The problem with anesthesia & weight loss drugs like Ozempic 

I regularly watch your videos from India. I don't have any medical degree or relationship with the medical field, but your videos have ignited my enthusiasm and curiosity. Basically, I am a civil engineer.

thank you - I'm on Ozempic and had surgery in January. I don't recall being advised to not take the Ozempic prior to surgery, which was performed one day before my weekly shot. I had no problems with aspiration at any rate, but this is good to know because I'll discuss it next time with my doctor to get clear instructions.

I just had my pre-surgery visit to Cleveland Clinic and met your med school friend Michael Walters. He was so nice and helpful during a difficult day (too long of a story!). Thanks to you for explaining all of the different aspects of cardiac anesthesia and thanks to him for being there for me yesterday.

Max. Come to Wisconsin. Awesome Health Systems here. You could lead anesthesiology or any department you chose to. At any hospital or hospital system here. We would be honored by you coming here

What about people with gastroparesis? Are they advised a longer period of no food or water?

In January 2023, I had general anesthesia for back surgery. I was taking Ozempic and no one told me to stop it although they knew I was taking it. They informed me that there was food in my stomach at the time of anesthesia. I did have a bit of aspiration but it wasn’t consequential, luckily.

I was on Mounjaro and had surgery in March. MAC. No one ever told me to not take my Mounjaro and neither my surgeon nor anesthesiologist was concerned about the drug. Luckily nothing happened. Now I am on Ozempic and will definitley remind my doctors if I ever have surgery again.

Thanks a lot for the entire channel basically. Started binging videos out of medical curiosity, ended up knowing a lot of reassuring stuff before my first anesthesia (not surgery tho, invasive endoscopy basically but still), ofc I realize that's not a lot, but I'm not even anxious

Thank you---really great information. You help us realize how complicated, on so many different levels, it is to safely and effectively provide anesthesia for various surgeries.

I’ve had very severe Gastroparesis (chronic delayed gastric emptying) for 15 years, since I was 13, and I CANNOT stress how important everything you mentioned in this video is enough! Even though I solely rely on tube feeds and TPN, my anesthesia plan often changes/is dependent on how nauseated I am on the day of the surgery or procedure, and if we believe I have an excessive amount of bile or acid in my stomach that we can’t drain out of my G tube completely, we opt for general over MAC, but MAC is always the default so we have the option to switch over if there are any issues. Thank you as always for getting the critical information out there!

Wow that was awesome and amazing ! I learned so much!!! I really enjoy donating to the anesthesiologist Foundation, since it was hard for me to go to college because of my cerebral palsy, I really wanted to be a anesthesiologist physician! I always learn a lot from you! You rock man

Thank you for getting this out there..im on ozempic and fortunately read about this before an mri which i was told to fast for. I had to call them and explain this whole thing..they hadnt heard about it!

Interesting. Seems like this would also make things like colonoscopies tougher. Having had a couple, it's already not fun. They demanded I not eat a thing for like... 32+ hours before the procedure? (going from memory, it was "stop eating by midnight, don't eat next day while doing the "cleanse" and then get the procedure somewhere between 8am and 2pm.) It would really suck if you had to extend that another day because your stomach empties slowly.

Thank you! 6:37

"this video is likely already outdated by the time you're watching it" me, watching 4 hours after posting: hmmmmm interesting *heads to google scholar*

Thanks. It was very informative. And information was extremely important

Very informative. Thank you very much

Great video Doctor Feinstein. Thank you.

As always, great information.

Wow, interesting! Congrats! SIX years post-op here! I've been through the weight loss, the regain and the re-loss. It is a journey! Charting my stats helped me, majorly! I even created a FREE planner/tracker to share with anyone that would like to try it

Translation to reality means that individuals receiving GLP-1 medications and undergoing procedures previously handled with conscious sedation alone, e.g., colonoscopy, will need to receive a general with an endotracheal tube.

