Ozempic Stomach Risks Result in Debate Among Anesthesiologists Over Surgery Guidelines

Some anesthesiologists say patients should be taken off drugs three weeks before surgery to avoid risks caused by Ozempic stomach side effects

An increasing number of anesthesiologists are expressing concerns over recent guidelines on the use of new generation diabetes and weightloss drugs before surgery, suggesting that they do not go far enough to protect patients from Ozempic stomach risks, which could result in severe adverse health consequences.

In late June, the American Society of Anesthesiologists (ASA) issued new Ozempic and Wegovy surgery guidelines that warned against using the drugs before elective surgery, due to the risk of vomiting and aspiration during anesthesia.

Ozempic (semaglutide) was originally approved for the treatment of people with Type 2 diabetes. However, in recent months Ozempic, along with a similar drug, Wegovy, has been increasingly prescribed for weight loss. While Wegovy is approved for weight loss use, Ozempic is not, and is prescribed “off-label” as a diet medication by a growing number of doctors.

Both drugs are part of a class of diabetic medications known as glucagon-like peptide-1 (GLP-1) receptor agonists, which also includes Trulicity, Byetta and others. However, side effects of Ozempic, Wegovy and other members of the class have been linked to serious stomach risks, including gastroparesis or stomach paralysis, which can result in severe and long-term gastrointestinal damage. As a result a growing number of Ozempic lawsuits have been filed in recent months, claiming that drug makers failed to adequately warn users and the medical community about the potential risks.

The ASA task force recommends that if patients take a drug like Ozempic or Wegovy on a daily basis, they should not take it the day of a surgery procedure. If they take the drug on a weekly basis, they should pause taking the medications a week before their surgery, according to the ASA, among other recommendations.

According to the ASA guidance, the drugs work by delaying the emptying of the stomach, which leads to less hunger. However, that means that during surgery and anesthesia, the stomach may not be empty, which has been linked to patients vomiting and facing a suffocation risk.

Ozempic Stomach Risk Guidance Concerns

Some anesthesiologists are now saying that those guidelines should be strengthened, and some have begun taking other measures to protect patients from Ozempic stomach risks, such as intubating them, even during only minor surgical procedures, according to a report published by MedPage Today, which indicated the debate has polarized the anesthesiologist community.

In July, researchers with the Mayo Clinic, Massachusetts General Hospital, and Toronto General Hospital published a report in the Canadian Journal of Anesthesia, suggesting that surgeons should probably not limit their protection of patients to the ASA guidelines.

Instead, they recommended patients be taken off any semaglutide-based drug for at least three weeks before surgery, to allow at least three half-lives to pass. This would mean about 88% of Ozempic or Wegovy are out of the patient’s system. If patients cannot be off the drugs that long before surgery, they called for doctors to consider rapid sequence induction intubation to limit the risk of patients emptying their stomach during the procedure.

The researchers say that even if general anesthesia is not planned, health care providers should be made aware the patient is on Ozempic and the risks that their stomach contents might not be empty if general anesthesia is suddenly needed. They also called for surgeons to use gastric ultrasound to assess stomach contents and shared decision making with the patient, so that they are aware of the risks and benefits of any decisions.

However, the researchers noted that there is very little definitive science linking semaglutide to surgical suffocation and vomiting risks, only compelling case reports and a few early studies, which makes any guidelines questionable.

“The above considerations are not clinical practice guidelines, as there is currently insufficient evidence to generate guidelines. They are opinion-based elements anesthesia providers should consider,” the researchers noted. “The considerations we give are a best attempt to balance the risk of a potentially life-threatening aspiration event against the risk to the patient of weight gain or temporarily poorer glycemic control.”

Ozempic and Wegovy Stomach Paralysis Risks

Gastroparesis, also known as delayed gastric emptying or stomach paralysis, weakens the normal muscle movement in the stomach. These stomach contractions are necessary to push food through the digestive tract.

When gastroparesis occurs, the stomach is slow to empty, resulting in symptoms including nausea, vomiting undigested food, abdominal pain, abdominal bloating, severe dehydration, feeling full after only a few bites, undigested food hardening in the stomach, acid reflux, fluctuating blood sugar levels, lack of appetite, weight loss, malnutrition and decreased quality of life. However, some users are reporting these side effects persisted long after Wegovy or Ozempic are discontinued.

In July, a CNN investigation outlined an alarming number of reports linking Ozempic and stomach paralysis, indicating that similar problems have been associated with other drugs in the same class in recent years.

In 2017, researchers with the Mayo Clinic conducted a study involving a similar diabetes medication known as Victoza, which found that the drug caused significantly slower digestion in users, taking about 70 minutes for half the food they ate to leave their stomachs, compared to four minutes for people who did not take the drug. However, the study found that people’s bodies tended to adjust over time.

The first known Ozempic stomach paralysis lawsuit was filed in early August, alleging Novo Nordisk knew about the risks, but failed to provide patients and healthcare providers with adequate warning. It was the first of what could be hundreds or thousands of gastroparesis lawsuits filed in the coming months and years.