Ozempic Users Are At Higher Risk Of Fatal Complications During Surgery: Doctors
Patients taking blockbuster weight-loss drugs like Wegovy or Ozempic can experience life-threatening complications if they require surgery or other procedures that require an empty stomach for anesthesia. Even this summer’s recommendation to pause the drugs for up to a week may not go far enough.
Some anesthesiologists in the US and Canada say they’ve seen a growing number of patients taking weight-loss drugs inhaling food and liquid into their lungs while sedated because their stomachs were still full — even after they had followed standard instructions to stop eating for six to six minutes eight hours in advance.
The drugs can slow digestion so much that patients are at increased risk of the problem called pulmonary aspiration, which can cause dangerous lung damage, infection and even death, said Dr. Ion Hobai, an anesthetist at Massachusetts General Hospital in Boston.
“This is such a serious potential complication that anyone taking this drug should know about it,” said Hobai, who was among the first to draw attention to the issue.
According to Komodo Health, a health technology company, nearly 6 million prescriptions for the Wegovy and Ozempic class of drugs were filled in the United States between January and May for people who do not have diabetes. The drugs cause weight loss by mimicking the action of hormones, which are primarily found in the gut and act after eating. They also target signals between the gut and brain that control appetite and satiety, and slow the rate of gastric emptying.
In June, the American Society of Anaesthesiologists published guidance We advise patients to abstain from daily weight loss medication on the day of surgery and to wait a week with weekly injections before sedation measures are instituted. dr Michael Champeau, the group’s president, said the action was based on anecdotal reports of problems – including aspirations – from around the country.
It’s not clear how many patients taking anti-obesity medication could be affected by the problem. However, because the consequences can be so dire, Hobai and a group of colleagues decided to speak out. registered mail the Canadian Journal of AnesthesiaThey called for the drug to be discontinued even longer — about three weeks before sedation.
That explains how long semaglutide, the active drug in Wegovy, stays in the body, said Dr. Philip Jones, Mayo Clinic anesthesiologist and deputy editor of the magazine.
“If 90% of that is gone, so after three weeks, hopefully everything should go back to normal,” Jones said.
Champeau and Jones both admitted that there was not enough evidence to say for sure how long semaglutide should be held to ensure safe anesthesia. Many patients don’t see their doctor far enough in advance to stop the drug three weeks before the procedure, Champeau noted.
Aspiration occurs in 1 in 2,000 to 3,000 surgeries requiring sedation almost half of patients who aspirate during surgery develop associated lung injury. However, case reports show that patients recently treated with semaglutide had problems even when they stopped eating 20 hours before the procedure.
“There’s nothing that says it’s okay to fast twice as long,” Champeau said.
Among the several reports that detailed potentially serious issues was also one of Hobai’s patients, a 42-year-old Boston man who recently started Wegovy, required an intubation and was suffering from respiratory failure, which put him in the intensive care unit. Despite an 18-hour fast, he aspirated food that remained in his stomach.
In Chapel Hill, North Carolina, a 31-year-old woman The patient, who was on a low dose of Ozempic, had fasted for 10 hours prior to a routine endoscopy prior to bariatric surgery last fall. The procedure had to be stopped because solid food remained in her stomach and she was at high risk of aspiration, the report said.
Since then, doctors have seen dozens of similar cases as use of the drug for weight loss has increased, Dr. Elisa Lund, an anesthesiologist at the University of North Carolina at Chapel Hill School of Medicine. “It’s increased exponentially,” she said.
Hobai is conducting a retrospective study of nearly 200 patients taking semaglutide. Although it will be released later this year, work to date seems to bear this out a small study from Brazil, he said. In this study, about a quarter of patients taking semaglutide had food debris in their stomachs during procedures that required sedation — even after stopping the drug for 10 days.
The American Society of Anaesthesiologists advises physicians, when in doubt, to treat patients who have not stopped taking the drug as if they have a full stomach, which may mean using other types of sedation protocols or delaying procedures when possible. Jones added that research is urgently needed to update the guidelines for doctors and patients.
Novo Nordisk, which makes Ozempic, Wegovy and similar drugs, said the company’s clinical trials and post-launch safety data had not shown the drugs caused aspiration. However, the drugmaker pointed out that the drugs are known to cause delayed gastric emptying and that the labels warn of potential gastrointestinal side effects.
Stopping the medication for three weeks can also lead to problems. Patients with diabetes need another way to control their blood sugar, and those looking to lose could potentially gain weight again, Hobai said.
Hobai suggests that people taking Wegovy and similar medications inform their doctor before sedation and discuss the risks and benefits.
“If you’re on this drug and you need surgery, you need to take some extra precautions,” he said.
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