GLP-1 drugs and anesthesia: what surgery risk claims get wrong

What did @jocampagnuolo actually say?

Dr. Joanne Campagnol, an anesthesiologist, told viewers that GLP-1 medications like semaglutide and tirzepatide cause delayed gastric emptying, which raises aspiration risk during anesthesia. Her core recommendation: follow the American Society of Anesthesiologists (ASA) guidance and stop GLP-1s at least seven days before any procedure. She also said, "Do not talk to your prescriber about this. They do not know the answer." That last part deserves some scrutiny.

The broader warning about gastroparesis-like effects and aspiration is legitimate clinical concern. The ASA did publish guidance in 2023 recommending a preoperative pause on these medications. But the blanket dismissal of prescribers is an overreach that could actually harm patients who need coordinated care decisions, especially those managing type 2 diabetes where stopping a GLP-1 abruptly has metabolic consequences.

Does the science back this up?

Mostly, yes, but with important caveats the video skips over. The delayed gastric emptying concern is real and documented, though the evidence connecting it directly to aspiration events during surgery is still accumulating rather than settled.

The ASA's 2023 consensus-based guidance recommends holding daily GLP-1 doses on the day of the procedure and weekly doses for one week prior. That recommendation was primarily expert consensus, not a meta-analysis of randomized controlled trials. A 2023 case series by Matharoo et al. in Anaesthesia documented residual gastric contents in fasted GLP-1 patients undergoing endoscopy, supporting the biological plausibility of the risk. However, a 2024 retrospective cohort study by Sheridan et al. in Diabetes Care found no statistically significant increase in pulmonary aspiration events in GLP-1 users compared to controls, suggesting the clinical magnitude of this risk is still being worked out. The science is directionally consistent with Dr. Campagnol's warning, but "extremely dangerous" is doing more work than the current evidence fully supports.

What did they get wrong (or right)?

Credit where it is due: the core message is sound. GLP-1 users should disclose their medication use before any procedure, and the ASA's seven-day guidance for weekly injectables is accurately represented. The explanation of why fasting matters before anesthesia is clear and correct.

The significant error is telling patients, "Do not talk to your prescriber about this. They do not know the answer." This is wrong on two counts. First, prescribers, including endocrinologists and primary care physicians, are often the most qualified people to weigh the metabolic risk of stopping a GLP-1 against surgical risk, particularly for diabetic patients. Second, the decision to pause a medication that affects blood glucose management should always involve the prescribing provider. The American Diabetes Association guidelines emphasize coordinated perioperative medication management. Telling patients their prescriber is irrelevant could lead to poorly managed blood sugar in the perioperative period, which carries its own serious risks documented by Frisch et al. (2010, Journal of Hospital Medicine).

The mispronunciation of drug names is minor but worth noting on a public health platform where brand recognition matters for patient safety.

What should you actually know?

If you are on a GLP-1 medication and have surgery or a procedure scheduled, there are a few things that actually matter. The ASA recommends holding weekly GLP-1 doses for seven days before elective procedures. That applies to semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound). Daily formulations like liraglutide should be held on the day of the procedure.

You should tell both your anesthesia provider and your prescriber. Not one or the other. Both. Your prescriber needs to know because stopping a GLP-1 can affect blood glucose levels, particularly if you are using it for type 2 diabetes rather than weight management. Your anesthesiologist needs to know so they can make decisions about precautionary measures like rapid sequence induction if indicated.

The risk of aspiration is the reason this matters, but it is not a certainty. Anesthesiologists have tools to mitigate aspiration risk. The goal of disclosing your medications is to give your care team full information, not to catastrophize every procedure. If you have questions about whether to pause your medication, that conversation should happen with your prescribing provider and the facility performing your procedure, together if possible.