP-1 medication.
These medications are legitimate, prescribed therapies that are helping you manage important health conditions. The need for modified surgical protocols is simply a reflection of how the medication works. It is a planning consideration, not a problem you created.
Good healthcare means adapting procedures to each patient’s unique circumstances. That is exactly what is happening here.
How to Prepare for Surgery While Taking GLP-1 Medications
Based on current best practices and recommendations from anesthesiology societies, here is a comprehensive guide to preparing for surgery when you are taking GLP-1 medications.
Step One: Disclose Your Medication Early
As soon as surgery is scheduled, inform the surgical scheduler that you are taking a GLP-1 medication. Do not wait until your pre-operative appointment. Early disclosure allows the surgical team to:
Build appropriate fasting protocols into your pre-operative instructions. Schedule any necessary additional appointments or testing. Coordinate with your prescribing physician about medication management. Allocate appropriate time for your case if special precautions are needed.
Step Two: Coordinate Between Your Providers
Your GLP-1 prescriber and your surgical team need to communicate about the plan. You can facilitate this by:
Asking your surgeon’s office to send records to your prescribing physician. Requesting a written plan for when to pause your medication and when to resume it. Ensuring all providers know your current dose and dosing schedule. Clarifying who you should contact with questions as your surgery date approaches.
Step Three: Follow Modified Fasting Instructions Precisely
If you are given extended fasting guidelines or instructions for a liquid diet before surgery, follow them exactly. These are not arbitrary restrictions. They are carefully designed to ensure your stomach is as empty as possible despite delayed gastric emptying.
Write down the instructions or ask for them in writing. Set alarms or reminders so you do not accidentally consume something during your fasting period. If you accidentally eat or drink something during the fasting window, notify your surgical team immediately rather than hoping it will not matter.
Step Four: Be Honest About Current Symptoms
Your surgical team needs accurate information about your current digestive status. If you are experiencing any of the following, tell them:
Nausea or vomiting. Heartburn or acid reflux. Feeling full very quickly when eating. Bloating or sense of heaviness in your stomach. Food feeling like it sits in your stomach for hours after meals.
These symptoms indicate that gastric emptying is particularly delayed right now, which may warrant additional precautions or potentially rescheduling elective surgery until your symptoms improve.
Step Five: Prepare Questions for Your Pre-Operative Appointment
Come to your pre-operative visit with a list of questions. Consider asking:
How long before surgery should I stop my GLP-1 medication? Should I follow a modified diet in the days before surgery? What specific fasting times apply to me given my medication? What should I do if I experience nausea or vomiting during my fasting period? When can I safely resume my GLP-1 medication after surgery? Are there any special considerations for my post-operative diet?
Having these conversations ahead of time reduces anxiety and ensures everyone is aligned on the plan.
A Simple Communication Script
If you feel uncertain about how to bring up this topic with your healthcare providers, Dr. Albert offered a straightforward script you can use or adapt:
“I want to make sure we are planning appropriately for my anesthesia. Currently, I am taking [medication name] at [dose and frequency]. I understand that GLP-1 medications can affect gastric emptying and potentially impact anesthesia safety. Can you tell me what precautions I should take, including whether I need to pause my medication before surgery and for how long?”
He emphasizes that this communication is clear, direct, and demonstrates that you are an informed patient who wants to participate actively in your safety planning.
Special Considerations for Emergency Surgery
Everything discussed so far has focused on elective procedures where there is time to plan and prepare. But what happens if you need emergency surgery while taking a GLP-1 medication?
In emergency situations, your anesthesiologist will:
Assess the urgency of the procedure against the aspiration risk. Consider you at high risk for retained gastric contents. Use rapid sequence intubation techniques designed to minimize aspiration risk. May perform gastric decompression (using a tube to empty stomach contents before anesthesia). Closely monitor you post-operatively for any signs of aspiration.
Emergency surgery always involves balancing risks. If the surgery cannot safely be delayed, the anesthesia team has protocols to manage aspiration risk as effectively as possible.
This is another reason why it is so important to inform emergency room staff immediately if you take GLP-1 medications. Even in urgent situations, this information influences care decisions.
What Happens During and After Surgery
Understanding what your anesthesia team is doing to protect you can provide reassurance.
Intra-Operative Precautions
When your anesthesiologist knows you are taking GLP-1 medications, they will implement several protective strategies:
Using rapid sequence intubation if appropriate, which minimizes the time your airway is unprotected. Ensuring the endotracheal tube cuff is properly inflated to prevent any aspiration around the tube. Potentially placing a nasogastric or orogastric tube to decompress your stomach. Positioning you appropriately to reduce reflux risk. Monitoring closely for any signs of regurgitation or aspiration.
