A large study shows that patients taking Ozempic-like GLP-1 drugs face an 11 times higher risk of vomiting or inhaling stomach contents into their lungs under anesthesia, as the medication delays stomach emptying, leaving food behind despite fasting.
https://www.sciencealert.com/ozempic-like-drugs-linked-to-11x-higher-vomiting-risk-under-anesthesia
34 Comments
Good research and easy to fix
Unless you are going into emergency surgery without warning I doubt it is much of an issue.
There is no reason you can’t stop it for a few weeks before surgery. You might gain a couple of kilos but it’s very easy to stop and start ozempic.
As for emergency surgery while it probably does increase your risk I know that any surgery is way more dangerous for obese people. It’s something emergency surgeons will have to watch out for more but I assume it was already a known risk.
As it says, patients are always told to fast before surgery. The only time this might be an issue is emergency surgery.
Well known already amongst anaesthesia. What to do about it is a different story.
Aspiration is the thing to really care about and it was still very rare within this study. We advise all patients on GLP to do a clear liquid diet for 24 hrs prior to planned surgery, which seems to help
Source: I’m an anesthesiologist
Yeah that’s why they tell you to stop taking it before surgery.
That’s why it says you shouldn’t take it when you’re going to be under anesthesia
It’s a good thing that it reduces your appetite then? It’s good that we are finding more about these meds, regardless of your views on them, they’d be around and they’d be with us for a long time.
As an anesthesia provider I find it interesting that all the comments are just saying ok no big deal just don’t eat , when it’s actually a big deal for me every day. With GLP-1 we want last meal 2 days prior and 1 day of just clear liquids before surgery. Also patients not fasting appropriately leads to us cancelling their surgery/procedure, which happens ALOT.
I wonder if these drugs can also impact people for fasting blood work. Very interesting.
Weve been cancel anyone who has taken their glp-1 that werk
I take a GLP1. My doctor’s office told me I shouldn’t take within 7 days before my procedure, which I deemed inadequate. After all, it is a weekly medication. So if I took it 7 days before, that’s not really skipping a dose. So I decided to skip it for 20 days. Yeah my weight loss slowed a bit, but I was back on the drug the same day and the procedure went off without a hitch.
7 days isn’t enough, but waiting three+ week like the article suggests is too long. Patients just aren’t going to do that. After 3 weeks off the medication, you have to drop down and restart at almost an introductory level of the medication. I was already on a lower dose so I didn’t mind. But people are going to have to fight to get a new prescription, and studies suggest that it isn’t as effective after breaks and people might need to get to higher doses to achieve the same effect.
My anesthesia team will ask if a patient is on a GLP-1. Whether the patient fasts or not, they will opt for gastric emptying and suck everything in the stomach out. Most patients comply and all there really is in the stomach is bile.
Gasman here. Ignore all the layman speculation in this thread.
These drugs are the bane of my existence. They came out and became super common far faster than our understanding of them developed.
For a good period of time we had no idea how significant their effects on fasting times was. After a few people aspirated several day old food nationwide we started treating everybody taking them as unfasted at baseline (using riskier ways to go to sleep, or necessitating dangerous medications we otherwise wouldn’t have used for simple procedures), then we would ask people to cease them (sometimes weeks ahead of surgery). It was a mildly scary time because we just didn’t know where the line was.
Years later we have a bit more understanding. Current protols here have these patients continue the GLP1s and have a 24hr fluid-only diet before surgery. Very sensible.
Seems like omitting it prior to elective surgery is an easy fix. Maybe not so much for emergencies though.
I had been using it prior to partial nephrectomy, I used it for a year, I lost 50kg, I used it for a year post surgery, I had to stop as it was making me suicidal in a very very big way, like an impending feeling of doom was with me everyday. I had no problems in surgery, sadly my cancer has returned so I am using it again to be as light as I can be for surgery as every kilo off is going to make my risk go down a little.
And this, kids, is why phase 4 exists.
(and also why your “totally safe natural supplements” lacking any tesst at all shouldn’t be trusted)
11 times what I wonder.
Yeah, this isn’t unknown and lower motility is why someone taking these meds must stop 10days prior to scheduled anesthesia. This has been the practice for years.
If it’s an unscheduled urgent surgery, then it is certainly a risk/benefit situation. If it was a bad appendix or bowel obstruction, then maybe. If it was a broken leg or an arm, then stabilize, manage pain and wait a bit.
Wife has had a few surgeries while on a. Glp-1 medication over the last ~12 months this has been a pretty normal thing for her she has always been told to fast for 24 hours rather than the usual ~12 due to left over food because of said drug
Did you know the GLP-1s basically came off license/patent in the last year, and that is literally the reason there has been such a large push in the media lately. They aren’t new, but they can now be mass-manufactured by any generic company for not much money and pushed for extreme profit on body dysmorphic anorexics or slightly over weight people who generally need to eat less and exercise more like me. The Primary patient for this class of drugs is the morbidly obese – but the industrial pharmaceutical complex is pushing them on normal people like sweets, or a Sertraline panacea for Depression.
There are always drawbacks to pharmaceutical drugs. Always.
Unsurprising finding, considering the known effect of delayed gastric emptying and potentially intestinal transit.
Had my wisdom teeth out a few years back and stopped Ozempic 2 weeks before on my own because it seemed wild not to be asked to do so.
Had no issues after fasting for 8 hours. All of my patients get the warning when they’re started on GLPs, and a reminder if I’m aware they’re going for a surgery. Should be common practice by now.
I think this is the first article describing a negative side effect that I’ve encountered. It was beginning to sound like this stuff was all up-side.
I had to stop mine 2 weeks before surgery.
Also it gives me super stinky burps
This has been known a long time, and hospitals have specific procedures including requiring longer fasting time for GLP-1 recipients.
47,000 patients…
That’s not enough patients.
Aspiration is so rare that detecting even a two-fold change from the 1.1/10,000 baseline would require ~214,000 patients per arm.
[https://journals.lww.com/anesthesiology/fulltext/10.1097/aln.0000000000004381~2023-american-society-of-anesthesiologists-practice](https://journals.lww.com/anesthesiology/fulltext/10.1097/aln.0000000000004381~2023-american-society-of-anesthesiologists-practice)
My dad is an anesthesiologist, these are very real issues. Airway management is a vital part of his job, not just pushing meds. Patients have to be off of their GLP-1 for a week prior to surgery.
Anyone tried putting a patient on a prokinetic like metoclopramide or domperidone the day before surgery to move things along?
I’m on 10 mg tirzepatide, had a GED done with the regular skip-the-dinner fasting, all fine, stomach fully empty.
A friend of mine was on 15 mg, and had to have a surgery delayed, as his Dr. did an ultrasound and found food in the stomach.
That’s worrisome. Maybe have those patients gast linger before a procedure?
I was on saxenda for a while and wondered if this was just me. I remember eating something and hours later still tasting it.
The people saying “oh just stop it 2 weeks before”-you all do realize emergency surgeries are a thing right? That is an issue.