AANA June 2026 Journal Course: GLP-1 Receptor Agonists: What CRNAs Need to Know About Their Expanding Role-GLP-1 Receptor Agonists: What CRNAs Need to Know About Their Expanding Role

GLP-1 Receptor Agonists: What CRNAs Need to Know About Their Expanding Role

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This article reviews the expanding role of GLP-1 receptor agonists (GLP-1RAs) and the perioperative implications for CRNAs. Originally developed for type 2 diabetes and later widely used for obesity, these drugs are now increasingly prescribed off-label for conditions such as alcohol, nicotine, and substance use disorders, and are being studied for neurodegenerative, cardiovascular, kidney, liver, and musculoskeletal diseases.<br /><br />The article explains GLP-1RA pharmacology and why these agents matter in anesthesia: they improve glucose control through glucose-dependent insulin secretion and glucagon suppression, but also delay gastric emptying through peripheral and central mechanisms. This delayed emptying raises concern for residual gastric contents and potential pulmonary aspiration during anesthesia or sedation, especially in patients with GI symptoms, during dose escalation, or when therapy has recently started. Current guidance from the AANA and ASA emphasizes individualized, patient-centered decision-making rather than automatic cancellation, with recommendations to consider holding daily agents on the day of surgery and weekly agents one week prior, while using “full stomach” precautions or point-of-care gastric ultrasound if medications were not held or symptoms are present.<br /><br />The review also highlights the need to balance aspiration risk against the metabolic benefits of GLP-1RAs, including lower perioperative glucose variability and reduced hyperglycemia-related complications. If therapy is withheld, clinicians should plan for possible rebound hyperglycemia and consider endocrinology consultation for diabetes bridging.<br /><br />A major additional concern is unregulated peptide use from compounding or online sources, which may involve unknown ingredients or unsafe dosing. CRNAs should specifically ask about prescription, compounded, and nonprescription peptide products.<br /><br />Finally, the article notes growing research on GLP-1RAs in addiction, neuroprotection, and other disease states, reinforcing the need for ongoing education, careful screening, and strong interdisciplinary communication to support safe perioperative care.

Keywords

GLP-1 receptor agonists

perioperative care

CRNA anesthesia

delayed gastric emptying

pulmonary aspiration

AANA guidelines

ASA recommendations

full stomach precautions

compounded peptides

rebound hyperglycemia