GLP-1 receptor agonists intentionally slow gastric emptying

This effect improves weight loss but increases aspiration risk under anesthesia

Patients can follow NPO instructions perfectly and still arrive with a full stomach

Anesthesia removes protective airway reflexes

A full stomach increases the chance of gastric contents entering the lungs

Aspiration can cause chemical pneumonitis, pneumonia, respiratory failure, and death

Case reports and ultrasound studies show delayed gastric emptying lasting many hours or days

Large population studies show aspiration rates haven’t exploded

Possible explanation: tachyphylaxis — tolerance over time to gastric slowing

GLP-1 meds improve glucose control and wound healing

Weight loss reduces surgical risk factors like difficult airways and clotting risk

Cardiovascular benefits lower post-operative complications

Shift toward a 24-hour clear liquid diet before surgery

Holding weekly GLP-1 injections for a full seven days

Treating all GLP-1 patients as full stomach regardless of fasting status

Increased use of rapid sequence induction and endotracheal tubes

Growing use of point-of-care ultrasound to assess gastric contents

Develop a high index of suspicion for GLP-1 medications

Ask specifically when the last dose was taken

Assess for nausea, bloating, reflux, or early satiety

Ask what the patient ate, not just when they ate

Educate patients using lung safety, not blood sugar, as the rationale

Escalate concerns immediately — do not assume the case is canceled

Checklists alone are no longer enough

Nurses must investigate individual physiology, not just follow rules

Transparency and clinical judgment save lives

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