Perioperative bronchoaspiration in a semaglutide user on a residue-free diet: a case report and insights from a complication.

INTRODUCTION: Perioperative bronchoaspiration is a serious complication often associated with inadequate fasting or delayed gastric emptying, including that caused by glucagon-like peptide-1 receptor agonists (GLP-1-RAs). Despite growing semaglutide use worldwide, evidence on the effectiveness of current preventive measures-such as residue-free diets-remains limited. CASE PRESENTATION: We report a 61-year-old female with obesity and chronic obstructive pulmonary disease who underwent elective coronary angiography. She had been using weekly semaglutide for weight loss, discontinued six days before the procedure, but did not disclose this during preoperative evaluation. Following institutional guidance, she adhered to a 24-h residue-free diet and 12-h fasting. A protocol breach led to omission of preoperative gastric ultrasound. During anesthesia induction, she experienced large-volume regurgitation requiring urgent airway management. Postoperative chest CT revealed aspiration-related inflammatory changes. She recovered uneventfully and later acknowledged omitting semaglutide use from her medical history because she did not consider it a "medication." CONCLUSION: This case demonstrates that even stricter dietary measures than those recommended in current guidelines may not eliminate aspiration risk in GLP-1-RA users. Active screening for GLP-1-RA use, consideration of extended discontinuation intervals, and routine bedside gastric ultrasound should be incorporated into perioperative protocols to enhance patient safety.