Nov. 12, 2024 – Most people taking GLP-1 drugs for weight loss or diabetes no longer need to stop taking them before elective surgery, according to new guidance from the American Society of Anesthesiologists (ASA).
But people should avoid such procedures when starting the drugs or during dose adjustments.
The new guidance comes just as the FDA has added a warning to the label of GLP-1 medicines about the risk of pulmonary aspiration, meaning stomach contents can be vomited and enter a person’s airways or lungs. Pulmonary aspiration can lead to a sometimes fatal condition called aspiration pneumonia.
The warning applies to the entire class of GLP-1 drugs, including liraglutide (Saxenda, Victoza), semaglutide (Ozempic, Rybelsus, Wegovy), and tirzepatide (Mounjaro, Zepbound).
People taking these brands should alert their health care provider that they are on the drugs before surgery or procedures that require deep sedation.
More than a year ago, the ASA publicized the risk of aspiration among people taking GLP-1s, which slow the movement of food through the gut and can create uncertainty about whether someone has an empty stomach.
The ASA sees the new label warning as a confirmation of their concerns, said Girish P. Joshi, MBBS, MD, vice chair of the ASA’s Committee on Practice Parameters.
The ASA’s “updated guidance provides an approach to mitigate this complication, but does not downplay the potential for pulmonary aspiration,” said Joshi, who is a professor of anesthesiology and pain management at the University of Texas Southwestern Medical Center in Dallas.
The new recommendation to continue GLP-1s before elective surgery has also been endorsed by numerous other professional doctor groups, ranging from gastroenterologists to bariatric surgeons. In a news release, the groups called the approach a balance of managing risks and benefits, such as continuing optimal blood sugar control among people with diabetes.
To reduce the risk of aspiration, some people may need to take extra precautions, like following a liquid diet for 24 hours beforehand, having an ultrasound to examine stomach contents just before the procedure, and, in some cases, delaying the procedure.
Reasons to consider delay include gastrointestinal side effects from GLP-1s like nausea, belly discomfort, or constipation, or due to being in the four- to eight-week period that it takes to increase doses. People with other medical conditions that can slow stomach emptying, like Parkinson’s disease, may also need to make special considerations with their care team.
Joshi said there would only be rare cases where it would be necessary to delay a procedure, and that there are also options to reduce risk for people who need emergency surgery.
The updated GLP-1 labels now state: “There have been rare postmarketing reports of pulmonary aspiration in patients receiving GLP-1 receptor agonists undergoing elective surgeries or procedures requiring general anesthesia or deep sedation who had residual gastric contents despite reported adherence to preoperative fasting recommendations.” The information doesn’t detail how many cases have occurred, nor the outcomes.
