June 23, 2023 – When you’re taking Ozempic or Rybelsus for kind 2 diabetes, Wegovy for weight reduction, or different drugs in the identical drug class, it isn’t clear how lengthy earlier than deliberate surgical procedure it’s best to cease taking the drug to be secure.
The generic identify for these drugs is semaglutide. Semaglutide can management blood sugar for folks with diabetes and might decelerate how lengthy meals stays within the stomach, serving to individuals who wish to drop some pounds really feel full longer.
Maintaining blood sugar regular throughout surgical procedure is vital, and so is having elective or deliberate surgical procedure on an empty abdomen.
The largest 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 can even come up slowly on their very own. Both manner, “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 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 probably be completely different for various types of semaglutide.
However there’s not sufficient proof but to know what the most secure timing must be, consultants stated. Till medical societies provide you with 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:
Defend’s publish yielded a variety of reactions and feedback. Within the first week, the publish 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 a variety of 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 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 concern now. We’re getting emails from our members searching 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 pointers” till extra research are completed.
In the meantime, medical doctors try 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.
Anesthesiologist Cliff Gevirtz, MD, has thus far encountered only some surgical sufferers taking GLP-1s for weight reduction. “And fortunately no aspiration,” stated Gevirtz, scientific 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 not ask a affected person or would not have time to do an ultrasound scan to verify how full or empty the abdomen may be.
They deal with all these circumstances 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 rapidly, then inserting a respiratory tube — all inside about 30 seconds.
There’s additionally a drug known as metoclopramide that may assist pace 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 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, 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 drugs for diabetes on the day of surgical procedure.
For individuals who take semaglutide for kind 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 might contemplate stopping the remedy earlier than surgical procedure.”