Anesthesiologists in the United States and Canada have raised concerns about a life-threatening complication called pulmonary aspiration, which is particularly heightened for patients taking weight-loss drugs such as Wegovy and Ozempic. These blockbuster drugs, with almost 6 million prescriptions written between January and May in the U.S. alone, work by imitating gut hormones that regulate appetite and slow down digestion. Although they have proven effective for weight loss, they pose a significant danger to patients who require surgery or other procedures that necessitate an empty stomach for anesthesia.

An increasing number of cases have been reported by anesthesiologists in which patients who followed the standard instructions to stop eating for six to eight hours before their procedures still had full stomachs. This can result in food and liquid being aspirated into the lungs while sedated, causing pulmonary aspiration. The consequences of this complication can be severe, including lung damage, infections, and even death. Dr. Ion Hobai, an anesthesiologist at Massachusetts General Hospital in Boston, has emphasized the seriousness of this issue and believes that all patients taking these weight-loss drugs should be aware of the risks. He was among the first to raise concerns about this complication.

In response to the growing number of cases, the American Society of Anesthesiologists issued guidance in June advising patients to refrain from taking weight-loss medications on the day of surgery and to hold off on weekly injections for a week before sedation procedures. However, some experts believe that this guidance may not be comprehensive enough. Dr. Michael Champeau, the president of the American Society of Anesthesiologists, acknowledges that there is insufficient evidence to determine the exact duration for which these drugs should be stopped before procedures. Dr. Philip Jones, a Mayo Clinic anesthesiologist and deputy editor-in-chief of the journal, suggests that the drug should be halted for approximately three weeks before sedation, as that is the approximate time it takes for semaglutide, the active ingredient in Wegovy, to be eliminated from the body.

While the extended timeframe of three weeks may be ideal for ensuring patient safety, it poses challenges for many patients who may not have the opportunity to see their healthcare providers far enough in advance to stop the drug three weeks prior to procedures. Aspiration occurs in approximately one out of every 2,000 to 3,000 operations requiring sedation, and finding a balance between mitigating risks and practicality for patients is crucial.

In light of these concerns, Dr. Hobai and a group of colleagues are calling for greater awareness and consideration of the risks associated with these weight-loss drugs. They argue that further research is necessary to establish evidence-based guidelines for the duration of medication cessation before sedation procedures. In the meantime, it is essential for healthcare providers and patients to engage in open conversations about the potential complications and make informed decisions regarding the use of these drugs in the context of surgical procedures.