American Society of Plastic Surgeons
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Understanding how medications interact with anesthesia and when to stop before plastic surgery

how medications interact with anesthesia and when to stop before plastic surgery

Most people understand that prescription medications and anesthesia do not mix. However, as new classes of drugs enter the market, there can be some confusion about what medications you can take up until surgery and which ones you need to put on pause.

While most people know to avoid drugs like blood thinners and certain heart medications, you may not know that increasingly popular weight loss drugs can also interfere with anesthesia. Understanding how medications interact with anesthesia can be crucial to your health and safety. There is a reason your doctor and anesthesiologist ask what medications you are taking before surgery.

The rise of a new class of weight loss drugs

A drug that helps people lose weight quickly and efficiently has been one of the "holy grails" of the pharmaceutical industry. Some companies believe they have stumbled onto that magic bullet thanks to semaglutides.

Semaglutide drugs are a class of medication that mimics the hormone GLP-1. This hormone helps the body to produce more insulin to reduce blood sugar. In specific quantities, this hormone can also interact with the brain. It suppresses appetite by signaling to your brain that you feel full.

Doctors have used semaglutide injections for more than a decade to help treat patients with type 2 diabetes. One of the side effects people with diabetes reported was an increase in weight loss. That's when the proverbial light bulb went off. Doctors began prescribing name-brand semaglutide drugs like Ozempic off-label to help individuals manage their weight.

Early studies indicated that the drug helped study participants shed more pounds than those who made lifestyle choices alone. Currently, only the semaglutide drug Wegovy has been FDA-approved for weight loss. However, other semaglutide drugs continue to be used off-label for weight loss purposes.

Weight loss drugs and anesthesia

Why is there a sudden interest in how medications interact with anesthesia? Many plastic surgeons are seeing an increase in the number of patients coming in needing surgical procedures to address loose and sagging skin following rapid weight loss thanks to semaglutide injections.

An interesting tidbit arose in talking with ASPS Member Surgeon Aviva Preminger, MD, about arm lifts. You must be cautious about surgery when on these weight loss medications. But why?

"Anesthesiologists have found that the way these drugs work is that they keep you feeling full for longer because they slow digestion," said Dr. Preminger. "When digestion gets slowed, your stomach stays full for longer and when you go to sleep for surgery, it puts you at increased risk for aspiration. Aspiration is when the contents of your stomach come up and go into your lungs."

Aspiration can cause serious complications including pneumonia, lung damage and even death.

Unfortunately, because these weight loss drugs are so new, many patients don't understand or are unaware of the significant complications that can arise when mixing semaglutides and anesthesia. Additionally, some patients forget to mention that they are taking these drugs to their plastic surgeon because they consider them "maintenance drugs" or something akin to taking a daily multivitamin. That isn't the case.

"Most anesthesiologists require patients to stop weight loss medications for at least two to three weeks prior to general anesthesia," said ASPS Member Surgeon Anna Steve, MD. "Some also require patients taking injectable weight loss medications to have longer fasting guidelines prior to surgery and use special anesthesia techniques like rapid sequence intubation to limit the risk of complications."

Dr. Steve also noted that some surgeons may ask patients to hold off on taking their weight loss medications for a specific period following surgery so they can optimize the nutrition available for optimal wound healing.

Keeping yourself safe before plastic surgery

Do you think continuing to take medication before surgery is no big deal? Think again. When discussing potential complications, Dr. Preminger warned, "It is a very real thing."

Continuing to take specific medications before surgery increases your risk of significant complications and potentially even death. For your safety, it is crucial that you always disclose all the medications you are taking to your doctor and the anesthesiologist. Include prescription drugs, recreational drugs, over-the-counter medications and herbal supplements. Your doctor is not here to judge you. They are here to keep you safe.

If you are preparing to undergo a surgical procedure, always do your homework. Some of the most common medications to avoid before surgery include:

  • Weight loss drugs
  • Blood pressure medications
  • Blood thinning medications
  • Blood clotting medications

Thoroughly read all the paperwork given to you by your doctor, and if there is something you don't understand, ask! Stop taking medications as outlined by your board-certified plastic surgeon who is an ASPS member and be honest with the anesthesiologist on the day of your procedure. Holding off on weight loss medication for a few weeks could be the best decision you ever make.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.


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