Patients who are on popular weight-loss medications like Wegovy and Ozempic may face heightened risks of life-threatening complications during surgeries or procedures requiring anesthesia, due to the potential for food and liquid inhalation into the lungs while sedated. This concern has prompted anesthesiologists in the U.S. and Canada to raise alarms and advocate for extended cessation periods of these medications prior to medical interventions.
These blockbuster drugs, which have gained widespread use for inducing weight loss, can significantly slow down digestion processes, increasing the risk of pulmonary aspiration, a condition where food or liquid enters the lungs, leading to severe lung damage, infections, and even death. Dr. Ion Hobai, an anesthesiologist at Massachusetts General Hospital, emphasized the gravity of this issue, stating that all individuals taking these medications should be aware of the potential risks associated with anesthesia.
Statistics from healthcare technology company Komodo Health revealed that nearly 6 million prescriptions for weight-loss drugs like Wegovy and Ozempic were issued between January and May in the U.S. for individuals without diabetes. These drugs mimic gut hormones responsible for post-meal responses, regulate appetite signals, and slow stomach emptying to promote weight loss.
The American Society of Anesthesiologists issued guidance in June, recommending that patients pause their daily weight-loss medications on the day of surgery and halt weekly injections for at least a week before sedation procedures. Dr. Michael Champeau, the society’s president, highlighted anecdotal reports from across the country as a basis for this action, which aimed to address emerging problems, including aspiration.
Dr. Hobai and a group of colleagues published a call to action in the Canadian Journal of Anesthesia, urging an even longer cessation period of about three weeks before undergoing sedation. They argued that this duration corresponds to the active medication’s presence in the body, providing a safer margin.
However, experts like Dr. Philip Jones, a Mayo Clinic anesthesiologist and deputy editor-in-chief of the journal, acknowledged that there is not enough evidence to definitively determine the ideal duration for medication cessation. Patients often may not have access to healthcare providers early enough to adhere to a three-week hiatus before procedures.
While aspiration occurs in 1 out of every 2,000 to 3,000 sedation procedures, case reports indicated issues among recent semaglutide (active ingredient in Wegovy) users who followed the standard fasting instructions. Patients in these reports encountered complications even when fasting for as long as 20 hours prior to their procedures.
Several cases demonstrating potential complications were documented, including that of a Boston man who required intubation and intensive care due to respiratory failure, despite fasting for 18 hours after starting Wegovy. Another case involved a woman in North Carolina who, despite fasting for 10 hours, faced the risk of aspiration during an endoscopy.
Dr. Elisa Lund, an anesthesiologist at the University of North Carolina at Chapel Hill School of Medicine, reported an exponential increase in similar cases, correlating with the growing use of these weight-loss medications.
As experts await further research, the American Society of Anesthesiologists advises doctors to treat patients who haven’t paused the medication as if they have full stomachs. Novo Nordisk, the manufacturer of Ozempic, Wegovy, and similar drugs, maintains that its clinical trials and post-marketing safety data do not establish a direct link between these medications and aspiration, although they acknowledge the medications’ propensity to delay stomach emptying and warn of possible gastrointestinal side effects.
Individuals using these medications are advised to discuss risks and benefits with their doctors before undergoing sedation and to adhere to additional precautions, should surgery or procedures be necessary.
