A critical issue is emerging in the medical field, one that could potentially impact the safety of surgical procedures. The use of GLP-1 drugs, such as Ozempic, is raising concerns among anesthesiologists due to an increased risk of pulmonary aspiration during surgery.
GLP-1 agonists, like Ozempic, are a groundbreaking class of medication that mimics a natural hormone, helping individuals feel fuller for longer periods. However, this very mechanism that aids in weight loss and diabetes management can also slow down digestion, leading to potential complications under anesthesia.
David Story, President of the Australian and New Zealand College of Anaesthetists (ANZCA), highlights the major concern: "The problem we're trying to prevent is aspiration of gastric contents. It's when someone regurgitates stomach contents, which can then enter the lungs or trachea. This can be life-threatening, leading to airway obstruction or lung injury, and in some cases, patients may require intensive care, and some may not survive."
Professor Story explains that patients often arrive for surgery without disclosing their GLP-1 medication use. Reasons vary from forgetting, not considering it as medication, taking it without medical oversight, or feeling embarrassed about using weight loss drugs.
"The risk of pulmonary aspiration is still relatively low," Story emphasizes, "but when it happens, it can be severe. Anaesthetists are now exploring different anesthetic administration methods to mitigate this risk. In some cases, we even choose to delay surgery to allow patients to fast on clear fluids for an additional 24 hours."
Vida Viliunas, President of the Australian Society of Anaesthetists, adds, "These drugs have a lasting effect, sometimes more than four weeks. Patients may not realize this and stop the medication prior to surgery, but it's still effective. I had a patient who didn't disclose her GLP-1 medication use, but I used a technique to protect her airway during intubation."
Dr. Viliunas stresses that the benefits of GLP-1s often outweigh the risks, and anesthetists are adept at adapting to protect patients. "Surgery may proceed, be deferred, or cancelled. If it's urgent, like a cancer operation, we'll proceed, but with risk mitigation techniques."
In response, ANZCA has updated its guidelines, recommending that anesthetists specifically ask patients about GLP-1 medication use. Patients on GLP-1 drugs are advised to fast on clear fluids for 24 hours, followed by a standard six-hour fast before surgery.
"The evidence around GLP-1s increasing pulmonary aspiration risk is limited," the college notes, "but our guidelines represent a consensus based on available evidence and expert opinion. We hope that as awareness grows, patients will disclose their GLP-1 use early so we can ensure the safest surgical pathway."
Ozempic-like medications have gained popularity for weight loss and type 2 diabetes treatment, with the World Health Organization recently endorsing them for long-term obesity management. Preliminary research from New South Wales University estimates that around 500,000 Australians are on GLP-1 medications.
Elif Ekinci, director of the Australian Centre for Accelerating Diabetes Innovations at Melbourne University, emphasizes, "Patients on GLP-1 medication should continue their treatment unless advised otherwise by a doctor. High blood sugar levels can also interfere with surgeries. In the long term, these medications are very effective for managing glucose levels, obesity, and reducing cardiovascular events in type 2 diabetes."
All doctors urge patients to be honest about their medication use. "Doctors won't judge," says Professor Story. "It's crucial for patient safety. Our role is to work with patients and optimize their care."
This issue highlights the delicate balance between the benefits and risks of medications, and the importance of open communication between patients and healthcare providers.