Yup, one of my abdominoplasty patients who was on wegovy puked during the case- anesthesiologist was not pleased

@MaxFeinstein can you talk about managing airways during anesthesia for patients with severe motility disorders. I have severe gastroparesis and chronic intestinal pseudo obstruction and am TPN dependent. What does managing anesthesia and airways look like for patients like myself?

Super interesting topic!

Interesting! Thanks.

I am a physician assistant anesthetist working at Atlanta. I had to intubate a patient who had BMI close to 50 for her eye muscle surgery at an outpatient surgical center. The rationale is the patient is on Ozempic. Normally, we only use LMA for this type of surgery.

Thanks

Would Reglan help in cases like these? ex: patient needing emergency surgery but was on a GLP1 med?

I have severe gastroparesis from a mitochondrial disorder. This has always been my normal precautions.

I had surgery yesterday morning, and I take Ozempic. I did not skip my dose, since it was due yesterday evening (I take it weekly). Because I take Ozempic, I had to have general (endotracheal) anesthesia, but I was also told they put in an orograstric tube to make sure I had nothing in my stomach.

this is VERY scary! I am on ozempic .2 for my type 2 diabeties, the weight loss was a bonus, I've lost 50 pounds so far, but that is not why I was put on it, my A1C was high and this got it from 8.9 down to 6.7, I am currently fighting cervical/uterine cancer, however on the 29th I go in for a ct scan to see if tumor shrunk, if it has, I see oncology Dr on the 31st for the results, if it has, surgery to remove it...hearing this scares the crap out of me, I'm already fighting for my life, but to find out that the surgery to save my life could end it, IDK what to do now

Are there similar guidelines for people who have delayed gastric emptying for other reasons (eg idiopathic gastroparesis)? I had a colonoscopy a few years ago, and the prep was retained in my stomach due to my gastroparesis. They went ahead with the procedure.

Doctor Max: Is IV raglan still used in cases of delayed gastric mobility?

how about a video about the anaesthesia machine ie circuit. what happens at minFlow etc

Very interesting. I take mounjaro amd was told to stop taking ot 2 weeks before my recent surgery. I was told it was because my blood glucose could drop. Whatever the reason, all went very well with my procedure.

I am, unfortunately, all too familiar with this. I have Gastroparesis, Esophageal Immobility Disorder AND I take Rybelsus for my Type 2 Diabetes. My stomach just never really empties.

What about residual stomach acid and other normal gastric secretions still present in absence of food in a pre-op patient?

Very fascinating info Max!! A question: Would it be an option to "force" the stomach empty before surgery either through inducing vomiting in the patient some time before the procedure or when that is not possible "suck" the stomach empty mechanically just after anesthesia is induced? I mean there must be plenty cases of anesthesia and surgery on a "full stomach" when you have no option to wait - such as traffic accidents etc. Also I think you have shown us the "breathing tube" that is inserted into the patient just after the patient falls asleep that has a small balloon that inflates and effectively seals off the area so no foreign elements can enter the lungs? Why not "always" use that in such cases? OK that was more than one question!

I had a small procedure done on my back. And the Anesthesiologist almost rescheduled my procedure when she found out I was on mounjaro! Luckily I was fasted about 48 hours at that point

What is done for emergency patients? Do you have to pump their stomach before surgery?

I have idiopathic gastroparesis (aka delayed gastric emptying for an unknown reason) and have a feeding tube cause i cant eat enough to keep myself alive. before i got my tube i wasnt allowed to eat for a minimum of 24 hours before anesthesia but now that i have my tube i only have to fast for the normal amount of time. this is because my tube goes into my stomach through a hole that was surgically made from the outside of my belly to the inside of my stomach then the tube goes down into my jejunum (a part of the small intestines). In my tube there is a port that i use to put things into my intestines like my meds and formula and a port that i can use to put things in and take things out of my stomach (but i almost never put things in cause it hurts) and that port allows my to "drain" or suck the contents of my stomach out whenever i need to. because im able to drain my stomach im able to eat for pleasure/funsies and empty my stomach when the pain and nausea starts and on days that i have surgery i am able to drain my stomach once at home and again at the hospital to make sure i have nothing in my stomach before surgery. and thats the very long story on why i can fast the normal amount of time even though my stomach is super slow

Delayed gastric emptying... Something called Gastroperisis, which I fell ill with in 2018 and have been tube fed with an NJ feeding tubr since 2020. My gastric emptying study showed delayed emptying and diagnosed me with Gastroperisis. Mine is idiopathic, but you cab get it from diabetes, abdominal surgery due to the vegas nerve being injured.

