Key Takeaways:
- The use of GLP-1 agonists, such as Ozempic, has risen, and anaesthetists are concerned about the potential risks of pulmonary aspiration during surgery.
- Patients on GLP-1 medication may not be declaring their use of the medication before surgery, or may not be properly prepared, which can increase the risk of life-threatening consequences.
- Anaesthetists are working to find different ways to administer anaesthetics to reduce the risk, and may delay surgery to allow patients to fast on clear fluids for an additional 24 hours.
- The Australian and New Zealand College of Anaesthetists (ANZCA) has updated its guidelines to recommend that anaesthetists specifically ask patients about GLP-1 medication and that patients on GLP-1 drugs take clear fluids for 24 hours before surgery.
- The World Health Organization has endorsed Ozempic-style medications as long-term treatments for obesity, and patients on GLP-1 medication should continue with their treatment before any procedure unless otherwise advised by a doctor.
Introduction to the Issue
The increasing use of glucagon-like peptide-1 (GLP-1) agonists, such as Ozempic, has led to concerns among anaesthetists about the potential risks of pulmonary aspiration during surgery. GLP-1 drugs are a breakthrough class of medication that mimic the activity of a natural hormone, helping people feel full for longer. However, they can slow down digestion, which can increase the risk of pulmonary aspiration during surgery. This can lead to life-threatening consequences, including obstruction of the airway, chemical or physical injury of the lungs, and even death.
The Risks of Pulmonary Aspiration
David Story, president of the Australian and New Zealand College of Anaesthetists (ANZCA), explained that the major problem anaesthetists are trying to prevent is aspiration of gastric contents. This occurs when someone regurgitates what’s in their stomach and it’s breathed into their lungs or passes into their trachea. The risk of pulmonary aspiration is still low, but anaesthetists are taking precautions to reduce the risk. Patients on GLP-1 medication may not be declaring their use of the medication before surgery, or may not be properly prepared, which can increase the risk of life-threatening consequences.
The Importance of Patient Disclosure
Patients on GLP-1 medication may not be telling their doctors about their use of the medication before surgery, which can make it difficult for anaesthetists to prepare for the potential risks. This can be due to various reasons, including forgetting, not realizing it counts as medication, taking it without a doctor’s oversight, or being embarrassed about using weight loss drugs. Anaesthetists are urging patients to be honest about their medication use, as it is crucial for their safety during surgery. Professor Story emphasized that doctors won’t judge patients, and it’s their role to work with them and optimize their care.
New Guidelines for Anaesthetists
The Australian and New Zealand College of Anaesthetists (ANZCA) has updated its guidelines to recommend that anaesthetists specifically ask patients about GLP-1 medication. The guidelines also recommend that patients on GLP-1 drugs take clear fluids for 24 hours, followed by a standard six-hour fast before surgery. These guidelines are based on a review of currently available evidence and expert opinion, and are intended to reduce the risk of pulmonary aspiration during surgery. Vida Viliunas, president of the Australian Society of Anaesthetists, noted that anaesthetists are used to thinking on their feet to protect patients, and will use techniques to mitigate the risk of pulmonary aspiration.
The Benefits and Risks of GLP-1 Medication
GLP-1 agonists, such as Ozempic, have been endorsed by the World Health Organization as long-term treatments for obesity. They have been shown to be effective in managing glucose levels and obesity, and have other long-term benefits, such as reducing cardiovascular events in type 2 diabetes. However, stopping GLP-1 medications like Ozempic before surgery can be disruptive, leading to high glucose levels and potential delays or cancellation of surgery. Elif Ekinci, director of the Australian Centre for Accelerating Diabetes Innovations at Melbourne University, emphasized the importance of patients continuing with their GLP-1 medication before any procedure, unless otherwise advised by a doctor.
Conclusion
The use of GLP-1 agonists, such as Ozempic, has risen, and anaesthetists are working to reduce the risks associated with their use during surgery. Patients on GLP-1 medication should be honest about their medication use, and anaesthetists should take precautions to reduce the risk of pulmonary aspiration. The updated guidelines from the Australian and New Zealand College of Anaesthetists (ANZCA) are an important step in reducing the risks associated with GLP-1 medication during surgery. By working together, doctors and patients can ensure that surgery is safe and effective, and that the benefits of GLP-1 medication are maximized.