Perioperative management of GLP-1 receptor agonists and SGLT2 inhibitors: An updated review for anesthesiologists.
- 1Department of Anesthesia, Organ Transplant Centre of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
- 2Department of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Abstract
The widespread adoption of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose linked transporter-2 (SGLT2) inhibitors have substantially improved glycemic control and cardiometabolic outcomes in patients with diabetes and related conditions. However, their increasing perioperative use has introduced important safety considerations for anesthesiologists. GLP-1RAs are associated with delayed gastric emptying, raising concerns regarding aspiration risk, while SGLT2 inhibitors have been linked to euglycemic diabetic ketoacidosis (EDKA), particularly in the context of surgical stress and perioperative fasting. This review synthesizes evolving evidence and international guidance to inform contemporary perioperative management of these agents. For GLP-1RAs, early recommendations advocating routine preoperative cessation have been increasingly challenged by recent large-scale outcome data demonstrating no increase in clinically significant aspiration under modern anesthetic practice, supporting an individualized, risk-based approach with targeted mitigation strategies for higher-risk patients. In contrast, perioperative guidance for SGLT2 inhibitors has converged toward preoperative discontinuation to minimize EDKA risk. The review highlights the central role of anesthesiologists in coordinating multidisciplinary, patient-centered care that balances metabolic safety with preservation of established cardiovascular and renal benefits.
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BibTeX
@article{majeed2026perioperative,
title = {{Perioperative management of GLP-1 receptor agonists and SGLT2 inhibitors: An updated review for anesthesiologists.}},
author = {Amer Majeed and Rida R Amir and Sajjad Rasool Dar and Arshad Mahmood},
journal = {Saudi journal of anaesthesia},
year = {2026},
month = oct,
doi = {10.4103/sja.sja_127_26},
url = {https://europepmc.org/article/MED/42960330},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Perioperative management of GLP-1 receptor agonists and SGLT2 inhibitors: An updated review for anesthesiologists.
AU - Amer Majeed
AU - Rida R Amir
AU - Sajjad Rasool Dar
AU - Arshad Mahmood
PY - 2026
DA - 2026/10/01
JO - Saudi journal of anaesthesia
DO - 10.4103/sja.sja_127_26
UR - https://europepmc.org/article/MED/42960330
AB - The widespread adoption of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose linked transporter-2 (SGLT2) inhibitors have substantially improved glycemic control and cardiometabolic outcomes in patients with diabetes and related conditions. However, their increasing perioperative use has introduced important safety considerations for anesthesiologists. GLP-1RAs are associated with delayed gastric emptying, raising concerns regarding aspiration risk, while SGLT2 inhibitors have been linked to euglycemic diabetic ketoacidosis (EDKA), particularly in the context of surgical stress and perioperative fasting. This review synthesizes evolving evidence and international guidance to inform contemporary perioperative management of these agents. For GLP-1RAs, early recommendations advocating routine preoperative cessation have been increasingly challenged by recent large-scale outcome data demonstrating no increase in clinically significant aspiration under modern anesthetic practice, supporting an individualized, risk-based approach with targeted mitigation strategies for higher-risk patients. In contrast, perioperative guidance for SGLT2 inhibitors has converged toward preoperative discontinuation to minimize EDKA risk. The review highlights the central role of anesthesiologists in coordinating multidisciplinary, patient-centered care that balances metabolic safety with preservation of established cardiovascular and renal benefits.
SN - 1658-354X
SN - 0975-3125
ER -