GLP1 meds and fasting

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A hospital system/anesthesia group near us officially changed their guidelines for surgical patients on these meds (Ozempic, Wegovy, etc): NPO for 24hrs for solids, 8hrs for clears, and off the med for 7days min. Checking here to see if anyone else’s group/hospital has officially changed their guidelines as we are looking into making something official within ours. I have yet to hear anything about them from the ASA. (Personally I RSI anyone who is on these.)
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We haven’t changed our NPO guidelines, but our preop clinic is recommending patients stop taking these medications 1-2 weeks prior to surgery.

I think it’s prudent to RSI anyone on these medications, but things become more complicated when it comes to outpatient procedures normally performed under sedation. It’s simply not practical to tube every colonoscopy patient on these medications.
 
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circleK said:
A hospital system/anesthesia group near us officially changed their guidelines for surgical patients on these meds (Ozempic, Wegovy, etc): NPO for 24hrs for solids, 8hrs for clears, and off the med for 7days min. Checking here to see if anyone else’s group/hospital has officially changed their guidelines as we are looking into making something official within ours. I have yet to hear anything about them from the ASA. (Personally I RSI anyone who is on these.)
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Apparently ozempic and wegovy are both semaglutide
 
nimbus said:
I took care of a fasted patient on ozempic for a EGD a couple months ago. Procedure was aborted because the stomach was full of food. n=1 but it was quite impressive.
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A gi bro told me at their own GI center, the policy now is at least a week.

They’ve had at least one if not more aspirations recently. They did not like that shlt.
 
At my shop I feel like I am the only one that's ringing the alarm bells about these drugs. Everyone is always like "Oh they delay gastric emptying? I didn't know that. Can we just do this one like we normally do?" I think I'm finally getting some colleagues as well as some surgeons to come around to the dangers, but of course the GI guys are sticking their heads in the sand. I personally have had varied approaches about whether to RSI or sedate normally based on other risk factors. I want (really need) more data before I can start bringing the butts and guts conveyor belt to a screeching halt.

My med school buddy that is a bariatric medicine specialist in a different state told me that the anesthesia group in his system came to him asking about the drugs because they did have some unexpected aspirations. He personally isn't aware of any research or guidance yet.

The half life of SubQ semaglutide is ~7 days per the med info on UpToDate. I don't know if anyone knows how long delayed gastric emptying occurs but I'm not sure even 1 week off it would be enough.
 
Our GI guys are loving the extra business. They are getting referrals for N/V only to tell the patients it’s the Ozempic. The outpatient facility is holding Ozempic for elective procedures but no changes in NPO time. Our hospital and its system haven’t made any changes yet but there is lots of talk about what to do.
 
coffeebythelake said:
Weve seen multiple aspiration events in our shop. I dont know if gastric emptying with 0.5 vs 1 vs 2 vs 2.5 mg of ozempic. I think this needs to be studied.
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I think the dosage does matter as the drug's effect on delayed gastric emptying increases significantly (IMHO) above 0.5 mg. The vast majority of patients report NO CHANGE in how they feel or how much they eat at 0.25 mg (the starting dose). Some report a nice effect at 0.5 mg but many require the 1.0 mg dose or greater to truly see the delayed gastric emptying. There is a reason WEGOVY is FDA approved for weight loss while Ozempic is not (dose related).

Now, I fully understand "caution" to many of you means "full stomach" period on any dosage but I disagree. The low dosage of Semaglutide is likely safe while the higher doses require full aspiration precautions. One last thing the half life is 7 days so for the drug to reach 25% it will require 2 weeks.
 
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BLADEMDA said:
I think the dosage does matter as the drug's effect on delayed gastric emptying increases significantly (IMHO) above 0.5 mg. The vast majority of patients report NO CHANGE in how they feel or how much they eat at 0.25 mg (the starting dose). Some report a nice effect at 0.5 mg but many require the 1.0 mg dose or greater to truly see the delayed gastric emptying. There is a reason WEGOVY is FDA approved for weight loss while Ozempic is not (dose related).

Now, I fully understand "caution" to many of you means "full stomach" period on any dosage but I disagree. The low dosage of Semaglutide is likely safe while the higher doses require full aspiration precautions. One last thing the half life is 7 days so for the drug to reach 25% it will require 2 weeks.
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Yeah, the reason is "newer patent"
 
We are trying to decide this at our shop too. Problematic when they come in for outpatient procedures. A lot of patients taking it at our outpatient Endo centers. I just took care of 3 patients this week who are on it and didn’t hold it. Luckily nothing happened but I didn’t feel great sedating them. It’s an outpatient Endo center so I would have to cancel the case since I can’t intubate there per policy. Some people are recommending 1 week but since it’s dosed every 7 days it could mean they haven’t missed a dose.
 
Simba1711 said:
We are trying to decide this at our shop too. Problematic when they come in for outpatient procedures. A lot of patients taking it at our outpatient Endo centers. I just took care of 3 patients this week who are on it and didn’t hold it. Luckily nothing happened but I didn’t feel great sedating them. It’s an outpatient Endo center so I would have to cancel the case since I can’t intubate there per policy. Some people are recommending 1 week but since it’s dosed every 7 days it could mean they haven’t missed a dose.
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many are taking the 2 mg dose which at 1 week means there is 1 mg of drug in their system. Semaglutide at 1 mg is still highly effective and very likely to delay gastric emptying.
 
