What is the rationale behind the Anesthesiology recommendation to hold one dose of weekly GLP-RA prior to general anesthesia?

There is evidence that people treated with GLP-1 receptor agonists (GLP-1RA) more often have residual food in the stomach after an overnight fast and greater gastric volume. There is anecdotal evidence of aspiration events in people treated with GLP-1RA. The ASA statement raises a concern and provides a warning but only a suggested approach.

With a ½-life of approximately a week for semaglutide, dulaglutide and tirzepatide, holding the medicine for a week is not an adequate period to reduce GLP-1RA exposure to zero and we do not really know what level of decline in plasma drug concentration is required to have no effect on gastric emptying. I suspect that it would take 3-6 weeks to have a large effect. It would be longer for exenatide once ...