June 23, 2023 – If you happen to’re taking Ozempic or Rybelsus for sort 2 diabetes, Wegovy for weight reduction, or different medicines in the identical drug class, it’s not clear how lengthy earlier than deliberate surgical procedure you need to cease taking the drug to be protected.
The generic title for these medicines is semaglutide. Semaglutide can management blood sugar for individuals with diabetes and may decelerate how lengthy meals stays within the stomach, serving to individuals who wish to shed weight really feel full longer.
Preserving blood sugar regular throughout surgical procedure is necessary, 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 absolutely 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, may be harmful.
These medicines have surged in reputation for weight reduction, leaving medical doctors questioning how lengthy to inform sufferers to cease the medicine upfront. 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 doubtless be completely different for various types of semaglutide.
However there’s not sufficient proof but to know what the most secure timing ought to be, consultants stated. Till medical societies give you official steering, medical doctors are checking with one another on Twitter, together with this publish from John Shields, MD, an orthopedic surgeon at Atrium Well being Wake Forest Baptist Davie Medical Middle in Bermuda Run, NC:
Protect’s publish yielded numerous reactions and feedback. Within the first week, the publish was retweeted 30 occasions and earned 250 “likes,” together with greater than 70 replies and feedback. Shields famous the overall consensus was to carry off on semaglutide for 1 to 2 weeks earlier than surgical procedure, however there have been numerous completely different opinions.
“A Scorching Subject”
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 most important anesthesia supplier group with 56,000 members. ASA President Michael Champeau, MD, may be very conscious of the problems surrounding these medicines throughout anesthesia and surgical procedure.
“It is a actually scorching concern now. We’re getting emails from our members on the lookout for steering,” he stated.
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 try to determine if they need to inform individuals 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 thus far encountered just a few surgical sufferers taking GLP-1s for weight reduction. “And fortunately no aspiration,” stated Gevirtz, medical director of office-based ambulatory anesthesia companies 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 could 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 medication 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, however it needs to be given half-hour upfront, so it doesn’t assist in emergency procedures.
The strategy on the MetroHealth System in Cleveland differs relying on whether or not an individual is taking a GLP-1 for diabetes or weight reduction, stated Ronnie Fass, MD, a gastroenterologist and the division director of gastroenterology and hepatology and the medical director of their Digestive Well being Middle.
Presently, clinicians at MetroHealth instruct sufferers to discontinue medicines for diabetes on the day of surgical procedure.
For individuals who take semaglutide for sort 2 diabetes, and since the remedy is taken as soon as every week, “there’s rising dialogue amongst surgeons that the remedy shouldn’t be stopped previous to surgical procedure. That is to make sure that sufferers’ diabetes is properly managed earlier than and through surgical procedure,” Fass stated.
In sufferers taking semaglutide for weight reduction solely, “there is no such thing as a clear reply at this level,” he added.
“Personally,” Fass stated, “if a affected person is taking [semaglutide] for weight reduction solely, I’d contemplate stopping the remedy earlier than surgical procedure.”
