ASA suggests patients stop popular weight loss medications before elective surgery
Editor's Note
The American Society of Anesthesiologists (ASA) announced on June 29 that patients taking any of the currently popular medications for weight loss or for the treatment of type 2 diabetes should withhold the medication prior to elective surgery to "reduce the risk of complications associated with anesthesia in adults and children."
Such announcement comes in the heels of the growing popularity of medications like Ozempic® (semaglutide), Trulicity® (dulaglutide), and other glucagon-like peptide-1 (GLP-1) receptor agonists that are approved by the Food and Drug Administration to treat type 2 diabetes and reduce the risk of cardiovascular disease. "The medications are also used for weight loss, as they delay gastric (stomach) emptying, decreasing hunger and reducing how much people eat," ASA noted in its press release.
“While there is currently a lack of scientific data on how GLP-1 receptor agonists affect patients having surgery and interact with anesthesia, we’ve received anecdotal reports that the delay in stomach emptying could be associated with an increased risk of regurgitation and aspiration of food into the airways and lungs during general anesthesia and deep sedation. These complications can be serious, so we are providing guidance on when GLP-1 agonists should be stopped in advance of an elective procedure," said Michael W. Champeau, MD, FAAP, FASA, ASA president.
The following guidance for patients taking GLP-1 agonists who are having elective procedures was put forth by ASA’s Task Force on Preoperative Fasting and taken directly from the press release:
Day or week prior to the procedure:
- Hold GLP-1 agonists on the day of the procedure/surgery for patients who take the medication daily.
- Hold GLP-1 agonists a week prior to the procedure/surgery for patients who take the medication weekly.
- Consider consulting with an endocrinologist for guidance in patients who are taking GLP-1 agonists for diabetes management to help control their condition and prevent hyperglycemia (high blood sugar).
Day of the procedure:
- Consider delaying the procedure if the patient is experiencing GI symptoms such as severe nausea/vomiting/retching, abdominal bloating or abdominal pain and discuss the concerns of potential risk of regurgitation and aspiration with the proceduralist or surgeon and the patient.
- Continue with the procedure if the patient has no GI symptoms and the GLP-1 agonist medications have been held as advised.
- If the patient has no GI symptoms, but the GLP-1 agonist medications were not held, use precautions based on the assumption the patient has a “full stomach” or consider using ultrasound to evaluate the stomach contents. If the stomach is empty, proceed as usual. If the stomach is full or if the gastric ultrasound is inconclusive or not possible, consider delaying the procedure or proceed using full stomach precautions. Discuss the potential risk of regurgitation and aspiration of gastric contents with the proceduralist or surgeon and the patient.
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