June 23, 2023 – For those who’re taking Ozempic or Rybelsus for kind 2 diabetes, Wegovy for weight reduction, or different medicines in the identical drug class, it isn’t clear how lengthy earlier than deliberate surgical procedure you must cease taking the drug to be protected.

The generic title for these medicines 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 wish to shed some pounds 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 largest 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 docs name it, may be harmful. 

These medicines have surged in reputation for weight reduction, leaving docs questioning how lengthy to inform sufferers to cease the medication upfront. Ozempic and Wegovy are injections taken as soon as per week, and Rybelsus is a pill taken as soon as a day, so the recommendation will doubtless be totally different for various types of semaglutide. 

However there’s not sufficient proof but to know what the most secure timing must be, consultants mentioned. Till medical societies provide you with official steering, docs 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 Middle in Bermuda Run, NC:

Protect’s submit yielded loads 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 overall consensus was to carry off on semaglutide for 1 to 2 weeks earlier than surgical procedure, however there have been loads of totally different opinions.  

“A Sizzling Challenge”

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, could be very conscious of the problems surrounding these medicines throughout anesthesia and surgical procedure. 

“It is a actually sizzling problem now. We’re getting emails from our members searching for steering,” he mentioned. 

The ASA plans to launch steering for docs within the subsequent week or two however is holding again on full “official tips” till extra research are achieved. 

In the meantime, docs are attempting to determine if they need to inform folks to cease taking these medicines — also called 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,” mentioned 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 docs can not ask a affected person or would not have time to do an ultrasound scan to test how full or empty the abdomen is perhaps. 

They deal with all these instances as if somebody simply ate a full meal. Anesthesiologists will do a “speedy sequence induction.” This entails giving the drugs that makes a affected person fall asleep, giving one other drugs that paralyzes them shortly, then inserting a respiratory tube — all inside about 30 seconds. 

There’s additionally a drug known as metoclopramide that may assist velocity up the emptying of meals or drinks from the abdomen, but it surely must 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, mentioned 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 kind 2 diabetes, and since the remedy is taken as soon as per 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 mentioned.

In sufferers taking semaglutide for weight reduction solely, “there isn’t a 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 remedy earlier than surgical procedure.”

Supply hyperlink