Perioperative Management of Ozempic (Semaglutide) Before Surgery
Ozempic (semaglutide) should be held for at least three half-lives (approximately 3 weeks) before elective surgery to minimize the risk of delayed gastric emptying and potential aspiration. 1
Rationale for Holding Ozempic Before Surgery
Ozempic (semaglutide) is a GLP-1 receptor agonist that significantly delays gastric emptying, which poses several perioperative risks:
- Increased risk of retained gastric contents
- Higher likelihood of regurgitation during anesthesia induction
- Potential for pulmonary aspiration
- Prolonged postoperative ileus
Recommended Holding Period Based on Indication
For Patients Taking Ozempic for Weight Loss
- Hold for at least three half-lives (approximately 3 weeks) before surgery 1
- This allows for approximately 88% of the drug to be cleared from the system
- Benefits of holding outweigh risks for non-diabetic patients
For Patients Taking Ozempic for Type 2 Diabetes
- Consult with the treating endocrinologist regarding the risk-benefit analysis 1
- Consider holding for at least three half-lives (approximately 3 weeks) before major surgery
- For minor procedures, holding for 1 week may be reasonable, though evidence is limited
- May need bridging diabetic therapy if held longer than the next scheduled dosing time
Risk Assessment Factors
Higher risk patients who require special consideration include:
- Recently started on Ozempic or had recent dose increases
- Experiencing symptoms of nausea, vomiting, or abdominal distention
- Taking other medications that delay gastric emptying (opioids, tricyclic antidepressants)
- History of gastroparesis or gastroesophageal reflux disease
Anesthetic Considerations
If Ozempic cannot be held for the recommended period:
- Consider gastric ultrasonography to assess gastric contents
- Implement aspiration risk reduction strategies:
- Modified rapid sequence induction
- Consider prokinetic medications (metoclopramide)
- Clear fluid diet for some period before pre-operative fasting
- Proper airway protection with rapid sequence intubation when indicated
Resuming Ozempic After Surgery
- Resume only when the patient is eating and drinking normally (usually 24-48 hours after surgery) 2
- Ensure no signs of metabolic derangement are present
- For diabetic patients, monitor blood glucose levels closely during the perioperative period
Comparison with Other Medications
Similar to SGLT2 inhibitors, which should be held 3-4 days before surgery 2, GLP-1 receptor agonists require careful perioperative management. However, due to their longer half-life, Ozempic requires a longer holding period than many other antidiabetic medications.
Practical Recommendations
- Document the indication, dose, and last dose of Ozempic taken
- Discuss with patients the importance of holding the medication before surgery
- Use a shared decision-making approach to discuss risks and benefits
- Consider postponing elective surgery if the medication cannot be held for the recommended period
- For emergency surgery, implement enhanced aspiration precautions
This approach balances the risks of delayed gastric emptying against the benefits of glycemic control, with different recommendations based on the indication for Ozempic use.