Drugs for Diabetes or Weight Loss: What To Know Before Surgery

GLP-1 Agonist Medications for Diabetes or Weight Loss

Certain types of medications taken for weight loss or diabetes management can affect the safety of patients when they are under general anesthesia or deep sedation. The risks can be minimized by taking certain steps before the surgery or procedure. Learn which medications can create risk and how to protect yourself or your loved one.

Which diabetes and weight loss drugs might increase my risks in surgery?

Medications that are classified as glucagon-like peptide-1 (GLP-1) receptor agonists might increase surgical risks for patients who are receiving general anesthesia or deep sedation. The generic versions of these drugs include dulaglutide, exenatide, liraglutide, lixisenatide, semaglutide, and tirzepatide. The brand names of these drugs are listed below:

Adlyxin^®
Bydureon BCise^®
Byetta^®
Mounjaro^®
Ozempic^®
Rybelsus^®
Saxenda^®
Trulicity^®
Victoza^®
Wegovy^®
Zepbound™

How could GLP-1 agonist drugs affect my anesthesia and safety in surgery?

Medications like Ozempic, Wegovy, Trulicity, Rybelsus, and others can delay the time it takes for food to empty from your stomach. In medical terminology, this is called “gastric emptying.”

Anecdotal reports suggest that GLP-1 agonists could increase the risk of stomach contents being regurgitated and then aspirated into the airway or lungs of a patient under general anesthesia or deep sedation. (Prevention of regurgitation and aspiration is why all patients are instructed to fast before any procedure that requires anesthesia or sedation.)

Aspiration of stomach content into the lungs is dangerous and life-threatening. There are ways for the Anesthesia Care Team to respond to regurgitation and aspiration during surgery to try to protect the patient, but it is better to avoid the risk.

When should I stop taking drugs like Ozempic and Wegovy before surgery?

Guidance issued by the American Society of Anesthesiologists (ASA) in 2023 advises the following regarding all GLP-1 agonist medications, whether used for diabetes management or weight loss:

If you take the drug daily, do not take it on the day of your procedure.
If you take the drug weekly, stop taking it a week prior to the day of your procedure.

This will decrease the risk of regurgitation of stomach contents and aspiration into your airway or lungs. Your level of consciousness under general anesthesia or deep sedation would prevent your body from clearing any resulting obstruction on its own.

Does taking a GLP-1 drug change how long I should fast before surgery?

As of late 2023, no evidence had been presented to suggest that patients who take GLP-1 medications should fast for a longer time before surgery than patients who are not taking one of these drugs.

Your anesthesiologist or surgical team will provide you with instructions for fasting. These instructions can vary depending on preexisting conditions such as reflux, diabetes, and obesity and previous procedures such as gastric bypass surgery.

When can I resume my GLP-1 diabetes or weight loss medication?

Typically, you can resume taking the medication after your surgery or procedure on the day it occurs. That means you won’t miss a dose if you are taking the drug daily.

If you take the medication weekly, it would be ideal to schedule your surgery for the day of the week when you typically take the medication. For example, if you take your medication on Fridays, you won’t need to skip a day if you schedule your surgery for a Friday. You usually can take the drug later in the day, as advised by the medical team, after your surgery or procedure has been completed.

If you cannot schedule your procedure for the day you take your medication, and you take it for diabetes, additional steps may be necessary to prevent hyperglycemia (high blood sugar), which is also a risk factor for surgery. Your anesthesiologist may consult with an endocrinologist or your physician about whether there are alternative measures you should take to control your blood sugar if you need to delay taking your GLP-1 medication. For example, if you take multiple diabetes medications, you may be advised to temporarily increase the dosage of one of the other drugs.

If you are asked to stop taking your GLP-1 medication or to change the dosing of any of your other medications, you may want to consult your prescribing physician to verify that it is safe for you to do so.

What happens if I don’t skip my GLP-1 agonist drug before surgery?

While it’s not advisable to continue taking your diabetes or weight loss drugs prior to surgery, if you do so, there are precautions your anesthesiologist can take on the day of surgery to increase your safety:

Conduct an ultrasound to evaluate your stomach contents. This option may not be suitable for all patients; for example, obesity can reduce an ultrasound’s effectiveness.
Choose the best option based on the results of the ultrasound:
- Proceed as usual with your surgery or procedure if the ultrasound showed your stomach was empty.
- Postpone the procedure, or proceed with the Anesthesia Care Team following “full-stomach precautions” if the ultrasound was inconclusive or showed your stomach was full. Full-stomach precautions alter the way your general anesthesia is administered.
Proceed with no ultrasound but with the Anesthesia Care Team using full-stomach precautions.

The use of full-stomach precautions should reduce the risk of aspiration, but those precautions require a predetermined dose of an anesthetic induction agent such as propofol. Using a predetermined dose instead of individualized dosing based on patient response can lead to more side effects.

Importantly, full-stomach precautions are available as an option only for general anesthesia; it is not an option for sedation, which is often used for procedures such as endoscopy and colonoscopy. Because of the risk of regurgitation and aspiration if you did not stop taking your GLP-1 medication, your anesthesiologist may recommend general anesthesia instead of sedation for these procedures.

Could my surgery be delayed even if I stop taking my medication?

Yes, it’s possible, if you are scheduled for elective surgery. Initial reports have found that patients who have experienced side effects such as nausea or vomiting while taking GLP-1 agonists are more likely to have residual contents in their stomach. For that reason, your anesthesiologist may advise you to postpone a surgery involving general anesthesia or deep sedation if you are experiencing any of the following symptoms on the day of your procedure:

Severe nausea, vomiting, or dry heaving
Abdominal bloating
Abdominal pain

What happens if I need emergency surgery?

When someone is taken to a medical center for urgent or emergency surgery, anesthesiologists are advised to proceed with anesthesia and treat the patient as having a full stomach. Regardless, if you are awake and alert in an emergency, you should let the anesthesiologist or surgical team know you are taking a GLP-1 agonist medication.

What should I discuss with the anesthesiologist before surgery?

Always tell your surgical team and anesthesiologist about GLP-1 agonist medications you are taking, as well as all other medications and supplements. They need this information to be able to assess your risks in surgery, advise you on minimizing risks, and prepare for any complications that could arise.

Your anesthesiologist may discuss the potential risk of regurgitation and aspiration with you. If they don’t raise the topic, don’t hesitate to ask about it or to express any concerns you may have. ASA issued its guidance about GLP-1 medications so that all members of the Anesthesia Care Team would understand the potential risks and how to address them.