These techniques are routine in anesthesia practice but become especially important with delayed gastric emptying.
Post-Operative Monitoring
After surgery, your healthcare team will watch for any signs that aspiration may have occurred:
Changes in oxygen saturation levels. New cough or respiratory symptoms. Fever developing in the first 24 to 48 hours after surgery. Abnormal breath sounds on lung examination. Changes in chest X-ray if imaging is performed.
If aspiration is suspected, treatment begins immediately and may include antibiotics, respiratory support, and close monitoring in a hospital setting.
My Personal Resolution and Lessons Learned
Remember that pre-operative appointment where I learned about GLP-1 medications and anesthesia the hard way? Here is how things ultimately proceeded.
After the initial surprise, my anesthesiologist and I had a detailed discussion. We decided to postpone my elective procedure by two weeks. During that time, I held my Mounjaro dose (with guidance from my prescribing physician), followed a clear liquid diet for 24 hours before surgery, and extended my solid food fast to 12 hours.
The procedure itself went perfectly. My anesthesiologist later told me that when they performed a gastric ultrasound before inducing anesthesia, my stomach appeared appropriately empty. All the extra precautions had worked.
What I learned from this experience:
Medical knowledge evolves constantly. Even healthcare providers are still learning about how GLP-1 medications interact with anesthesia as these drugs become more widely used. Patient advocacy includes proactive communication about all medications, even ones that seem unrelated to the planned procedure. Flexibility and patience serve you well. Sometimes the safest path involves adjusting timelines or plans. Questions are always appropriate. There is no such thing as asking too much when it comes to understanding your surgical safety planning.
The two-week delay felt inconvenient at the time, but it was absolutely the right decision. Surgical safety is not something to compromise for convenience.
The Evolving Guidelines and Future Directions
Medical societies including the American Society of Anesthesiologists are actively working on standardized guidelines for managing patients on GLP-1 medications during surgery. As research continues and more data accumulates, protocols will likely become more refined and specific.
Current trends in the field include:
Increased use of pre-operative gastric ultrasound to objectively assess stomach contents. Development of medication-specific holding time recommendations based on pharmacokinetic data. Research into agents that might accelerate gastric emptying in patients who need urgent surgery. Enhanced patient education materials to improve awareness of this issue. Better electronic medical record alerts to flag patients on GLP-1 medications during surgical booking.
If you are taking GLP-1 medications and anticipate any future surgical procedures, staying informed about evolving guidelines will help you advocate effectively for your safety.
Key Takeaways for Patients on GLP-1 Medications
GLP-1 medications significantly slow gastric emptying, which can increase aspiration risk during anesthesia. This is not a reason to avoid necessary surgery, but it does require modified preparation protocols. Always inform your entire surgical team about your GLP-1 medication, including dose and frequency. You will likely need to pause your medication before elective surgery (specific timing determined by your healthcare team). Standard fasting guidelines may not be sufficient; be prepared for extended fasting or liquid diet requirements. Communication between your GLP-1 prescriber and surgical team is essential. Emergency surgery is still possible and safe, but requires special anesthesia precautions. These protocols exist to protect you, not to complicate your life or make you feel problematic.
Moving Forward with Confidence
Taking GLP-1 medications should not make you fearful of necessary medical procedures. These are manageable considerations that healthcare teams handle routinely. What matters is ensuring everyone involved in your care has accurate information and sufficient time to plan appropriately.
You are not an inconvenience and not creating problems. You are a patient with specific medical considerations, and good healthcare means adapting to those considerations thoughtfully.
The conversation that started with my pre-operative surprise has made me a more proactive patient in all my healthcare interactions. I now lead with complete medication disclosure, ask questions early and often, and request written care plans whenever possible.
These practices serve me well not just around surgery, but in all aspects of managing my health.
If you have surgery scheduled and you are taking GLP-1 medications, take a deep breath. You now know what questions to ask and what to expect. You have the tools to be an active, informed participant in your surgical safety planning.
And unlike my colonoscopy surprise, you will walk into that appointment already knowing that yes, being on a GLP-1 medication does change things. But with good communication and appropriate planning, it changes them in manageable, safe ways. Besides, who doesn’t just love going through the colonoscopy prep a second time?
You are prepared. Your team is prepared. Everything is going to be okay. Love your journey!
Special thanks to Andrew Albert, MD, MPH Medical Staff President – Advocate Illinois Masonic Medical Center. Dr. Albert is a highly accomplished executive physician with 20 years of strategic leadership and medical oversight as a Medical Staff executive, Medical Director, Chief of Gastroenterology, and leader in population health initiatives for the Advocate Aurora health system. You can also find him on TikTok @doctordaba.