Patients who take blockbuster medication like Wegovy or Ozempic for weight reduction might 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 medicine for as much as every week might 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 medication who inhaled meals and liquid into their lungs whereas sedated as a result of their stomachs have been nonetheless full - even after following customary directions to cease consuming for six to eight hours prematurely.

The medication can sluggish digestion a lot that it places sufferers at elevated threat for the issue, known as pulmonary aspiration, which may trigger harmful lung harm, infections and even dying, mentioned Dr. Ion Hobai, an anesthesiologist at Massachusetts General Hospital in Boston.

“This is such a serious sort of potential complication that everybody who takes this drug should know about it,” mentioned Hobai, who was among the many first to flag the difficulty.

Nearly 6 million prescriptions for the category of medicine that embody Wegovy and Ozempic have been written between January and May within the U.S. for individuals who don’t have diabetes, in keeping with Komodo Health, a well being care expertise firm. The medication induce weight reduction by mimicking the actions of hormones, discovered primarily within the intestine, that kick in after individuals eat. They additionally 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 every 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 medication could also be affected by the difficulty. But as a result of the results could be so dire, Hobai and a gaggle of colleagues determined to talk out. Writing within 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 medicine 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 is gone, which is after three weeks, hopefully everything should go back to normal,” Jones mentioned.

Champeau and Jones each acknowledged there’s not sufficient proof to say for sure how lengthy semaglutide must be held to make anesthesia protected. Many sufferers gained’t see suppliers far sufficient prematurely to cease the drug three weeks earlier than procedures, Champeau famous.

Aspiration happens in one in every 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. But case reviews present current sufferers on semaglutide had issues even once they stopped meals so long as 20 hours earlier than their procedures.

“There’s nothing that says if you fast twice as long, it will be OK,” Champeau mentioned.

Among the a number of reviews detailing probably severe issues was one in every of Hobai’s sufferers, a 42-year-old man in Boston who 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 circumstances as use of the weight-loss medicine has grown, mentioned Dr. Elisa Lund, an anesthesiologist on the University of North Carolina at Chapel Hill School of Medicine. “It has exponentially increased,” she mentioned.

Hobai is finishing a retrospective research of just about 200 sufferers taking semaglutide. While it’ll be revealed later this yr, the work up to now seems to verify 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 may imply utilizing several types of sedation protocols or delaying procedures, if doable. Jones added that analysis is urgently wanted to replace tips for docs and sufferers.

Novo Nordisk, which makes Ozempic, Wegovy and related medication, mentioned the agency’s scientific trial and post-marketing security information didn't present that the medicines led to aspiration. But the drugmaker famous that the medicines are identified to trigger delayed emptying of the abdomen and that the labels warn of doable gastrointestinal uncomfortable side effects.

Stopping the medicines for 3 weeks could cause issues, too. Patients with diabetes will want one other method to management their blood sugar and people in search of to shed weight might regain some, Hobai mentioned.

Hobai suggests that individuals utilizing Wegovy and related medication inform their docs earlier than sedation and talk about the dangers and advantages.

“If you’re taking this drug and you need an operation, you will need to have some extra precautions,” he mentioned.

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