June 23, 2023 – Should you’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 it is best to cease taking the drug to be secure.

The generic title for these drugs 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 need to drop a few 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 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 docs name it, could be harmful. 

These drugs have surged in recognition 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 every week, and Rybelsus is a pill taken as soon as a day, so the recommendation will possible be totally different for various types of semaglutide. 

However there’s not sufficient proof but to know what the most secure timing needs to be, specialists stated. Till medical societies provide you with official steering, docs 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 whole lot of 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 final consensus was to carry off on semaglutide for 1 to 2 weeks earlier than surgical procedure, however there have been a whole lot of totally 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 drugs throughout anesthesia and surgical procedure. 

“It is a actually scorching problem now. We’re getting emails from our members in search of steering,” he stated. 

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

In the meantime, docs are attempting to determine if they need to inform individuals 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. 

Docs’ Recommendation

Anesthesiologist Cliff Gevirtz, MD, has to this point 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 providers 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 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 “fast 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 respiration 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, nevertheless it 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, 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 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 might take into account stopping the remedy earlier than surgical procedure.”

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