Sufferers who take blockbuster medicine like Wegovy or Ozempic for weight reduction could face life-threatening problems in the event that they want surgical procedure or different procedures that require empty stomachs for anesthesia. This summer season’s steering to halt the treatment for as much as every week could not go far sufficient, both.
Some anesthesiologists within the U.S. and Canada say they’ve seen rising numbers of sufferers on the weight-loss medicine who inhaled meals and liquid into their lungs whereas sedated as a result of their stomachs had been nonetheless full — even after following customary directions to cease consuming for six to eight hours upfront.
The medicine can sluggish digestion a lot that it places sufferers at elevated threat for the issue, known as pulmonary aspiration, which might trigger harmful lung harm, infections and even loss of life, mentioned Dr. Ion Hobai, an anesthesiologist at Massachusetts Normal Hospital in Boston.
“That is such a severe type of potential complication that everyone who takes this drug ought to learn about it,” mentioned Hobai, who was among the many first to flag the problem.
Practically 6 million prescriptions for the category of medication that embrace Wegovy and Ozempic had been written between January and Could within the U.S. for individuals who don’t have diabetes, in accordance with Komodo Well being, a well being care know-how firm. The medicine induce weight reduction by mimicking the actions of hormones, discovered primarily within the intestine, that kick in after folks eat. Additionally they goal indicators between the intestine and the mind that management urge for food and emotions of fullness, and by slowing how briskly the abdomen empties.
In June, the American Society of Anesthesiologists issued steering advising sufferers to skip each day weight-loss medicines on the day of surgical procedure and maintain off on weekly injections for every week earlier than any sedation procedures. Dr. Michael Champeau, the group’s president, mentioned the motion was primarily based on anecdotal reviews of issues — together with aspiration — from across the nation.
It’s not clear what number of sufferers taking the anti-obesity medicine could also be affected by the problem. However as a result of the results will be so dire, Hobai and a gaggle of colleagues determined to talk out. Writing in the Canadian Journal of Anesthesia, they known as for the drug to be stopped for even longer — about three weeks earlier than sedation.
That accounts for a way lengthy semaglutide, the energetic treatment in Wegovy, stays within the physique, mentioned Dr. Philip Jones, a Mayo Clinic anesthesiologist who can be deputy editor-in-chief of the journal.
“When 90% of it’s gone, which is after three weeks, hopefully the whole lot ought to return to regular,” Jones mentioned.
Champeau and Jones each acknowledged there’s not sufficient proof to say for sure how lengthy semaglutide ought to be held to make anesthesia secure. Many sufferers received’t see suppliers far sufficient upfront to cease the drug three weeks earlier than procedures, Champeau famous.
Aspiration happens in certainly one of each 2,000 to three,000 operations that require sedation, and virtually half of sufferers who aspirate throughout surgical procedure develop a associated lung harm. However case reviews present latest sufferers on semaglutide had issues even once they stopped meals so long as 20 hours earlier than their procedures.
“There’s nothing that claims in case you quick twice as lengthy, will probably be OK,” Champeau mentioned.
Among the many a number of reviews detailing doubtlessly severe issues was certainly one of Hobai’s sufferers, a 42-year-old man in Boston who just lately started taking Wegovy, needed to be intubated and suffered respiratory failure that put him in intensive care. He aspirated meals that remained in his abdomen regardless of fasting for 18 hours.
In Chapel Hill, North Carolina, a 31-year-old-woman on a low dose of Ozempic had fasted for 10 hours earlier than a routine endoscopy previous to bariatric surgical procedure final fall. The process needed to be stopped as a result of strong meals remained in her abdomen and he or she was at excessive threat for aspiration, the report mentioned.
Since then, docs have seen dozens of comparable instances as use of the weight-loss treatment has grown, mentioned Dr. Elisa Lund, an anesthesiologist on the College of North Carolina at Chapel Hill College of Medication. “It has exponentially elevated,” she mentioned.
Hobai is finishing a retrospective research of virtually 200 sufferers taking semaglutide. Whereas it’ll be printed later this yr, the work thus far seems to substantiate a small research from Brazil, he mentioned. In that research, a few quarter of sufferers taking semaglutide had residual meals of their stomachs throughout procedures requiring sedation — even after stopping the drug for 10 days.
The American Society of Anesthesiologists advises docs who’re doubtful to deal with sufferers who haven’t paused the drug as if they’ve full stomachs, which might imply utilizing various kinds of sedation protocols or delaying procedures, if potential. Jones added that analysis is urgently wanted to replace tips for docs and sufferers.
Novo Nordisk, which makes Ozempic, Wegovy and comparable medicine, mentioned the agency’s medical trial and post-marketing security knowledge didn’t present that the medicines led to aspiration. However the drugmaker famous that the medicines are identified to trigger delayed emptying of the abdomen and that the labels warn of potential gastrointestinal uncomfortable side effects.
Stopping the medicines for 3 weeks may cause issues, too. Sufferers with diabetes will want one other technique to management their blood sugar and people looking for to drop some pounds could regain some, Hobai mentioned.
Hobai suggests that individuals utilizing Wegovy and comparable medicine inform their docs earlier than sedation and talk about the dangers and advantages.
“In case you’re taking this drug and also you want an operation, you have to to have some further precautions,” he mentioned.
The Related Press Well being and Science Division receives help from the Howard Hughes Medical Institute’s Science and Instructional Media Group. The AP is solely accountable for all content material.
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