Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are known to delay gastric emptying, which has raised concerns about their safety during the perioperative period. This systematic review assesses the association between GLP-1RAs exposure and anesthetic-related adverse outcomes in patients undergoing surgery or esophagogastroduodenoscopy (EGD). Methods: In accordance with PRISMA guidelines, we conducted a systematic search of PubMed, Embase, the Cochrane Library, CNKI, WanFang Data, and SinoMed from their inception until August 31, 2025. The search encompassed RCTs and cohort studies that examining the impact of GLP-1RAs on anesthetic risk in patients undergoing surgery or EGD. The primary outcomes were incidence of aspiration events and the presence of residual gastric content (RGC). Two reviewers independently extracted the data, and we conducted the meta-analysis using a random-effects model. Results: A total of 21 cohort studies involving 275,282 patients were included. The meta-analysis indicated that preoperative exposure to GLP-1RAs was associated with a significantly higher risk of RGC compared with non-use (OR 5.11,95% CI 3.67-7.11, P<0.00001, I 2=66%). However, there was no statistically significant difference in the incidence of aspiration events between the two groups (OR 1.03, 95% CI 0.87-1.23, P=0.70, I 2=0%). Conclusion: The use of GLP-1RAs prior to procedures is associated with increased RGC and higher rates of aborted procedures, though not with significantly elevated the risk of aspiration. Our findings inform the preoperative management of GLP-1RAs, supporting discontinuation in elective settings and underscoring the need for prospective studies to strengthen evidence-based guidelines.

Aims: Intravenous ibuprofen (IVIB) has been approved in the treatment of postoperative pain and fever in adults, but the application of multiple- or single- dosage IVIB remains divergent in clinical practice. This study aims to evaluate the efficacy and safety of IVIB in the management of postoperative pain and fever in adults who were unable to take oral medicine. Methods: A systematic review and meta-analysis was conducted based on randomized controlled trials (RCTs) regarding postoperative pain and fever management comparing IVIB with placebo, or other analgesic and antipyretic agents from 8 databases. Risk of bias and quality of evidence assessment were performed. The primary outcomes mainly included visual analogue scale (VAS) score within postoperative 24h and the reduction of temperature. Results: Twenty-three RCTs with 3716 participants were included. For postoperative pain, moderate-to-low certainty evidence indicated that IVIB was associated with lower postoperative VAS scores than placebo, with MD ranging between -3.53 (95% CI, -4.32 to -2.75) at 0 minute to -0.96 (95% CI, -1.35 to -0.57) at 24 hours. Compared to intravenous acetaminophen, IVIB appeared lower VAS scores (MD, -1.54 at 0min; -0.36 at 24h). For fever, IVIB appeared satisfactory antipyretic efficiency in a short period of time, but there was no difference between IVIB and intravenous acetaminophen. Moderate-to-low certainty evidence indicated that IVIB was well tolerated in both pain and fever management. Conclusions: Moderate-to-low certainty evidence supported that adults with postoperative pain and fever who were unable to take oral medicine would benefit from IVIB.