Conclusion
Once weekly semaglutide 1.0 mg resulted in a significant late-phase retention of solid meal measured by repeated scintigraphic imaging. This effect correlated with appetite suppression and likely contributed to weight loss.

academic.oup.com

RF24 | PSUN116 Once-weekly semaglutide delays a late phase gastric emptying of solid meal measured by repeated scintigraphic imaging in obese women with PCOS

AbstractBackground. GLP-1 agonism have the potential to affect gastric emptying (GE), yet the reports for subcutaneous semaglutide, currently the most effe
academic.oup.com academic.oup.com
 

Semaglutide, delayed gastric emptying, and intraoperative pulmonary aspiration: a case report.​

Klein SR 1,
Hobai IA 1

Author information​

Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, 28 Mar 2023,
DOI: 10.1007/s12630-023-02440-3 PMID: 36977934

Abstract​

Purpose​

We report a case in which the use of semaglutide for weight loss was associated with delayed gastric emptying and intraoperative pulmonary aspiration of gastric contents.

Clinical features​

A 42-yr-old patient with Barrett's esophagus underwent repeat upper gastrointestinal endoscopy and ablation of dysplastic mucosa. Two months earlier, the patient had started weekly injections of semaglutide for weight loss. Despite having fasted for 18 hr, and differing from the findings of prior procedures, endoscopy revealed substantial gastric content, which was suctioned before endotracheal intubation. Food remains were removed from the trachea and bronchi using bronchoscopy. The patient was extubated four hours later and remained asymptomatic.

Conclusion​

Patients using semaglutide and other glucagon-like peptide 1 agonists for weight management may require specific precautions during induction of anesthesia to prevent pulmonary aspiration of gastric contents.

Full text links​

 
IMG_9229.jpeg

Looks like APSF had an article about it, then it disappeared? https://www.apsf.org/article/is-the...e-1-glp-1-receptor-agonists-under-recognized/
 
Seems to be a wonder drug for weight loss. Maybe just have patients scheduled for surgery take reglan for a couple of days if they are on semaglutide? Would need to coordinate with the surgeons to prescribe it.
 
GassYous said:
It's incredible that we have these medications to replace a simple lack of control and prudent intake.
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Come on now. Obesity is a huge problem. There are likely genetic and environmental factors at play. We all know people who eat like pigs and are thin as a rail, conversely people who have been fat from birth. This drug works well and dramatically. We should address the problems as they relate to anesthesia, not condemn the medication.
 
dannyboy1 said:
Come on now. Obesity is a huge problem. There are likely genetic and environmental factors at play. We all know people who eat like pigs and are thin as a rail, conversely people who have been fat from birth. This drug works well and dramatically. We should address the problems as they relate to anesthesia, not condemn the medication.
Click to expand...
Obesity isn't caused by medical or genetic factors in the vast majority of cases. You know this. Just plain and simple over eating of massively processed food, with sedentary lifestyle. These aren't people that are overweight because they chose the salmon salad over the turkey tacos. These are professional eaters, eating pound bags of Oreos @ a time.

Adding this medication doesn't remove the sedentary life, nor does it address the lifestyle choices that lead to this self inflicted disaster...

It remains to be seen whether these drugs has any long term health benefits. We know it helps with weight loss for approximately 28 weeks or maybe 1 year. But no mortality benefits yet... we'll have to see...

I would be surprised if the type of person who can harm their own body so much to get to 300, 400, 500lbs can simply take a pill and then change all their disastrous health habits.

Even roux en y, didnt improve longevity in these patients. They lost weight but died @ the same time, just for other reasons...
 
PpfSuxTube said:
Obesity isn't caused by medical or genetic factors in the vast majority of cases. You know this. Just plain and simple over eating of massively processed food, with sedentary lifestyle. These aren't people that are overweight because they chose the salmon salad over the turkey tacos. These are professional eaters, eating pound bags of Oreos @ a time.

Adding this medication doesn't remove the sedentary life, nor does it address the lifestyle choices that lead to this self inflicted disaster...

It remains to be seen whether these drugs has any long term health benefits. We know it helps with weight loss for approximately 28 weeks or maybe 1 year. But no mortality benefits yet... we'll have to see...

I would be surprised if the type of person who can harm their own body so much to get to 300, 400, 500lbs can simply take a pill and then change all their disastrous health habits.

Even roux en y, didnt improve longevity in these patients. They lost weight but died @ the same time, just for other reasons...
Click to expand...
Yes, it did.


www.medpagetoday.com

Bariatric Surgery Cuts All-Cause Mortality Rate Over Many Years

But younger patients seem to face higher suicide risk
www.medpagetoday.com www.medpagetoday.com
 
PpfSuxTube said:
Obesity isn't caused by medical or genetic factors in the vast majority of cases. You know this. Just plain and simple over eating of massively processed food, with sedentary lifestyle. These aren't people that are overweight because they chose the salmon salad over the turkey tacos. These are professional eaters, eating pound bags of Oreos @ a time.

