Semaglutide is one of the hottest drugs in the pharmacy. You may recognize the brand names Ozempic for diabetes and Wegovy for weight loss. Anesthesiologists in Canada and the US are raising the alarm if patients need surgery while on Ozempic or Wegovy. Other drugs in this category include liraglutide (Victoza for diabetes and Saxenda to lose weight) or tirzepatide (Mounjaro) for diabetes. These drugs are effective against type 2 diabetes and help severely overweight people shed pounds. They do have some adverse effects, however.
What Is the Risk for Gastroparesis?
At a large medical conference called Digestive Disease Week 2024, researchers reported a higher chance of gastroparesis among patients on GLP-1 medications. This condition is also known as stomach paralysis because food moves through the stomach so much more slowly than normal. In one study, gastroparesis was 50% more common with such drugs. Another study report an increased relative risk of 66%. Diabetes alone can cause gastroparesis, but even after excluding people with diabetes, the researchers still found a signal.
Early clinical trials did not detect this complication. The absolute risk appeared to be low, roughly 0.1% in one study and 0.53% in the other. However, this reaction could be serious because it can complicate surgery increasing the risk for aspiration pneumonia. That is extremely dangerous!
Why Do You Need an Empty Stomach Prior to Surgery?
If you have ever had to undergo surgery, you know that the instructions are to stop eating and drinking prior to the operation. Here is how the NHS (National Health Service) in the UK describes this process:
“Eating and drinking before a general anaesthetic”
“Usually, before having a general anaesthetic, you will not be allowed anything to eat or drink. This is because when the anaesthetic is used, your body’s reflexes are temporarily stopped.
“If your stomach has food and drink in it, there’s a risk of vomiting or bringing up food into your throat. If this happens, the food could get into your lungs and affect your breathing, as well as causing damage to your lungs.
“The amount of time you have to go without food or drink (fast) before you have your operation will depend on the type of operation you’re having. However, it is usually at least 6 hours for food, and 2 hours for fluids. You’ll be told how long you must not eat or drink for before your operation.”
Why Is Aspiration So Dangerous?
An article in the journal Thoracic Surgery Clinics (Aug. 25, 2015) describes the problem this way:
“…aspiration is a potentially fatal complication with significant associated morbidity [“a disease state or symptom”].
“While anesthesia is generally safe, respiratory complications such as anesthesia-related aspiration can be fatal. Occurring as often as 1 in every 2–3,000 operations requiring anesthesia, almost half of all patients who aspirate during surgery develop a related lung-injury, such as pneumonitis or aspiration pneumonia.”
Another article published in JAMA (June 15, 1964) describes the situation this way:
“Aspiration of gastric contents during general anesthesia is often fatal but is preventable. Obstetrical patients and patients requiring emergency surgery most often have a ‘full stomach.’ Prevention of aspiration in such patients can be approached positively, by inserting an endotracheal tube before induction of general anesthesia, or negatively, avoiding general anethesia and substituting ‘conduction’ anesthesia. Examination of possible approaches to the ‘full stomach’ leads to a conclusion that risks associated with some anesthetic techniques are unwarranted except in rare instances.”
The bottom line is that surgeons and anesthesiologists do not want patients to have food or fluid in their stomachs prior to surgery!
Avoiding Surgery While on Ozempic or Wegovy:
So many people are now taking GLP-1 agonists to control blood sugar or lose weight, it is not surprising that surgeons are facing this aspiration problem. Anyone who might need surgery while on Ozempic or Wegovy must take very special precautions.
Semaglutide can slow stomach emptying. Doctors call this gastroparesis. Another way of thinking about it is stomach paralysis.
Normally, the stomach should empty within 2 to 4 hours of a meal. With semaglutide on board, however, some people still have solid food in their stomachs 10 to 18 hours later.
The Canadian anesthesiologists are recommending that people undergoing elective surgery stop Ozempic or Wegovy injections at least 3 to 4 weeks before the procedure (Canadian Journal of Anesthesis, August, 2023). That may work for people taking such drugs for weight loss. Those with diabetes need alternative ways to control their blood sugar during that time.
A Reader Warns About Surgery While on Ozempic or Wegovy:
Q. Please warn your readers about Ozempic and anesthesia. Apparently, there can be an adverse reaction during surgery. Anesthesiologists know this but it is still new to the public. Some surgeons now recommend stopping semaglutide for seven days prior to anesthesia. My daughter had a serious reaction, so people should be careful and talk to their doctors!
A. What you are describing is called gastroparesis. In extreme forms it results in stomach paralysis. As a result, food does not move out of the stomach into the small intestine as it normally would.
Usually, food exits the stomach within two to four hours. Under the influence of semaglutide (Ozempic, Wegovy), it may take days or sometimes even longer.
Under anesthesia, food in the stomach puts a patient at risk for aspiration. That means the contents can be inhaled into the lungs, causing a serious, if not deadly, complication. As a result, some anesthesiologists are recommending that the drugs be stopped as long as a month before elective surgery.
Emergency Surgery While on Ozempic or Wegovy:
If someone requires emergency surgery while taking liraglutide, semaglutide or tirzepatide, all bets are off. The JAMA article mentioned above recognizes that during such situations the anesthesiologist and surgeon must take special precautions to avoid aspiration.
That is why if you or anyone you know must undergo emergency surgery while on Ozempic or Wegovy, all health care personnel must be informed about the possibility of stomach paralysis. There will likely be food in the digestive tract and that will require heroic efforts to avoid a life-threatening aspiration risk.
You can read more about this worrisome situation at this link.
