Is "NPO After Midnight" Enough Time in the Age of GLPs?

Glucagon-like peptide-1 receptor agonist (GLP-1 RA) use is rapidly increasing in the US, driven by its use for weight management and type 2 diabetes. Fasting after midnight before the day of surgery is a widely held guideline for our patients to decrease gastric contents and the risk of aspiration. With the growing popularity of GLP-1 RAs, has there been any changes in this fasting guideline for surgical patients?

Residual gastric contents (RGC)

Publishing in JAMA Surg., Sudipta Sen et al. studied gastric contents with ultrasound and compared RGC in GLP users and non-users. All 124 patients followed the recommended duration of fasting prior to surgery.

GLPs must be stopped to allow gastric emptying

Fifty-nine percent of patients on GLP had increased residual gastric contents, compared to 19% of non-users. This was significant. The American Society of Anesthesiologists recommends stopping GLP’s one week prior to surgery.