Adding this medication doesn't remove the sedentary life, nor does it address the lifestyle choices that lead to this self inflicted disaster...

It remains to be seen whether these drugs has any long term health benefits. We know it helps with weight loss for approximately 28 weeks or maybe 1 year. But no mortality benefits yet... we'll have to see...

I would be surprised if the type of person who can harm their own body so much to get to 300, 400, 500lbs can simply take a pill and then change all their disastrous health habits.

Even roux en y, didnt improve longevity in these patients. They lost weight but died @ the same time, just for other reasons...
Click to expand...
I have friends and family on this drug. They describe feeling full all the time and develop an aversion to overeating because they will pay for it later. It definitely works.
 
PpfSuxTube said:
Obesity isn't caused by medical or genetic factors in the vast majority of cases. You know this. Just plain and simple over eating of massively processed food, with sedentary lifestyle. These aren't people that are overweight because they chose the salmon salad over the turkey tacos. These are professional eaters, eating pound bags of Oreos @ a time.

Adding this medication doesn't remove the sedentary life, nor does it address the lifestyle choices that lead to this self inflicted disaster...

It remains to be seen whether these drugs has any long term health benefits. We know it helps with weight loss for approximately 28 weeks or maybe 1 year. But no mortality benefits yet... we'll have to see...

I would be surprised if the type of person who can harm their own body so much to get to 300, 400, 500lbs can simply take a pill and then change all their disastrous health habits.

Even roux en y, didnt improve longevity in these patients. They lost weight but died @ the same time, just for other reasons...
Click to expand...
You make a good point.

However, I think, you are missing the BIG picture.

If pharmacy puts a vial of a drug that looks exactly like the one you are supposed to get out of the pyxis drawer (but is wrong), and you draw it up and give it - yes you are responsible because you didn't check and double check. Of course.... BUT, I also think there was a systemic issue at play as well. There are likely much better examples to show that systemic issues are at play in many mistakes (while not taking responsibility away from the person who makes the final mistake).

CLEARLY something is wrong with our society. It isn't just lazy, or poor choice making. It could be the plastics we all ingest. Maybe other environmental issues. Also, the way food is packaged and made and sold is very different from another era. Do you expect everyone to just grow all their own food? Work environments are so different from 100 years ago. That is a function of society and not personal choices.

I get the "personal responsibility" point - but I also think it is way way more complicated than just that.
 
I find it hard to believe that these drugs delay emptying such that food stays in the stomach more than 18 hours. That seems nuts.

I like the idea of using ultrasound to check.
 
dannyboy1 said:
I have friends and family on this drug. They describe feeling full all the time and develop an aversion to overeating because they will pay for it later. It definitely works.
Click to expand...
I mean great but absolutely Irrelevant, sorry. Just anecdotes.
I support these drugs or measures that decrease obesity but your point about obesity being somehow caused by medical or genetic factors is very far from the mark in most cases. Most cases of obesity are down to over eating and sloth.
 
Last edited:
coffeebythelake said:
what is the point of this question? are you going to argue that there is no long term benefit?
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My point is more of a retort to the earlier statement about obesity having some sort of medical explanation that makes it ok to eat a bag of Oreos in one sitting.

It's not ok to eat yourself to 400lbs.

Popping a pill to lose weight doesnt undo whatever self destructive behaviour you have that made you eat like that. That's self hate or something else that manifest in other ways that also shorten your life...

Its a very serious disorder that I just don't think will go away by simply losing weight. There must be more in it. Eating to 400lbs is a massive problem

Thats my point...
 
GassYous said:
Seems like it's been working real well to help the obesity epidemic
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They weren't really used very much - Saxenda was approved for weight loss, but the other GLP-1s (Trulicity, Victoza) were used almost exclusively for diabetes. None of them have taken off like Wegovy/Ozempic or Mounjaro. But we know that they offer other benefits besides just weight loss, because they're pretty old medications.
 
PpfSuxTube said:
Ok. Not answering the question tho. Study follow up time?
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You keep dismissing the existing data by claiming there is a lack of long term data.

I guess @VA Hopeful Dr should hop into his time machine and go 50 years into the future and return with some solid data about the long term effects of a drug that has been out for 18 years.

Is 50 years in the future enough? Or should he do a few more trips perhaps 100 years? 200 years? Remember it takes 1.21 gigawatts of energy to make each trip..
 

Semaglutide and Tirzepatide are now being compounded off-label across the USA. You can buy these drugs, well the off-label non FDA approved versions, from weight loss NPs for about $200 per month. I expect millions of people to be using the brand name or off-label versions of these medications. I see people at the gym using these meds plus steroid/growth hormone and now all the aesthetician NPs are prescribing it as well. These drugs work and there is no doubt you lose weight by taking them.

 
Would there be any benefit to asking these patients to start metoclopramide a few days before surgery? I’ve given it to my diabetic patients for nausea and it really helps them
 
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