Anti-Hyperglycemic Medication Management in the Perioperative Setting: A Review and Illustrative Case of an Adverse Effect of GLP-1 Receptor Agonist

Abstract

A host of anti-hyperglycemic agents are currently available and widely prescribed for diabetes and weight loss management. In patients undergoing surgery, use of these agents poses a clinical challenge to surgeons, anesthesiologists, and other perioperative care providers with regard to optimal timing of discontinuation and resumption of use, as well as possible effects of these agents on physiology and risk of postoperative complications. Here, we provide a comprehensive review of anti-hyperglycemic medications' effects on physiology, risks/benefits, and best practice management in the perioperative setting. Additionally, we report an illustrative case of small bowel obstruction in a patient taking semaglutide for 6 months prior to an otherwise uncomplicated laparoscopic hysterectomy and bilateral salpingo-oophorectomy. This review is meant to serve not as a replacement of, but rather as a consolidated complement to, various society guidelines regarding perioperative anti-hyperglycemic agent management.

Keywords: GLP-1 receptor agonists; anti-hyperglycemic agents; perioperative care; pharmacovigilance.

Figure 1

(A). Initial CT of the abdomen and pelvis upon readmission demonstrating small bowel obstruction. Imaging findings of mechanical small bowel obstruction with transition point anterior central abdomen (red circle). Immediately proximal to this location, there is some fecal content within the dilated small bowel loop up to 3.5 cm. Beyond this area, the small bowel is under-distended. (B). Final computed tomography of abdomen pelvis prior to discharge demonstrating interval resolution of small bowel obstruction. Interval resolution of previously observed small bowel obstruction with decompression of small bowel loops. No free air. Air-fluid level in the stomach may relate to gastric dysmotility. (C). Small bowel follow through on hospital day 2 demonstrating evidence of resolving partial small bowel obstruction. Oral contrast in nondilated ileum. Small amount of nonspecific gas in jejunum and left aspect of the colon. Evidence suggestive of resolving partial small bowel obstruction.