Ppatients fast before surgery to prevent food from entering their lungs while underwater – a serious concern that can lead to lung infection. But for those following a range of treatments, including the widely popular Ozempic and Wegovy, fasting may not be enough to guarantee an empty stomach.
The American Society of Anesthesiologists issued accompaniment Thursday recommends patients stop taking this class of treatment, called GLP-1 drugs, before undergoing surgery.
While there is limited data on how these drugs affect people undergoing surgery, there are concerns – based on anecdotal reports – that delayed gastric emptying caused by these drugs could increase the risk of regurgitation and food aspiration into the lungs when patients under anesthesia, the group said.
GLP-1 drugs for type 2 diabetes and obesity have gained immense popularity due to their ability to significantly reduce people’s weight. They mimic the effects of the glucagon-like peptide 1 hormone that helps people feel full after eating. The class of treatments includes Novo Nordisk’s diabetes drug Ozempic and obesity drug Wegovy, as well as Eli Lilly’s diabetes drug Mounjaro.
The drugs have gastrointestinal side effects such as nausea, vomiting and delayed gastric emptying. People often feel these effects the most when they start taking the drugs and increase the dosage, and the effects usually wear off over time.
Delayed gastric emptying on GLP-1 drugs may also affect how well patients can absorb other oral medications they are taking. The label for Lilly’s Mounjaro recommends that patients using oral contraception switch to a non-oral form or add an additional method of birth control for the month after they start taking the drug and after each dose increase. Studies showed that the drug’s effect on gastric emptying was greatest after the first dose and decreased after subsequent doses, according to the label.
The anesthesiologist group said that for people undergoing urgent surgery, doctors should take precautions, assuming the patient has a full stomach.
For elective procedures, the group recommends that patients taking a daily dose of a GLP-1 drug should continue treatment on the day of surgery, and those taking a weekly dose should maintain it for the week before surgery.
The group also said that if the patient experiences gastrointestinal symptoms such as severe nausea, vomiting, or abdominal pain or bloating, doctors should consider delaying surgery. Some data to suggest that the presence of gastrointestinal side effects is related to how much food is in the stomach.
If the patient has no gastrointestinal symptoms, but the GLP-1 drug was not retained, doctors should consider using an ultrasound to assess what’s in their stomach, the group said. If the stomach is empty, doctors can proceed as usual, but if the stomach is full or the ultrasound is inconclusive, doctors should consider delaying the procedure or adding precautions for a full stomach.
Anesthesiologists should also discuss the risk of regurgitation and food aspiration with other physicians involved in the surgery and with the patient, the group said.
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