Patients using medications with semaglutide (the active ingredient in Ozempic and Wegovy) should take extra care with fasting before a procedure with anesthesia or sedation. These medicines delay stomach emptying and, therefore, can increase the risk of pulmonary aspiration during the procedure, reinforces a study carried out at the University of Texas, in the United States, and published in Jama Surgery.
Initially indicated for the treatment of diabetes, these medications gained fame for their effect on weight loss and have become increasingly popular.
The use of semaglutide, present in medicines such as Ozempic and Wegowy, must be suspended 21 days before a procedure involving anesthesia or sedation. Photograph: Fernanda/Adobe Stock
Pre-surgical fasting serves to ensure that the patient has minimal gastric residual volume. This is because, under anesthesia or sedation, the person loses defense reflexes, increasing the risk of regurgitation of this content and aspiration, leading to serious lung damage.
In the study, of the 124 patients monitored, more than half (56%) of those who used these medications showed residues after the standard fast, which usually lasts eight hours for the general diet and two hours for liquids without residues, such as water. and tea.
Drugs such as semaglutide and others such as liraglutide and dulaglutide simulate the effect of GLP-1 (Glucagon-Like Peptide-1), a hormone produced by the intestine, and released in the presence of glucose, which signals to the brain that the person is fed. , decreasing appetite and the speed of gastric emptying and increasing satiety. They act directly on the stomach and gastrointestinal tract, reducing motility, and on the pancreas, stimulating the release of insulin and decreasing the release of glucagon, which helps control hyperglycemia.
“Initially the impact of these medications on gastric emptying was not so valued, but, after episodes in which residues were detected even long after the last dose, societies have been changing recommendations”, says anesthesiologist Wilson Nogueira Soares Junior, from the Hospital Israeli Albert Einstein.
Take a break from medication until you have an endoscopy
Since last year, the Brazilian Society of Anesthesiology and the Brazilian Society of Diabetes have recommended a pause in use of these medicines before a routine surgical procedure under anesthesia or sedation, including tests such as endoscopy. Thus, anyone taking liraglutide must discontinue use two days beforehand, the medications dulaglutide, tirzepatide and lixisenatide require 15 days of interruption, and semaglutide, 21 days. The rule does not apply to obstetric and emergency procedures.
“Many professionals who prescribe them have not been guiding patients regarding the new safety guidelines related to fasting for elective surgeries, which increases the risk and impacts the dynamics of hospital care, with delays and the eventual suspension of procedures”, observes Soares Junior. That’s why It is essential that the patient always reports the use of medication to the medical team.
If he is admitted without respecting the medication suspension time, it is possible to perform an ultrasound to assess the volume of gastric content residues. Depending on the result, you can choose to suspend or allow the intervention.
Emergency surgeries do not require fasting recommendations. In these cases, other techniques are used, such as epidural anesthesia or spinal anesthesia, general anesthesia with rapid sequence intubation or topical anesthesia with the patient awake, performing pre-oxygenation and always leaving the aspirator ready for any emergency. “With these measures, we were able to minimize the risk of possible regurgitation and aspiration of gastric contents in cases where the procedure cannot be postponed”, explains the specialist.
Tags: Ozempic special care anesthesia
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