From the Guidelines
Semaglutide should be held for at least 1 week before major surgery to minimize the risk of pulmonary aspiration and other perioperative complications. This recommendation is based on the most recent and highest quality study available, which suggests that the benefits of continuing semaglutide in the perioperative period may be outweighed by the risks of delayed gastric emptying and pulmonary aspiration 1. The study highlights the importance of considering individual patient factors, such as the presence of diabetes mellitus, when making decisions about perioperative semaglutide management.
Key Considerations
- For patients taking Ozempic (weekly semaglutide), skip the dose the week before surgery
- For those on Wegovy, also skip the dose the week before surgery
- For daily semaglutide (Rybelsus), stop taking it 1-2 days before surgery
- Semaglutide's effects on gastric emptying and potential for nausea and vomiting should be taken into account when making perioperative management decisions
- The medication's long half-life (approximately one week for injectable forms) means that stopping it shortly before surgery can still maintain some therapeutic effect while reducing perioperative risks
Perioperative Management
The decision to stop semaglutide before surgery should be made in consultation with the healthcare team, taking into account individual patient circumstances and the specific surgical procedure 1. Patients should always inform their surgeon and anesthesiologist about semaglutide use, and the medication can typically be resumed once the patient is eating normally after surgery and any post-operative nausea has resolved.
From the Research
Semaglutide Administration Before Surgery
- Semaglutide is a long-acting glucagon-like peptide-1 receptor agonist (GLP1-RA) used for the treatment of type 2 diabetes mellitus (T2DM) and obesity 2, 3, 4, 5, 6.
- The use of semaglutide before surgery may pose risks due to its side effect of delayed gastric emptying, which can increase the risk of intraoperative pulmonary aspiration 3, 4, 6.
- A case report showed that a patient taking semaglutide had food residue in the gastric body despite following preoperative fasting guidelines, necessitating the abortion of the procedure to reduce the risk of pulmonary aspiration 3.
- Another case report highlighted the association between semaglutide use and delayed gastric emptying, resulting in intraoperative pulmonary aspiration of gastric contents 4.
- The potential anesthetic risks of semaglutide therapy warrant careful consideration, and further studies are needed to assess the need to modify pre-operative guidelines for patients using semaglutide 6.
Considerations for Anesthesia
- Anesthesiologists should be aware of alternative methods to ensure no food is present in the stomach to mitigate the risk of pulmonary aspiration during general anesthesia for patients taking semaglutide 3, 4.
- The use of semaglutide may require specific precautions during induction of anesthesia to prevent pulmonary aspiration of gastric contents 4.
- The risk of delayed gastric emptying and constipation associated with semaglutide use may affect surgical outcomes and complications, and further research is needed to investigate this 6.
Benefits and Risks of Semaglutide
- Semaglutide has shown effectiveness in improving glycemic control, weight loss, and reducing cardiovascular risks associated with diabetes mellitus 2, 5, 6.
- However, semaglutide therapy is also associated with concerning adverse effects like acute pancreatitis, anesthetic risks, acute kidney injury, and diabetic retinopathy 6.
- The benefits and risks of semaglutide therapy should be carefully considered, and a cross-disciplinary approach is needed to understand the molecular mechanisms and clinical implications of semaglutide on patients with complex medical histories and treatment regimens 6.