June 23, 2023 – If you’re taking Ozempic or Rybelsus for type 2 diabetes, Wegovy for weight reduction, or other medications in the identical class of medication, it is just not clear how long before a planned surgery it is best to stop taking the drugs for safety reasons.
The generic name for these drugs is semaglutide. Semaglutide can control blood sugar in individuals with diabetes and slow the time food stays within the stomach, so people attempting to drop some pounds feel fuller for longer.
It is significant to maintain blood sugar levels constant during surgery. The same applies to planned operations, during which the patient must be fasting.
The biggest risks of a full stomach during surgery are lively vomiting and partial or complete blockage of the tube that delivers anesthetic to the lungs. Stomach contents might also slowly come up on their very own. In any case, “aspiration,” as doctors call it, could be dangerous.
These drugs have gotten increasingly popular for weight reduction, and doctors are wondering how long they need to tell their patients to stop taking the drugs. Ozempic and Wegovy are injections given once per week, and Rybelsus is a tablet taken once a day, so the advice for various types of semaglutide will likely be different.
However, there is just not yet enough evidence to know when the safest time must be, experts said. Until medical societies issue official guidelines, doctors mutual exchange on Twitterincluding this post by John Shields, MD, an orthopedic surgeon at Atrium Health Wake Forest Baptist Davie Medical Center in Bermuda Run, NC:
Shields' post garnered quite a few reactions and comments. In the primary week, the post was retweeted 30 times and received 250 likes and greater than 70 replies and comments. Shields noted that the overall consensus is to avoid taking semaglutide for 1 to 2 weeks before surgery, but there are numerous differing opinions.
“A hot topic”
One medical society that has been working on guidelines over the past three weeks is the American Society of Anesthesiologists (ASA). The ASA is the biggest anesthesia provider group with 56,000 members. ASA President Dr. Michael Champeau could be very aware of the issues related to these medications during anesthesia and surgery.
“This is a really hot topic now. We get emails from our members asking for advice,” he said.
The ASA plans to issue guidelines for physicians in the following week or two, but is waiting to supply full “official guidelines” until more studies have been conducted.
Meanwhile, doctors try to determine whether or not they should advise patients to stop taking these drugs — also often known as glucagon-like peptide-1 receptor agonists, or GLP-1 — 12 hours, 24 hours or as much as two weeks before a scheduled surgery.
Doctors’ advice
Anesthesiologist Dr. Cliff Gevirtz has seen only a number of surgical patients taking GLP-1 for weight reduction. “And thankfully, no aspiration,” said Gevirtz, clinical director of outpatient anesthesia services at Somnia Anesthesia in Harrison, NY.
The key word is “planned” surgery. There are also emergency operations where doctors cannot ask the patient or wouldn’t have time to make use of ultrasound to envision how full or empty the stomach is.
They treat all of those cases as if someone had just eaten a full meal. Anesthesiologists perform a “rapid sequence induction,” which involves giving the patient a drug that puts them to sleep, then one other that quickly paralyzes them, after which inserting a respiration tube—all inside about 30 seconds.
There can also be a drugs called metoclopramide that may speed up the emptying of foods and drinks from the stomach, however it should be given half-hour upfront and is subsequently not useful in emergency situations.
The approach on the MetroHealth system in Cleveland varies depending on whether the person is taking GLP-1 for diabetes or for weight reduction, says Dr. Ronnie Fass, a gastroenterologist and division chief of gastroenterology and hepatology and medical director of the Digestive Health Center there.
Currently, MetroHealth doctors instruct patients to stop taking diabetes medications on the day of surgery.
Because semaglutide is taken once per week, “there is increasing discussion among surgeons that the drug should not be stopped before surgery when treating type 2 diabetes. This is to ensure that the patient's diabetes is well controlled before and during surgery,” Fass said.
For patients taking semaglutide just for weight reduction, “there is no clear answer at this point,” he added.
“Personally,” said Fass, “if a patient [semaglutide] I would consider stopping the medication before surgery just to lose weight.”