I have to go for adrenal vein sampling in a month. Was told 2 weeks off of Trulicity and clear liquids the day before. Gas brohs aren't playing anymore with these meds.

Wow, delaying stomach emptying for TWO DAYS!? That's crazy! You could turn a glass of milk into a block of cheese in that time! I wonder if this has caused any issues with oral medications not being absorbed as expected. Most stuff will probably absorb OK but what about stomach irritation from aspirin/ NSAIDs. A gastro-resistant coating isn't going to help if the tablets are sitting in your stomach literally all day... And how about meds that don't absorb or function correctly if they're not at a high enough pH?

I understand the issue you are discussing, so how do you manage emergency surgeries where the patient has not fasted at all?

You've not mentioned manually pumping the stomach to empty it of food or liquid. I don't know anything about it, other than non-medical comments in relation to overdosing or ingestion of toxins. Can you comment on that and explain why it's not an option? Thanks!

Max, doesn't the endotracheal tube protect from aspiration pneumonia ?

I used mounjaro, and last year I had some seizures that were really bad so I was emergently intubated. When they attempted extubation several days later, I vomited intensely. I tried to tell them the mounjaro made my stomach empty slow, but it was so new nobody really knew.

Curious whether it’s ever appropriate to pump a stomach of its contents just prior to surgery to make a safer condition for anesthetic?

Is pumping out the contents of the stomach a reasonable option?

hey dr. feinstein how can we can a jacket like yours lol

Koko wings - first-ballot hall of fame call meal

After off getting weight loss surgery. Most people don’t keep the weight off after these drugs

Noti gang 💯💯 Best way to start the day

My hospital just instituted policy on these drugs.

Me, who just started Ozempic for my diabetes three days ago: 👁️👄👁️

Interesting, no mention of NPO status pushing a patient into DKA with a normal blood sugar.

So…I will say I have seen a lot of comments for this video which basically state “wow, I had surgery with this medication and was not told about the adverse side affects.” These are still very new medications on the market that are gaining a lot of traction for weight loss, so there is still a lot we do not know about them. Don’t discredit you doctors!!! The only small problem I have with this video is the statement “type 1 diabetics do not produce enough insulin.” In the grand scheme of the disease yes, we don’t produce enough insulin 😅. But the absolute truth is we will eventually not produce any insulin as a result of an autoimmune disease killing off our beta cells in our pancreas. While for type 2 patients, the increase in insulin production from these medications is beneficial, the benefit for me is the delayed gastric emptying, slower digestion, and slower absorption of carbs. Also, having fewer/smaller meals that I have to give myself insulin for is a huge cost saver, since insulin is so expensive (even after my deductible, insulin can be $100 a month where Ozempic is only $25 a month). However, overall that does not take away from the overall theme of the video which is to say we either need to increase NPO time for these patients or decreasing medication before surgery. Also Max if you see this can you one day talk about how anesthesiologist take care of emergency surgeries when a patient was not able to be NPO? Do you pump the stomach always or do as this video suggest and take an ultrasound of the stomach prior to surgery?

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I do enjoy a good canceled case. Thanks Ozempic

If a patient comes in through the ER there isn't an option to not eat, so there must be a way to have anesthesia on a full stomach. No one should be taking drugs to lose weight.

Delayed gastric emptying with Ozempic (etc) is not a problem with opioid free anesthesia but Max’s training is devoid of this approach for better, safer outcomes 🥲