Should Wegovy (semaglutide) be stopped before a surgical procedure under local anesthesia?

Perioperative Management of Wegovy (Semaglutide) for Surgical Procedures Under Local Anesthesia

Wegovy (semaglutide) should be discontinued at least 3 weeks before any surgical procedure, including those under local anesthesia, due to the significant risk of delayed gastric emptying and potential for aspiration. 1

Risk Assessment and Rationale

Semaglutide significantly delays gastric emptying, which creates risks even with local anesthesia procedures:

• Multiple case reports document regurgitation and pulmonary aspiration in patients taking GLP-1 receptor agonists despite extended fasting periods of 18-20 hours 2, 3
• 24.2% of patients on semaglutide had increased residual gastric content compared to only 5.1% in control groups, even with extended fasting 4
• The risk exists regardless of the indication for semaglutide use (weight loss or diabetes management) 1

Recommended Protocol for Local Anesthesia Procedures

1. Timing of Discontinuation:

   • For weight loss patients: Discontinue Wegovy at least 3 weeks before the procedure 1
   • For diabetes patients: Consult with the treating endocrinologist to develop an alternative glycemic control plan during the perioperative period 1

2. Risk Stratification:

   • Higher risk: Procedures involving sedation, supine positioning, or airway manipulation
   • Lower risk: Minor procedures with upright positioning and minimal sedation

3. If Wegovy Cannot Be Discontinued:

   • Consider postponing elective procedures 1
   • Implement aspiration risk reduction strategies:
     • Extended fasting (>12 hours for solids)
     • Consider prokinetic drugs pre-operatively (e.g., metoclopramide)
     • Position patient upright when possible
     • Have suction readily available

Common Pitfalls to Avoid

• Inadequate discontinuation time: Stopping semaglutide only a few days before surgery is insufficient due to its long half-life of approximately one week 3, 1
• Assuming standard fasting is sufficient: Patients on semaglutide may still have significant gastric contents even with extended fasting of 18-20 hours 2, 3
• Overlooking the risk with local anesthesia: While general anesthesia poses higher aspiration risks, local anesthesia with sedation still carries risk due to potential depression of protective reflexes 2

Special Considerations

• For urgent/emergent procedures where Wegovy cannot be discontinued, treat the patient as having a full stomach regardless of fasting time 1
• Point-of-care gastric ultrasound can be considered to assess residual gastric contents in high-risk cases 1
• The presence of preoperative digestive symptoms (nausea, vomiting, dyspepsia, abdominal distension) further increases the risk of residual gastric content 4

While the American Society of Anesthesiologists has recommended discontinuing GLP-1 receptor agonists before surgery, some experts note limited scientific evidence supporting this recommendation 5. However, given the documented cases of aspiration despite extended fasting, a cautious approach prioritizing patient safety is warranted until more definitive evidence emerges.