June 23, 2023 – If you happen to’re taking Ozempic or Rybelsus for sort 2 diabetes, Wegovy for weight reduction, or different drugs in the identical drug class, it’s not clear how lengthy earlier than deliberate surgical procedure you must cease taking the drug to be protected.
The generic title for these drugs is semaglutide. Semaglutide can management blood sugar for folks with diabetes and may decelerate how lengthy meals stays within the stomach, serving to individuals who need to drop some weight really feel full longer.
Maintaining blood sugar regular throughout surgical procedure is essential, and so is having elective or deliberate surgical procedure on an empty abdomen.
The most important dangers of a full abdomen throughout surgical procedure are actively vomiting and partially or totally blocking the tube that delivers anesthesia to the lungs. Abdomen contents may come up slowly on their very own. Both means, “aspiration” as medical doctors name it, will be harmful.
These drugs have surged in reputation for weight reduction, leaving medical doctors questioning how lengthy to inform sufferers to cease the medication prematurely. Ozempic and Wegovy are injections taken as soon as every week, and Rybelsus is a pill taken as soon as a day, so the recommendation will probably be completely different for various types of semaglutide.
However there’s not sufficient proof but to know what the most secure timing needs to be, consultants mentioned. Till medical societies provide you with official steering, medical doctors are checking with one another on Twitter, together with this submit from John Shields, MD, an orthopedic surgeon at Atrium Well being Wake Forest Baptist Davie Medical Heart in Bermuda Run, NC:
Defend’s submit yielded plenty of reactions and feedback. Within the first week, the submit was retweeted 30 instances and earned 250 “likes,” together with greater than 70 replies and feedback. Shields famous the final consensus was to carry off on semaglutide for 1 to 2 weeks earlier than surgical procedure, however there have been plenty of completely different opinions.
“A Sizzling Difficulty”
One medical society that has been engaged on steering for the previous 3 weeks is the American Society of Anesthesiologists (ASA). The ASA is the biggest anesthesia supplier group with 56,000 members. ASA President Michael Champeau, MD, may be very conscious of the problems surrounding these drugs throughout anesthesia and surgical procedure.
“It is a actually sizzling problem now. We’re getting emails from our members in search of steering,” he mentioned.
The ASA plans to launch steering for medical doctors within the subsequent week or two however is holding again on full “official tips” till extra research are finished.
In the meantime, medical doctors are attempting to determine if they need to inform folks to cease taking these medicines — also referred to as glucagon-like peptide 1 receptor agonists or GLP-1s — 12 hours, 24 hours, or as much as 2 weeks earlier than deliberate surgical procedure.
Medical doctors’ Recommendation
Anesthesiologist Cliff Gevirtz, MD, has up to now encountered just a few surgical sufferers taking GLP-1s for weight reduction. “And fortunately no aspiration,” mentioned Gevirtz, scientific director of office-based ambulatory anesthesia providers at Somnia Anesthesia in Harrison, NY.
The important thing phrase is “deliberate” surgical procedure. There are additionally emergency surgical procedures the place medical doctors can’t ask a affected person or shouldn’t have time to do an ultrasound scan to test how full or empty the abdomen may be.
They deal with all these instances as if somebody simply ate a full meal. Anesthesiologists will do a “speedy sequence induction.” This includes giving the drugs that makes a affected person fall asleep, giving one other drugs that paralyzes them shortly, then inserting a respiration tube — all inside about 30 seconds.
There’s additionally a drug referred to as metoclopramide that may assist velocity up the emptying of meals or drinks from the abdomen, nevertheless it needs to be given half-hour prematurely, so it doesn’t assist in emergency procedures.
The method on the MetroHealth System in Cleveland differs relying on whether or not an individual is taking a GLP-1 for diabetes or weight reduction, mentioned Ronnie Fass, MD, a gastroenterologist and the division director of gastroenterology and hepatology and the medical director of their Digestive Well being Heart.
Presently, clinicians at MetroHealth instruct sufferers to discontinue drugs for diabetes on the day of surgical procedure.
For many who take semaglutide for sort 2 diabetes, and since the medicine is taken as soon as every week, “there’s rising dialogue amongst surgeons that the medicine shouldn’t be stopped previous to surgical procedure. That is to make sure that sufferers’ diabetes is nicely managed earlier than and through surgical procedure,” Fass mentioned.
In sufferers taking semaglutide for weight reduction solely, “there isn’t any clear reply at this level,” he added.
“Personally,” Fass mentioned, “if a affected person is taking [semaglutide] for weight reduction solely, I’d think about stopping the medicine earlier than surgical procedure.”
