The Anesthesia Association came out with some new guidelines of what to do to prepare before surgery if you are are on a GLP-1 Agonist (semaglutide, ozempic, wegovy, mounjaro).
This is all new stuff, so the guidelines will likely change in the future. But I heard a story recently of a patient on semaglutide who had tons of noodles in their stomach despite not eating for 24 hours. Per the OR staff, the amount was “impressive.” This is an issue for surgery as we don’t want you to aspirate food- that is why we don’t let you eat after midnight the night before surgery. As the GLP-1 Agonists slow down gastric emptying, food stays in your stomach longer. This puts you at risk.
Their current ASA recommendations:
- DAYS PRIOR TO PROCEDURE, hold dosing prior to procedure for one week. This is irrespective of if you are doing it for diabetes or for weight loss. If you are using it for diabetes, consider consulting an endocrinologist for ways to bridge the time between stopping and your surgery for hyperglycemia treatment.
- DAY OF PROCEDURE: If you have GI symptoms (nausea, vomiting, abdominal bloating, or abdominal pain), consider delaying elective procedures, including plastic surgery. Why? The risk of regurgitation and pulmonary aspiration. IF you did not hold your medication and you have no GI symptoms, proceed with “full stomach precautions.” Consider ultrasound to see if stomach is full. There is no evidence to suggest optimal duration of fasting for patients, so until we have adequate evidence, we will continue with current ASA fasting guidelines.
My thoughts?
You don’t want to aspirate. Aspiration is when stomach acid and stomach contents land in your lungs, which is really dangerous.
You don’t want low blood sugar. We make patients stop diabetes medication around surgery, as you aren’t eating prior to surgery, and we would much rather have sugar be too high, not too low.
You want to be aware of how much you are eating. I know many people on semaglutide who “don’t feel like eating.” You need nutrition to heal. There are many studies which show STATISTICALLY BETTER scars and lower infection rates when people protein load before surgery for a month and continue the month after. If you go into any surgery nutritionally deficient, you are going to have a harder time healing, feel worse, higher risk of infection, and form worse scars.