Semaglutide Names and Preoperative Holding Period
Semaglutide is marketed as Ozempic and Wegovy, and should be held for 3 weeks (three half-lives) before elective surgery with anesthesia. 1, 2
Brand Names
- Semaglutide is sold under the brand names Ozempic (for type 2 diabetes) and Wegovy (for weight loss) 2
- It is a long-acting GLP-1 receptor agonist with a 7-day half-life 2, 3
Recommended Holding Period Before Anesthesia
The American Society of Anesthesiologists recommends holding semaglutide for at least three half-lives—approximately 3 weeks—before elective procedures requiring anesthesia. 1, 2
Why 3 Weeks is Critical
- Three half-lives achieves approximately 88% drug clearance, which is necessary to minimize aspiration risk 2
- The initial ASA recommendation of 1 week has proven insufficient based on emerging evidence 1
- Multiple case reports document pulmonary aspiration requiring ICU admission in patients who stopped semaglutide only 4-6 days before surgery, despite fasting 18-20 hours 1
- One case report showed regurgitation of large gastric volumes in a patient who stopped semaglutide just 2 days prior, despite 20 hours of fasting 4
The Gastric Emptying Problem
- Semaglutide significantly delays gastric emptying, causing 24.2% of patients to have residual gastric contents compared to only 5.1% of controls, even after 12+ hours of fasting 1
- Standard fasting guidelines are insufficient for patients on semaglutide 1, 2
- Patients with pre-existing digestive symptoms require more than 21 days of discontinuation 1
Management When 3 Weeks Isn't Possible
If surgery cannot be delayed for 3 weeks, treat the patient as a "full stomach" case with high aspiration risk. 1, 2
Risk Reduction Strategies
- Administer prokinetic drugs (metoclopramide or erythromycin) pre-operatively 1, 2
- Perform point-of-care gastric ultrasound to assess residual gastric contents 1, 2, 5
- Use rapid sequence intubation if proceeding with general anesthesia 1, 2
- Choose endotracheal intubation over supraglottic airways, as case reports show aspiration with supraglottic devices 1
- Consider delaying the procedure if gastric volume >1.5 ml/kg or solid contents are present on ultrasound 2
Additional Risk Factors to Assess
- Patients taking other medications that delay gastric emptying (opioids, PPIs, tricyclic antidepressants) are at even higher risk 2
- Recent recreational drug use (alcohol, cannabis) increases aspiration risk 2
- History of gastro-esophageal surgery increases risk 2
- Chronic semaglutide therapy (median 57 months) shows higher gastric residue rates 1
Special Clinical Considerations
For patients using semaglutide for weight loss, the risks of continuing until shortly before surgery clearly outweigh the benefits. 1
- Patients with diabetes require endocrinology consultation to balance glycemic control against aspiration risk 1
- Studies show 7/10 weight-loss patients had solid food in the stomach after 10 hours of fasting 6
- Recently initiated therapy (within 4 weeks) may present higher risk 6
Common Pitfalls to Avoid
- Do not rely on standard fasting guidelines alone—they are inadequate for semaglutide patients 2, 6
- Do not assume 1 week discontinuation is sufficient—this outdated recommendation has led to documented aspiration events 1
- Do not assume absence of symptoms means empty stomach—gastric ultrasound has revealed retained contents in asymptomatic patients 1, 7