How weight loss drugs could interfere with anesthesiology

A report from the University of Texas MD Anderson Cancer Center has named weight loss medications, including glucagon-like peptide 1 receptors, as ones that could potentially interfere with anesthesia in patients. 

In November, the American Society of Anesthesiologists called for all patients to stop taking the medications prior to elective procedures and surgeries, warning of side effects including complications from retained gastric contents. 

Here is what three specialists have told Becker's about how GLP-1s, including Ozemic and Wegovy, might impact anesthesia: 

"The downside of these medications is that it delays gastric emptying, and that's how it helps make you lose weight because you feel fuller. But some of our patients may need to skip a dose or they need their NPO time [before surgery] to be longer. Our anesthesiology colleagues are actively doing research into the effect with the anesthesia. We're doing active research. We have several studies ongoing at the Rothman Institute looking at the effect of these medications after joint replacement." — Max Courtney, MD, chief of joint replacement at Rothman Orthopaedic Institute (Philadelphia). 

"From the perspective of an anesthesiologist, the most notable concern is that of aspiration secondary to delayed gastric emptying. This is of particular concern the first 20 weeks of starting the medication, but may reduce significantly with longer duration of use. Given this documented concern, the American Society of Anesthesiologists has published guidelines for the perioperative management of all the GLP-1 inhibitors, like Ozempic. Briefly, daily dosed GLP-1 inhibitors should be held the day of surgery and weekly dosed drugs should be held for a full week. This has led to delaying, changing and at times cancellation of elective cases because those guidelines are not followed. Unfortunately, that includes all the negative consequences associated with cancellations the day of surgery. As with any new drug, the more familiar everyone becomes, unwanted consequences should decrease." — Michael Finamore, DO, anesthesia provider for the Orthopaedic Surgery Center (Youngstown, Ohio). 

"Ozempic and other GLP-1 medications have become the hot topic in the surgical world. The American Society of Anesthesiologists recommends that patients on the GLP-1s hold the medication for one week prior to anesthesia. If the patients that are on the GLP-1 medications are not discovered at least eight days prior to the procedure, the rate of cancellations is going to increase. Having the surgical staff educate the patients on this requirement leaves holes in the care coordination of the patient. For example, if the patient is on the GLP-1 medication for diabetes, they must follow-up with their primary care provider to discuss how to manage their diabetes for the week that they are off of the medication. Another factor that is concerning my staff are the patients that receive their GLP-1s from markets that are not regulated by the FDA, and therefore not prescribed by a physician. If the patient fails to disclose they are on this medication, there could be great risk to the patient." — Jackie McLaughlin, BSN, RN, manager of surgical services, outpatient infusions and the pain clinic at Aspirus Howard Young Medical Center (Woodruff, Wis.). 

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