Blamed but not at fault: Anti-obesity medication adverse effects misidentified as perioperative complications — a comprehensive review and medicolegal warning for anesthesiologists

Apr 28, 2026Korean journal of anesthesiology

Side effects of weight-loss drugs mistaken for surgery complications: a warning for anesthesiologists

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Abstract

Non-arteritic anterior ischemic optic neuropathy from semaglutide has a hazard ratio of 7.64.

Drug-induced adverse effects from anti-obesity medications may mimic surgical or anesthetic complications, complicating diagnosis.
Acute pancreatitis linked to GLP-1 receptor agonists has an adjusted hazard ratio of 9.09 compared to other treatments.
Bowel obstruction may occur from resuming GLP-1 receptor agonists too soon after surgery, leading to unnecessary surgical interventions.
Emotional lability in patients could be misinterpreted as emergence delirium due to anti-obesity medications.
Preoperative documentation and clear postoperative orders for anti-obesity medications are suggested as essential components of patient care.

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The rapid proliferation of anti-obesity medications (AOMs), including glucagon-like peptide-1 receptor agonists (GLP-1 RAs), the dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 agonist tirzepatide, and non-incretin agents, including orlistat, phentermine, and bupropion/naltrexone, has created an underappreciated perioperative patient safety hazard. Existing guidelines have focused narrowly on GLP-1 RAs and aspiration risk, leaving some critical gaps unaddressed: (1) the misidentification trap, whereby drug-induced adverse effects, including acute pancreatitis, bowel obstruction, sudden visual loss, and neuropsychiatric dysfunction, are clinically and radiographically indistinguishable from surgical or anesthetic complications, exposing clinicians to unwarranted blame, and (2) the full perioperative risk profile of non-GLP-1 AOM classes. This narrative review synthesizes the current pharmacovigilance evidence, consensus guidelines, and clinical case data to address these gaps. Non-arteritic anterior ischemic optic neuropathy (NAION) from semaglutide (HR 7.64; World Health Organization safety alert 2025) may be attributed to anesthetic corneal injury, emotional lability may be misinterpreted as emergence delirium, drug-induced pancreatitis from GLP-1 RAs (adjusted HR 9.09 vs. comparator) may be misattributed to the operating surgeon, and bowel obstruction from premature postoperative GLP-1 RA resumption has prompted unnecessary re-laparotomy. Structured preoperative AOM documentation, explicit postoperative hold orders, and the inclusion of drug etiology in postoperative differentials constitute the defensible standard of care in the era of pharmacological obesity management.

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Blamed but not at fault: Anti-obesity medication adverse effects misidentified as perioperative complications — a comprehensive review and medicolegal warning for anesthesiologists

Abstract

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