For clinicians

GLP-1 Perioperative Hold Calculator

Decision support for anesthesiologists, CRNAs, and surgical teams managing patients on GLP-1 receptor agonists (semaglutide, tirzepatide, liraglutide, dulaglutide, exenatide). Based on the October 2024 multi-society consensus guidance from ASA, AGA, ASMBS, ISPCOP, and SAGES.

Patient & procedure

GLP-1 drug class

Dose phase

Escalation phase carries higher delayed-gastric-emptying risk than maintenance.

Procedure type

Day-of GI symptoms

Nausea, vomiting, dyspepsia, or abdominal distension.

Patient has type 2 diabetes

Recommendation

Continue GLP-1; standard risk mitigation

→Liquid-only diet for 24 hours preoperatively.
→Standard NPO guidelines after that.
→Consider gastric ultrasound if any concern at induction.
→Standard aspiration prophylaxis.
→No routine GLP-1 hold required per 2024 multi-society guidance.

Note: This is decision support only — not a clinical mandate. Consider patient-specific factors, institutional protocols, and the most recent multi-society guidance. Diabetes patients on GLP-1s for glycemic control may have additional perioperative glucose-management considerations not captured here.

2024 Multi-Society Guidance Summary

The 2024 update walked back the 2023 ASA recommendation to hold GLP-1s the day of surgery (weekly) or one week prior (weekly dosing). Most patients should now continue their GLP-1 with risk mitigation, not blanket holding.

Liquid-only diet 24h before procedure minimizes residual gastric contents in patients on GLP-1s.
Point-of-care gastric ultrasound right before induction in higher-risk patients (escalation phase, GI symptoms, full stomach concerns).
Anesthesia plan adjustment: rapid sequence induction, head-up positioning, or awake intubation may be appropriate for highest-risk cases.
Escalation phase > maintenance phase for delayed gastric emptying risk. Patients still titrating doses are higher-risk.
Symptoms matter: nausea, vomiting, abdominal distension, or dyspepsia on the day of surgery should prompt reassessment regardless of dose phase.

Primary references

Last reviewed against multi-society guidance: April 25, 2026. Recommendations may have updated since this review — always verify against the most recent published guidance and your institution's protocols before acting.

Medical disclaimer: This calculator provides estimates only based on phase 3 clinical trial data and publicly listed prices. It is not medical advice. Real-world weight loss varies significantly. Consult a licensed healthcare provider before starting any medication.

Useful? Share with your service line or anesthesia department.

See the patient-facing GLP-1 cost & weight loss calculator →