Patients taking blockbuster drugs such as Wegoby and Ozempic for weight loss can face life-threatening complications if they need surgery or other procedures that require fasting anesthesia.
This summer’s guidance to stop medication for up to a week may not be enough.
Some anesthesiologists in the United States and Canada found that some patients on weight-loss medications still had a full stomach despite following standard instructions to stop eating between the ages of 6 and 6 years. Because of this, he says, more patients are aspirating food and liquids into their lungs while sedated. 8 hours in advance.
These drugs slow digestion so much that they can lead to dangerous lung damage, infections, and even death, a problem called pulmonary aspiration, said Dr. Ion Hobai, an anesthesiologist at Massachusetts General Hospital in Boston. patients are at increased risk of
“This is a very serious potential complication, so anyone taking this drug should be aware of this,” said Horbye, who was one of the first to warn of the problem.
Nearly 6 million prescriptions for people without diabetes were written in the U.S. between January and May for a class of medicines that includes Wegobee and Ozempic, according to healthcare technology company Komodo Health.
This drug induces weight loss by mimicking the effects of hormones that reside primarily in the gut and begin after a meal in humans.
It also targets signals between the gut and brain that control appetite and satiety by slowing the rate at which the stomach empties.
in June, American College of Anesthesiologists Issues Guidance Patients are advised to refrain from daily weight-loss medications on the day of surgery and to refrain from weekly injections for a week prior to sedation procedures.
The group’s president, Dr. Michael Champeau, said the move was based on anecdotal reports of problems from around the country, including aspiration.
It is unclear how many patients taking antiobesity drugs may be affected by this problem.
But the consequences could be so disastrous that Horvay and a group of colleagues decided to speak up.
writing Canadian Journal of Anesthesiaasked to discontinue the drug for a longer period of about 3 weeks before sedation.
Dr. Philip Jones, an anesthesiologist at the Mayo Clinic and deputy editor of the magazine, said this explains how long Wegobee’s active drug, semaglutide, stays in the body.
“After three weeks, when 90% is gone, hopefully everything will be back to normal,” Jones said.
Champeau and Jones acknowledged that there was not enough evidence to say with certainty how long semaglutide should be held for safe anesthesia.
Champeau noted that many patients would not see their healthcare provider long enough to stop the drug three weeks before the procedure.
Aspiration occurs in 1 in 2,000 to 3,000 surgeries requiring sedation. Nearly half of patients with aspiration Associated lung injury occurs during surgery.
However, case reports indicate that recent patients receiving semaglutide had problems even when they stopped eating 20 hours before the procedure.
“There’s no such thing as fasting twice as good,” says Champeau.
Among the several reports detailing potentially serious problems were one of Hobai’s patientsA 42-year-old Boston man who recently started taking Wegoby had to be intubated, had respiratory failure, and was admitted to the intensive care unit.
He aspirated food that remained in his stomach despite fasting for 18 hours.
In Chapel Hill, North Carolina, 31 year old woman Patients taking low-dose Ozempic fasted for 10 hours before undergoing routine endoscopy prior to bariatric surgery last fall.
The report said the operation had to be called off because solids remained in the stomach and there was a high risk of aspiration.
Doctors have seen dozens of similar cases since then, according to Dr. Elisa Rand, an anesthesiologist at the University of North Carolina at Chapel Hill School of Medicine, as weight-loss drugs have become more popular. “It increased exponentially,” she said.
Hobai is completing a retrospective study of about 200 patients taking semaglutide.It’s due for publication later this year, and previous research seems to have confirmed it. A small study from BrazilHe said.
In that study, about a quarter of patients taking semaglutide had food left in their stomachs during procedures requiring sedation, even after stopping the drug for 10 days.
The American Association of Anesthesiologists advises skeptical physicians to treat patients who have not stopped taking the drug as if they were full. This means using a different type of sedation protocol or delaying the procedure if possible.
Jones added that research is urgently needed to update guidelines for doctors and patients.
Novo Nordisk, which makes medicines such as Ozempic and Wegoby, said its clinical trials and post-marketing safety data did not show its medicine caused aspiration.
However, the drug company noted that the drug is known to slow gastric emptying and the label warns of possible gastrointestinal side effects.
Stopping the drug for 3 weeks can also cause problems.
Diabetics will need other ways to control their blood sugar levels, but those trying to lose weight may regain some of it, Horby said.
Hobai suggests that people using Wegovy or similar drugs tell their doctor before sedation to discuss the risks and benefits.
“If you’re on this drug and need surgery, you’ll need special precautions,” he says.