Introduction

Ozempic (semaglutide) has become an increasingly popular weight loss medication, but its use can present some unique challenges when a patient needs to undergo anesthesia. In this article, we’ll explore the key risks of using Ozempic with anesthesia and how healthcare providers can mitigate complications.

How Ozempic Affects the Body

Ozempic is a glucagon-like peptide-1 (GLP-1) receptor agonist prescribed for type 2 diabetes and chronic weight management. It helps regulate blood sugar levels while also promoting feelings of fullness and weight loss.

Some of the main effects of Ozempic include:

• Slowing gastric emptying and intestinal motility
• Lowering blood glucose levels
• Increasing satiety hormones
• Potentially increasing heart rate
• Causing nausea and vomiting
• Rarely affecting liver function

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Ozempic Use Presents Anesthetic Challenges

While the glucose-lowering and weight loss effects can be beneficial, Ozempic’s mechanism of action can present challenges in the perioperative setting.

As an anesthesiologist developing an anesthesia plan for a patient taking Ozempic, some of the main risks to consider include:

Hypoglycemia

The blood sugar-lowering effects of Ozempic mean patients are at higher risk of hypoglycemia during the perioperative fasting period. Close monitoring of glucose levels and IV dextrose availability is key.

Delayed Gastric Emptying

The slowed emptying of the stomach significantly increases aspiration risk during intubation and surgery. This requires airway protection strategies.

Nausea and Vomiting

The stimulation of GLP-1 receptors increases nausea risk post-op. Preventative anti-nausea medication may be needed.

Heart Rate Changes

Increased heart rate may require adjustment of anesthetic agents or cardiovascular medications perioperatively.

Liver Function

Though rare, Ozempic can affect liver function which may impact drug metabolism. Liver function tests pre-op may be considered.

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Risk Mitigation Strategies with Ozempic

Fortunately, through careful planning and communication, anesthesiologists can incorporate strategies to mitigate the risks of Ozempic use during the perioperative period.

Thorough Pre-Op Planning

• Confirm when Ozempic was last administered and if any doses were held pre-op (There’s currently not a standard, however, general consensus is to hold the medication for 1 to 2 weeks before surgery)
• Review all medications for potential interactions with anesthetic agents
• Order lab tests if needed to assess glucose control or liver function
• Ensure patient is well-hydrated prior to procedure

Airway Protection

• Use cricoid pressure and rapid sequence induction when intubating
• Avoid bag-mask ventilation to prevent gastric insufflation
• Keep patient positioned with head-up tilt

Prevent Hypoglycemia

• Use dextrose-containing IV fluids
• Have dextrose readily available to treat low blood glucose
• Monitor glucose levels throughout procedure

Manage Nausea and Vomiting

• Administer prophylactic anti-nausea medications
• Continue anti-emetic treatment post-operatively
• Slowly advance diet to tolerate oral intake

Monitor Cardiovascular Status

• Choose anesthetics less likely to increase heart rate
• Have medications available to lower heart rate if needed
• Frequently assess blood pressure and heart rate trends

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Conclusion

Ozempic introduces unique considerations into the development of a safe anesthesia plan. However, through thorough pre-operative planning, clear communication between the surgical and anesthesia teams, and tailored risk mitigation strategies, the benefits of Ozempic can be maintained while avoiding complications from the medication’s effects.

What has been your experience with Ozempic or other weight loss medications and anesthesia? We welcome your comments and questions below. Let’s keep the conversation going to ensure optimal safety.

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FAQ

What are the main risks of Ozempic with anesthesia?

The top risks include hypoglycemia, aspiration from delayed gastric emptying, postoperative nausea/vomiting, increased heart rate, and impaired liver function.

How can anesthesiologists prevent aspiration in patients on Ozempic?

Using rapid sequence intubation, avoiding bag mask ventilation, small endotracheal tubes, head-up positioning, and suctioning can all help prevent aspiration with Ozempic.

Should Ozempic be held prior to surgery?

Typically, it is advised to hold 1-2 weeks of Ozempic prior to surgery. However, the exact timing should be determined through discussion between the surgical, anesthesia, and primary care teams.

Does Ozempic increase the risk of post-op nausea and vomiting?

Yes, by stimulating GLP-1 receptors, Ozempic can significantly increase the risk of post-operative nausea. Preventive anti-nausea medication is recommended.

How can hypoglycemia be avoided in patients on Ozempic?

Checking glucose levels, using dextrose IV fluids, having dextrose on hand, and adjusting other diabetic medications helps prevent hypoglycemia.