Some popular weight-loss drugs, such as Wegovy and Ozempic, may increase the risk of serious complications for patients who undergo surgery or other procedures that require anesthesia, according to some doctors. They say the drugs can slow down digestion so much that patients may inhale food or liquid into their lungs while sedated, causing a potentially fatal condition called pulmonary aspiration.
What are Wegovy and Ozempic?
Wegovy and Ozempic are injectable drugs that belong to a class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists. They are approved by the Food and Drug Administration (FDA) for treating type 2 diabetes and obesity. They work by mimicking the actions of hormones that are released after eating, which help regulate blood sugar levels, appetite, and feelings of fullness. They also slow down how fast the stomach empties, which can help people eat less and lose weight.
How do these drugs affect anesthesia?
Anesthesia is a state of controlled unconsciousness that is induced by drugs to prevent pain and discomfort during surgery or other procedures. To avoid complications, patients are usually instructed to stop eating and drinking for six to eight hours before anesthesia, to ensure that their stomachs are empty. This reduces the risk of vomiting and inhaling stomach contents into the lungs, which can cause inflammation, infection, and damage to the lung tissue.
However, some anesthesiologists say that patients who take Wegovy or Ozempic may have delayed gastric emptying, meaning that their stomachs may still contain food or liquid even after fasting for the recommended time. This can increase the risk of pulmonary aspiration, especially if they receive general anesthesia, which involves inserting a tube into the airway to help with breathing.
Pulmonary aspiration can cause serious complications, such as pneumonia, acute respiratory distress syndrome (ARDS), sepsis, and death. According to a report by the American Society of Anesthesiologists (ASA), pulmonary aspiration is one of the leading causes of anesthesia-related mortality in the U.S., accounting for about 10% of deaths.
What are the recommendations for patients on weight-loss drugs?
In June 2021, the ASA issued a guidance advising patients who take GLP-1 receptor agonists to stop taking them on the day of surgery if they are daily injections, or one week before surgery if they are weekly injections. The guidance was based on anecdotal reports of problems from anesthesiologists across the country.
However, some doctors say that this may not be enough, as semaglutide, the active ingredient in Wegovy and Ozempic, can stay in the body for up to three weeks. They suggest that patients should stop taking the drug for at least three weeks before any procedure that requires anesthesia, to allow their stomachs to return to normal function.
Dr. Ion Hobai, an anesthesiologist at Massachusetts General Hospital in Boston, was among the first to raise the issue in a letter published in the Canadian Journal of Anesthesia. He said that he and his colleagues have seen several cases of pulmonary aspiration in patients who took Wegovy or Ozempic before surgery, despite following the standard fasting instructions.
“This is such a serious sort of potential complication that everybody who takes this drug should know about it,” he said.
Dr. Philip Jones, a Mayo Clinic anesthesiologist and deputy editor-in-chief of the Canadian Journal of Anesthesia, agreed that stopping the drug for three weeks may be safer than one week. He said that semaglutide has a half-life of about one week, meaning that it takes one week for half of it to be eliminated from the body.
“When 90% of it is gone, which is after three weeks, hopefully everything should go back to normal,” he said.
However, both Hobai and Jones acknowledged that there is not enough evidence to say for sure how long semaglutide should be stopped before anesthesia. They called for more research and data collection on the topic.
Dr. Michael Champeau, president of the ASA, said that the guidance is based on the best available information at the moment, but it may change as more evidence emerges.
“We’re always looking at new information and new data,” he said. “We want to make sure we’re doing what’s best for our patients.”
What should patients do if they need surgery or anesthesia?
Patients who take Wegovy or Ozempic should inform their doctors and anesthesiologists about their medication use before any surgery or procedure that requires anesthesia. They should also follow their doctors’ instructions on when to stop taking the drug and how to resume it after recovery.
Patients should not stop taking their medication without consulting their doctors first, as this may affect their blood sugar control and weight management. They should also not assume that they are safe from pulmonary aspiration if they fast longer than recommended, as this may cause dehydration and low blood sugar levels.
Patients should also be aware of the signs and symptoms of pulmonary aspiration, such as coughing, choking, wheezing, chest pain, fever, and difficulty breathing. They should seek immediate medical attention if they experience any of these after anesthesia.
Patients who have questions or concerns about their weight-loss drugs and anesthesia should talk to their doctors and anesthesiologists for more information and guidance.