Perioperative risks of glucagon-like peptide-1 receptor agonists and their implications in airway management using supraglottic airway devices

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely used for managing diabetes and obesity. The increasing prevalence of these conditions has necessitated new considerations in perioperative care. By delaying gastric emptying, these agents may challenge the traditional fasting-based assumptions of gastric emptiness before anesthesia. Residual gastric contents may persist despite adherence to standard fasting guidelines. Yet, a corresponding increase in aspiration-related complications has not been consistently observed. The clinical implications of this discrepancy remain a matter of ongoing discussion. These uncertainties have implications for airway management, particularly the use of supraglottic airway devices (SGAs), which are commonly used for elective anesthesia under the assumption of a low aspiration risk. In patients treated with GLP-1 RAs, airway decisions may require individualized risk assessment rather than reliance on fasting duration alone. This narrative review aimed to synthesize current evidence regarding the effects of GLP-1 RAs on gastric physiology and aspiration risk, and discuss their potential implications for SGAs in perioperative practice.