semaglutide Related drugs for weight loss have been adopted as obesity drugs in recent months. They also raise serious questions for hospital clinicians who believe the drug may pose a risk to patients undergoing surgery. anesthesia.
Whether to administer Ozempic (semaglutide) before elective surgery and, if so, for how long, remains to be determined at this time. Official guidance on best practice has yet to keep up with the growing popularity of this drug and other glucagon-like peptide-1 (GLP-1) agonists. weight loss.
Ozempic is indicated for treatment type 2 diabetes However, it is also prescribed off-label for weight loss. Novo Nordisk’s other GLP-1 drugs, Wegovy (semaglutide) and Saxenda (liraglutide) injection, are FDA-approved for weight loss. These drugs work by making you feel less hungry and eating less. Semaglutide is also available as her once-daily tablet for type 2 diabetes (Rybelsus).
The American Association of Anesthesiologists (ASA) has been working on guidance on the drug for the past three weeks. “This is a really hot issue right now, and we’re getting emails from members asking for advice,” said ASA President Dr. Michael Champeau. Medscape Medical News.
However, despite interest in how drugs affect surgical patients and interact with anesthesia, relatively little evidence exists in the literature outside of case studies. Therefore, at this time the association has not issued any official recommendations.
“Due to the lack of scientific literature, I’ll just call this a ‘guideline’ at this time,” said Champeau, an adjunct clinical professor of anesthesiology, perioperative and analgesic medicine at Stanford University in Palo Alto, Calif. ‘ said. “Maybe it doesn’t include words like ‘should’, it probably includes words like ‘should’ and ‘should consider’.”
The ASA’s guidance could come out in writing as early as next week, he added.
It’s a really hot issue right now. We have been receiving emails from members asking for advice.
Meanwhile, it remains unclear whether doctors should advise stopping these drugs 24 hours, 48 hours, or up to two weeks before surgery.
Seeking some consensus, John Shields, M.D., an orthopedic surgeon at Atrium Health Wake Forest Baptist Davie Medical Center in Bermudaran, North Carolina, asked his colleagues on #MedTwitter:
Anyone have guidelines for ozempic around time of surgery?
– holding med?
– how long NPO?Referencing delayed gastric emptying and aspiration risk #medtwitter
— John Shields, MD, FAAOS (@jointdocShields) June 14, 2023
Clinicians often advise not to eat or drink 12-24 hours before elective surgery, as a full stomach can interfere with anesthesia (NPO). For her weekly GLP-1 injections, the optimal duration remains unresolved, as gastric emptying may be slowed. A major concern is aspiration, where the patient actively vomits or passively regurgitates stomach contents under anesthesia.
shields Twitter post It received great feedback and comments. The post was retweeted 30 times and received 72 replies and comments within four days. Shields noted that the general consensus is to keep semaglutide for one to two weeks before treatment. Other suggestions include recommending a liquid diet only 24-48 hours before surgery, recommending an NPO protocol 24-36 hours before surgery, or having the last dose given 5-6 days before surgery. included adjusting weekly injections.
Anesthesiologist Cliff Gewirtz, M.D., said only a handful of surgical patients had previously taken GLP-1 for weight loss. “And thankfully there were no aspirations,” added Gewirtz, clinical director of office-based outpatient anesthesia services at Somnia Anesthesia in Harrison, New York.
To minimize the risk, some doctors may do an ultrasound scan to assess stomach contents. Surgery may be postponed if surgery is elective in patients with a full stomach. Another option is to continue the case but treat the patient as the anesthesiologist performs emergency procedures. For safety, many treat this case as if the patient had a full stomach.
Dr. Gewirtz said he would treat the patient as “full” and conduct tests. rapid sequence induction With compression of the cricoid cartilage. The patient was then scheduled to be extubated once the laryngeal reflex returned.
Rapid induction therapy involves giving people a drug to put them to sleep, another drug to quickly paralyze them, and then inserting a breathing tube. All of this within about 30 seconds. Cricoid compression involves pressing the neck to seal the top of the esophagus during intubation, minimizing the chance of food being returned.
to donate metoclopramide Another option, Gewirtz said, is 30 minutes before surgery. Metoclopramide accelerates gastric emptying. Pre-dosing is important because waiting for the drug to work can lengthen the stay in the operating room.
Is it a clinically relevant issue to keep semaglutide before surgery? , said Ronnie Fass, M.D., chief of the Department of Gastroenterology and Hepatology.
Fass recommended different strategies based on indications for semaglutide. MetroHealth clinicians now instruct patients to stop taking diabetes medications on the day of surgery. For those taking semaglutide for diabetes, there is a growing argument among surgeons that the drug should not be stopped before surgery, because the drug is taken once a week. “Surgery,” Fass said.
As for patients taking semaglutide solely for weight loss, “there is no clear answer at this time,” he said.
Fass said the issue is complicated by the fact that the drug is taken once a week. “This raises important questions about the use of drugs during surgery and may increase the likelihood of side effects in general and in certain types of surgery.” if you have [semaglutide] If weight loss is the only goal, consider stopping the drug before surgery. ”
The ASA was able to act quickly because last year, before the popularity of GLP-1 agonists exploded, a task force of experts was already considering how long people should fast before surgery.
While still a work in progress, Champeau provided Medscape readers with recommendations to “peek in”. “This guidance will look at how long before the drug should be discontinued, rather than a longer period of fasting before surgery,” he said. “We have absolutely no data on the latter question.”
Damian McNamara staff Journalist based in Miami. It covers a wide range of specialties including infectious diseases, gastroenterology and emergency medicine. Follow Damien on Twitter: @MedReporter.
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