Are there interactions between anesthesia and Wegovy (semaglutide)?

Interactions Between Anesthesia and Wegovy (Semaglutide)

Wegovy (semaglutide) significantly increases the risk of pulmonary aspiration during anesthesia due to delayed gastric emptying, even with prolonged fasting periods. 1

Mechanism of Interaction and Primary Risk

Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), causes significant delayed gastric emptying which creates a serious anesthesia-related risk:

• Multiple case reports document regurgitation and pulmonary aspiration in patients on semaglutide despite extended fasting periods (8-20 hours) 1, 2, 3
• A prospective observational study found increased residual gastric content in 40% of patients taking semaglutide within 10 days of surgery versus only 3% in control patients 4
• The delayed gastric emptying effect persists well beyond the recommended pre-operative fasting period 4, 5

Recommended Perioperative Management

Pre-operative Considerations

• Hold semaglutide for at least 4 weeks before elective procedures when feasible 3
• If unable to hold for 4 weeks, consider:
  • Point-of-care gastric ultrasound to evaluate residual gastric content 4
  • Full stomach precautions during anesthesia induction 3
  • Rapid sequence induction with endotracheal intubation 1

During Anesthesia

• Implement aspiration precautions:
  • Consider rapid sequence induction regardless of fasting status 1
  • Use endotracheal intubation rather than supraglottic airway devices 1
  • Have suction immediately available 2

Post-operative Management

• Monitor for signs of aspiration pneumonitis
• Consider temporarily discontinuing semaglutide if vomiting occurs post-operatively 6
• When restarting semaglutide, consider dose reduction 6

Other Potential Drug Interactions

While the primary concern is aspiration risk, other potential drug interactions should be monitored:

• No significant direct interactions between semaglutide and common anesthetic agents have been documented 1
• Unlike some antiviral medications that have multiple interactions with anesthetic drugs, semaglutide does not appear to have significant pharmacokinetic interactions with anesthetic medications 1

Special Considerations

• Risk factors for increased aspiration risk: Male sex and younger age were associated with higher risk of increased residual gastric content in patients on semaglutide 4
• Duration of effect: Semaglutide has a half-life of approximately one week, so effects persist long after the last dose 3
• Disclosure importance: Patients may not disclose semaglutide use, especially when used for weight loss rather than diabetes management 5

Common Pitfalls to Avoid

1. Assuming standard fasting guidelines are sufficient - Even with 18-20 hour fasting, significant gastric content has been documented 2, 3
2. Failing to specifically ask about GLP-1 RA use - Patients may not volunteer this information 5
3. Underestimating the duration of effect - The gastric emptying delay persists much longer than the pharmacokinetic half-life would suggest 4