Ozempic and Surgery
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The ASA guidelines:
The American Gastroenterological Association (AGA)"
The American Gastroenterological Association (AGA) expressed concerns that the ASA recommendations would lead to “canceling or postponing endoscopic procedures in patients taking this class of medication who require sedation or proceeding to general endotracheal intubation in some situations, which may lead to added time, cost and clinical risk to patients.”29 Rather than postponing or delaying elective endoscopies, the AGA recommends placing patients on a clear liquid diet on the day before procedure in lieu of holding GLP-1 RAs.29 The suggestion to initiate a clear liquid diet the day before sedation procedures is based on weak evidence from a single retrospective chart review.20 Additional AGA recommendations include the use of gastric POCUS, rapid sequence induction and intubation in patients with active GI symptoms, and proceeding with procedures as planned in patients without GI symptoms.29 The divergence in recommendations will likely create problems for patients and has the potential to lead to case cancellations and perioperative complications.
If it were me passing gas - stop the medicine as the ASA recommends. I've had one patient regurgitate during surgery - outcome was good. My partner had one regurgitate - she went on to die in the ICU weeks later.
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Clear fluids are good. But why an expensive test? Whatever happened to scaring the crap out of pts prior, warning them of choking and dying, or threats of “if we find anything in your stomach prior to surgery, your operation will be cancelled & it won’t be rebooked”.
