Doctors are being forced to delay surgery for some patients who are on Ozempic-like drugs, which can pose a heightened risk of life-threatening consequences to patients when they are under anaesthetic.
As the use of glucagon-like peptide-1 (GLP-1) agonists such as Ozempic have risen, anaesthetists said some patients where failing to declare they were on the medication before showing up for surgery, or had not arrived properly prepared.
GLP-1 drugs are a breakthrough class of medication that mimic the activity of a natural hormone, helping people feel full for longer.
But David Story, president of the Australian and New Zealand College of Anaesthetists, (ANZCA) said they slowed digestion, which could potentially increase the risk of pulmonary aspiration during surgery.
“The major problem we’re trying to prevent is aspiration of gastric contents. That is where someone regurgitates what’s in their stomach and it’s breathed into their lungs or passes into their trachea,” he said.”That can lead to either obstruction of the airway, which can be life-threatening … it can lead to chemical or physical injury of the lungs, leading to the situation where a patient may need to go to ICU and some patients with this condition can die.
“And this is what we’re really concerned about.”
Professor Story said patients were showing up for surgery without telling doctors they were on GLP-1 drugs because they had either forgotten, did not realize it counted as medication, were taking it without a doctor’s oversight, or were embarrassed about using weight loss drugs.
Weight loss drugs and surgery: What anaesthetists need to know
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Anaesthetists are being warned about potential risks when operating on patients taking popular weight loss drugs like Ozempic and Wegovy.
GLP-1 medications, used for both type 2 diabetes and weight loss, can delay stomach emptying, increasing the risk of a patient inhaling stomach contents during surgery.
Vida Viliunas, an anaesthetist at the Royal Australian College of Anaesthetists (ANZCA), explained the concern. “if the stomach is full, ther’s a risk of aspiration – that’s where the stomach contents come up into the airway,” she said.
“On these medications, I found out later … but I used a technique of intubation that protects the airway from soiling from gastric contents.”
Dr Viliunas stressed the benefits of GLP-1s frequently enough outweighed the risks and that anaesthetists were used to thinking on their feet to protect patients.
“Surgery can either proceed, be deferred or cancelled,” she said.
“Say somebody has a cancer that needs to be operated on, that is relatively urgent … we will decide to proceed.
“I have techniques that I will use to mitigate the risk.”
New guidelines for anaesthetists
ANZCA has updated its guidelines, recommending anaesthetists specifically ask their patients whether they are on GLP-1 medication.
It also recommends patients on GLP-1 drugs take clear fluids for 24 hours, followed by a standard six-hour fast before surgery.
Ozempic and Surgery: Why Disclosing Medication Use is Crucial for Patient Safety
Recent reports highlight a growing concern among medical professionals: patients undergoing surgery who are also taking glucagon-like peptide-1 (GLP-1) receptor agonists like Ozempic, Wegovy, and Mounjaro are not always disclosing this data to their surgical teams. This omission can lead to complications, including delayed or cancelled procedures, and potentially impact patient safety. experts strongly advise patients to be upfront with their doctors about all medications, including GLP-1s, before any surgical intervention.
The Rising Popularity of GLP-1 Medications
GLP-1 receptor agonists were originally developed to treat type 2 diabetes by helping the body regulate blood sugar. Though, they’ve gained significant popularity for their effectiveness in promoting weight loss, leading to increased off-label use. Drugs like ozempic (semaglutide) and Wegovy (also semaglutide, but at a higher dose) have become widely known, and newer medications like Mounjaro (tirzepatide) are also gaining traction. https://www.cdc.gov/diabetes/treatments/medication/glp-1-agonists.html
Why Disclosing GLP-1 Use is Critical Before Surgery
Several factors make it essential for patients to inform their surgical teams about their GLP-1 medication use:
* impact on Gastric Emptying: GLP-1s slow down gastric emptying, meaning food stays in the stomach longer. This can pose a risk during anesthesia and increase the potential for aspiration (stomach contents entering the lungs). https://www.asahq.org/madeforthismoment/preparing-for-surgery/medications/glp-1-receptor-agonists/
* Blood Sugar Control: Stopping GLP-1 medications abruptly before surgery can lead to elevated blood glucose levels, potentially increasing the risk of infection and hindering wound healing.
* Potential for Surgical Delays or Cancellation: Uncontrolled blood sugar or the risk of aspiration can necessitate postponing or even cancelling a scheduled surgery.
“In the short term, I think stopping the GLP-1 medications like ozempic can be disruptive as it can lead to high glucose levels and it can also lead to potential delays in the surgery or cancellation of surgery,” explains Elif Ekinci, as reported by ABC news. https://www.abc.net.au/news/health/2024-01-18/ozempic-wegovy-mounjaro-surgery-risks-anaesthetic-blood-sugar/103304128
Doctor’s Recommendations: Honesty and Collaboration
Medical professionals are emphasizing the importance of open interaction. Professor Story, interviewed by ABC News, stated, “We as doctors won’t judge them. It’s much more critically important that we certainly know about it for their safety … that’s our role as doctors, to work with them and optimise their care.”
The general consensus is that patients should not stop taking GLP-1 medications before surgery unless specifically instructed to do so by their physician. Doctors will assess each case individually and provide tailored guidance on when and how to adjust medication schedules to minimize risks.
Long-Term Benefits of GLP-1s
Despite the short-term considerations for surgery, experts emphasize the long-term benefits of these medications. “In the long term,these are very good medications. They are very good at managing glucose levels and obesity and have other long-term benefits as well, like reduction in cardiovascular events in particular in type 2 diabetes,” Ekinci noted.
Key Takeaways:
* Always disclose: Inform your surgical team about all medications you are taking, including GLP-1 receptor agonists like Ozempic, Wegovy, and Mounjaro.
* Follow medical advice: Do not stop taking your medication unless specifically instructed by your doctor.
* Open communication is key: Discuss any concerns you have with your healthcare providers.
* Prioritize safety: Honesty and transparency are crucial for ensuring a safe surgical experience.
This information is for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
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