Surgery Delays Rise as Anesthesiologists Warn of Risks Linked to Ozempic and Similar Drugs
Table of Contents
Patients taking GLP-1 medications, including Ozempic, may face surgery delays as medical professionals grapple with a heightened risk of life-threatening complications during anesthesia.
The increasing use of glucagon-like peptide-1 (GLP-1) agonists like Ozempic is prompting concern among anesthesiologists, with some patients failing to disclose their use of these medications before surgery or being inadequately prepared for procedures. These drugs, lauded for their effectiveness in weight management, work by mimicking a natural hormone to promote feelings of fullness. However, their impact on digestion is raising red flags in the operating room.
The Aspiration Risk: A Life-Threatening Concern
David Story, president of the Australian and New Zealand College of Anaesthetists (ANZCA), explained the core issue: GLP-1 drugs slow down the digestive process. This deceleration significantly increases the potential for pulmonary aspiration during surgery – a scenario where stomach contents are regurgitated and inhaled into the lungs.
“The major problem we’re trying to prevent is aspiration of gastric contents,” Story stated. “That is where someone regurgitates what’s in their stomach, and it’s breathed into their lungs or passes into their trachea.”
The consequences of aspiration can be severe. According to Story, it can lead to airway obstruction, chemical or physical injury to the lungs, and potentially necessitate intensive care, even resulting in death. “And this is what we’re really concerned about.”
Why Patients Aren’t Disclosing Medication Use
The problem is compounded by patients not informing their doctors about their use of GLP-1 medications. Reasons cited include simply forgetting, not recognizing the drugs as needing disclosure, obtaining the medication without a doctor’s prescription, or feeling embarrassed about using weight loss drugs. Ozempic has gained significant attention, often hailed as a “miracle drug” for its weight loss benefits.
Despite the risks, anesthesiologists emphasize that pulmonary aspiration remains a relatively rare complication. However, they are proactively adapting their techniques to mitigate the danger when patients are found to be on GLP-1 medications. In some instances, this has led to the postponement of surgeries to allow for an extended fasting period – up to 24 additional hours with clear fluids – to ensure the stomach is as empty as possible.
This precaution is crucial because anesthesia relaxes airway reflexes, making patients more vulnerable to regurgitation if the stomach isn’t empty. “Usually, the stomach clears itself, and one of the reasons we fast people prior to surgery is to allow the stomach time to clear itself. That is slowed down in patients who take these drugs,” Story explained. “The risk is still small, but because it can be such a serious complication, we’re careful.”
Lasting Effects & Emergency Protocols
Vida Viliunas, president of the Australian Society of Anaesthetists, highlighted another challenge: patients discontinuing the medication before surgery without understanding its prolonged effects. “I had a patient last week who had taken herself off this medication for two weeks,” she said. “Unfortunately, these drugs last for a long time, certainly more than two weeks, sometimes more than four weeks. They still have this effect on the transit of food through the gastrointestinal tract.”
Viliunas emphasized that, despite the risks, the benefits of GLP-1s often outweigh them. She and her colleagues are prepared to adapt in emergency situations, utilizing techniques like specialized intubation to protect the airway. “Surgery can either proceed, be deferred or cancelled,” she stated. “Say somebody has a cancer that needs to be operated on, that is relatively urgent … we will decide to proceed. I have techniques that I will use to mitigate the risk.”
Updated Guidelines & Broader Implications
ANZCA has responded by updating its guidelines, now recommending that anesthesiologists specifically ask patients about their use of GLP-1 medications. The updated guidelines also recommend a 24-hour clear fluid diet followed by a standard six-hour fast before surgery for patients on these drugs. While acknowledging the limited evidence directly linking GLP-1s to increased aspiration risk, the college stated its guidelines represent a consensus based on current evidence and expert opinion.
The World Health Organization recently endorsed Ozempic-style medications as long-term treatments for obesity, further increasing their prevalence. Approximately 500,000 people in Australia are estimated to be on GLP-1 medications, according to preliminary research from New South Wales University.
Elif Ekinci, director of the Australian Centre for Accelerating Diabetes Innovations at Melbourne University, cautioned against patients stopping their medication before procedures without medical advice, noting that fluctuating blood sugar levels can also complicate surgeries. “In the long term, these are very good medications. They are very good at managing glucose levels and obesity, and have other long-term benefits as well, like reduction in cardiovascular events in particular in type 2 diabetes,” she said. “In the short term, I think stopping the GLP-1 medications like Ozempic can be disruptive because it can lead to high glucose levels, and it can also lead to potential delays in the surgery or cancellation of surgery.”
Ultimately, doctors are urging patients to be honest about all medications they are taking. “We as doctors won’t judge them,” Story assured. “It’s much more important that we know about it for their safety … that’s our role as doctors, to work with them and optimise their care.”
