UNITED STATES (AP) – Patients taking blockbuster drugs like Wegovy or Ozempic to lose weight can face life-threatening complications if they need surgery or other procedures that require an empty stomach for anesthesia. Guidance issued this summer to stop the drug for up to a week may not be enough either.
Some anesthesiologists in the United States and Canada say they have seen an increasing number of patients on weight-loss drugs who inhaled food and fluid into their lungs while sedated because their stomachs were still full, even after following standard instructions to stop eating. eat six to eight hours in advance.
The drugs can slow digestion so much that it increases the risk of patients suffering from pulmonary aspiration, which can cause dangerous lung damage, infections and even death, said Dr. Ion Hobai, an anesthesiologist at Massachusetts General Hospital in Boston.
“This is such a serious type of potential complication that everyone taking this drug should know about it,” said Hobai, who was one of the first to point out the problem.
About 6 million prescriptions for the class of drugs that include Wegovy and Ozempic were written between January and May in the United States for people without diabetes, according to Komodo Health, a healthcare technology company. The drugs induce weight loss by mimicking the actions of hormones, found primarily in the gut, that kick in after eating. They also target signals between the gut and the brain that control appetite and feelings of fullness, and slow down the rate at which the stomach empties.
In June, the American Society of Anesthesiologists issued guidance advising patients to skip daily weight-loss medications on the day of surgery and to refrain from weekly injections for a week before any weight-loss procedure. sedation. Dr. Michael Champeau, the group’s president, said the action was based on anecdotal reports of problems — including aspiration — from around the country.
It is not clear how many patients taking anti-obesity drugs may be affected by the problem. But because the consequences can be so dire, Hobai and a group of colleagues decided to speak out. Writing in the Canadian Journal of Anesthesia, they called for the drug to be stopped longer, about three weeks before sedation.
That explains how long semaglutide, Wegovy’s active drug, stays in the body, said Dr. Philip Jones, a Mayo Clinic anesthesiologist and also deputy editor of the journal.
“When 90% (of the drug) is gone, which is after three weeks, hopefully everything should be back to normal,” Jones said.
Champeau and Jones acknowledged that there is not enough evidence to say for sure how long semaglutide should be maintained for safe anesthesia. Many patients will not see providers early enough to stop the medication three weeks before procedures, Champeau noted.
Aspiration occurs in one in every 2,000 to 3,000 operations requiring sedation, and nearly half of patients who aspirate during surgery develop related lung injury. But case reports show that patients who took semaglutide recently had problems even when they stopped eating up to 20 hours before their procedures.
“There’s nothing that says if you fast twice as long, you’ll be fine,” Champeau said.
Among the several reports detailing potentially serious problems was one of Hobai’s patients, a 42-year-old man from Boston who recently started taking Wegovy, had to be intubated and suffered respiratory failure that put him in intensive care. He breathed in food that remained in his stomach despite fasting for 18 hours.
In Chapel Hill, North Carolina, a 31-year-old woman taking a low dose of Ozempic fasted for 10 hours before a routine endoscopy before bariatric surgery last fall. The procedure had to be stopped because he had solid food left in his stomach and was at high risk of pulmonary aspiration, according to the report.
Since then, doctors have seen dozens of similar cases as use of the weight-loss drug has increased, said Dr. Elisa Lund, an anesthesiologist at the University of North Carolina School of Medicine at Chapel Hill. “They have increased exponentially,” she said.
Hobai is completing a retrospective study of nearly 200 patients taking semaglutide. Although it will be published later this year, the work so far appears to confirm a small study from Brazil, she said. In that study, about a quarter of patients taking semaglutide had food residue in their stomachs during procedures requiring sedation, even after stopping the drug for 10 days.
The American Society of Anesthesiologists advises doctors in doubt to treat patients who haven’t stopped the drug as if they had a full stomach, which may mean using different types of sedation protocols or delaying procedures, if possible. Jones added that research is urgently needed to update the guidelines for doctors and patients.
Novo Nordisk, which makes Ozempic, Wegovy and similar drugs, said the company’s clinical trial and post-marketing safety data did not show that the drugs caused aspiration. But the drugmaker noted that the drugs are known to slow stomach emptying and that labels warn of possible gastrointestinal side effects.
Stopping the drugs for three weeks can also cause problems. Diabetes patients will need another way to control their blood sugar, and those looking to lose weight may gain some weight back, Hobai said.
Hobai suggests that people using Wegovy and similar drugs tell their doctors before sedation and discuss the risks and benefits.
