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Protocol Modifications for Conscious Sedation and Weight Loss (Ozempic) Medications
Description
As a weight loss aid, Ozempic mimics a natural hormone that tells the brain you're full. By increasing the time it takes for food to leave the body, it also slows digestion. Although it has a minor effect on gastric emptying time, the most common side effects are nausea and vomiting.
Currently, there is not enough evidence-based data to define definitive protocols regarding its impact on anesthesia. However, it is reasonable to conclude that the increased risks of nausea and vomiting during anesthesia increase the likelihood of aspiration. As sedation deepens, the patient's protective reflexes that prevent aspiration become less intact, increasing the risk of aspiration.
For patients taking weight loss drugs, it is crucial to exercise caution during sedation as their protective reflexes may be compromised. Therefore, sedation dentists must carefully monitor these patients and take appropriate measures to ensure their safety.
Understandably, an anesthesiologist providing general anesthesia will have a different protocol than a dentist providing conscious sedation. Despite the possibility of withholding all food for 48 hours before the appointment, patients may experience difficulty adhering to the restriction and may experience hypoglycemia during conscious sedation.
“Until more evidence-based research on the impact of Ozempic and anesthesia (specifically conscious sedation) is available, I'd recommend a medical consult with the patient's primary care provider (PCP). Unless their PCP strongly recommends otherwise, have the patient withhold their Ozempic at least two weeks before sedation and be NPO for six hours before the appointment.”
As an additional precautionary measure, record a baseline blood glucose at the sedation workup and take blood glucose readings on the day of sedation at presentation, every hour after that, and upon dismissal. Sedation should be kept on the light side, and Ondansetron 4mg should be administered prophylactically immediately after venipuncture is obtained and before removal of the IV. Furthermore, I’d like to emphasize that it’s crucial to monitor the patient closely during sedation and respond immediately to any signs of nausea or vomiting.
The above recommendations are for IV sedation. Since it has always been the recommendation from DOCS that patients take their diabetic medication and have a light breakfast on the day of the appointment, and given Ozempic’s tendency to cause nausea and vomiting, advise the patient to take oral Ondansetron or Compazine po before the appointment.
Additional Information
Author Bio
Anthony Feck, DMD
An engaging international lecturer, established clinician, author and educator, Dr. Anthony Feck has a well-known teaching and lecturing style blending humor with contagious passion. A former associate professor of periodontics and restorative dentistry at the University of Kentucky College of Dentistry, he has been in private practice in Lexington, KY, since completing his education. He co-founded DOCS Education with Dr. Michael Silverman in 1999 and currently serves as the Dean of Faculty.
Dr. Feck also has an extensive background in dental implantology. He has taught over 60 courses on this subject at his teaching center. He has also been involved in the development of new dental implant designs, which has culminated in a newly designed implant being named after him, a prestigious honor recognizing his contributions to both the education and advancement of dental implantology. He has authored 10 dentistry manuals and published 27 articles on dental topics.
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Commercial Disclosure
This free Dental Learning presentation is made possible through the continued support of DOCS Education. Anthony Feck, DMD is a consultant and/or speaker for the following companies and/or organizations: Dental Learning, DOCS Education. Anthony Feck, DMD may receive an honorarium as compensation from the CE Supporter of this presentation and/or from Dental Learning for the time involved in preparing and delivering this online presentation.
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