The Risk of Aspiration Is Low With Continuing Semaglutide During Elective Eye Surgery When Patients Receive Only Moderate Sedation

Purpose The purpose of this study was to assess aspiration risk in patients undergoing elective eye surgery with moderate sedation as the anesthetic while taking the glucagon-like peptide type 1 receptor agonist (GLP-1RA) Ozempic formulation of semaglutide.  Setting and design This retrospective observational study took place in Fleming Island Surgery Center and East West Surgery Center, Fleming Island, Florida.  Methods Records of patients actively taking the Ozempic formulation of semaglutide and presenting for elective eye surgery from July 1, 2022, through December 31, 2023, were reviewed to determine the incidence of aspiration. The patient risk assessment included body mass index in kg/m2 (BMI), and medical history regarding diabetes mellitus (DM), gastroesophageal reflux disease (GERD), hiatal hernia (HH), and narcotic use. Analysis assessments included the time and dose of the last semaglutide administration (0-7 days, 8-14 days, or >14 days), type and duration of surgery, type of anesthesia or sedation, pre- and post-operative oxygen saturation (SpO2), respiratory problems, and post-operative nausea or vomiting (PONV).  Results A total of 155 surgical records of patients actively taking semaglutide were identified and reviewed. The BMI range was 21-52; 143 cases had DM (all DM cases were type 2), 58 cases had GERD, and 12 cases had concurrent narcotic use. One hundred fifty-one patients received moderate sedation, two received intravenous propofol with local block, and two underwent general anesthesia. One hundred twenty of the 155 cases had taken semaglutide within one week of the surgery. There were no significant intra- or postoperative respiratory issues, PONV, or significant changes in the postoperative SpO2 in any of the patients.  Conclusion There were no cases of aspiration or respiratory compromise in any patients who continued semaglutide at the time of their surgical procedure. In this study, continuing semaglutide while undergoing elective eye surgery with only moderate sedation for anesthesia did not pose an aspiration risk, minimized disruption to patient medical routines, and reduced the negative impact of procedure cancellation.