Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly utilized for weight loss and glycemic control in patients with diabetes. However, their impact on gastrointestinal motility and the potential association with aspiration risk during anesthesia remains underexplored. This study aims to comprehensively assess the risk of aspiration in patients receiving GLP-1 RAs undergoing anesthesia. Methods: A retrospective cohort study was conducted using electronic health records from a tertiary medical center. Patients aged 18-75 years with a diagnosis of diabetes or obesity who underwent elective surgery under anesthesia were included. The study cohort comprised patients who had received GLP-1 RAs (n=500) and a control group of patients who did not receive GLP-1 RAs (n=500). Demographic characteristics, medical history, GLP-1 RA dosage, and duration of therapy were recorded. The primary outcome was the incidence of aspiration events during anesthesia. Logistic regression analysis was performed to assess the association between GLP-1 RA use and aspiration risk. Results: Of the 1000 patients included, 35 aspiration events (3.5%) were recorded during anesthesia. Among patients receiving GLP-1 RAs, the incidence of aspiration was 2.8%, compared to 4.2% in the control group. Logistic regression analysis adjusting for age, BMI, and comorbidities revealed no significant association between GLP-1 RA use and aspiration risk (adjusted odds ratio 0.65, 95% CI 0.35-1.21, p=0.17). Subgroup analysis based on GLP-1 RA dosage and duration of therapy showed consistent results.