Ozempic Before Surgery: Guidelines & Preparation Checklist

Understand current guidelines for stopping Ozempic before surgery, why it matters, and how to communicate with your surgical team to ensure safe perioperative management.

Current Guidelines for Ozempic & Surgery (ASA 2023)

The American Society of Anesthesiologists (ASA) published updated perioperative guidance in 2023 specifically addressing GLP-1 receptor agonists like Ozempic (semaglutide), Mounjaro (tirzepatide), and similar medications. The primary recommendation: discontinue GLP-1 medications 24 hours before elective surgery.

This 24-hour window balances two competing concerns: (1) maintaining adequate gastric emptying to reduce aspiration risk during anesthesia, and (2) not discontinuing the medication so early that you're without coverage for longer than necessary. For weekly injectables like Ozempic, this typically means skipping or rescheduling your weekly injection if it falls within 24 hours of your scheduled surgery.

The ASA also recommends heightened anesthetic precautions for GLP-1 users: your anesthesiologist may use rapid-sequence intubation (a faster technique to secure your airway), maintain head-of-bed elevation, or use other strategies to minimize aspiration risk. Make sure your surgical team knows you take a GLP-1 medication.

Understanding Aspiration Risk

Aspiration is the primary surgical concern related to GLP-1 medications. Here's how it happens:

During anesthesia, you lose consciousness and your protective airway reflexes are temporarily suppressed. Normally, your throat and vocal cords prevent anything in your mouth or stomach from entering your lungs. Under anesthesia, this protection is absent.

Ozempic slows gastric emptying—food and fluids move slowly from your stomach into your small intestine. If you undergo anesthesia with food or liquid still in your stomach, there's a risk that stomach contents could flow backward into your esophagus and potentially down into your lungs when you're unable to protect your airway. This is aspiration, and it can cause serious complications: chemical pneumonia (from stomach acid), bacterial pneumonia (from food material), airway obstruction, or severe hypoxemia (low blood oxygen).

Stopping Ozempic 24 hours beforehand allows your stomach to partially empty to normal levels, reducing the volume of material at risk for aspiration. It doesn't eliminate the risk entirely, but it significantly reduces it to acceptable levels for elective surgery.

Stopping Ozempic: Timing by Surgery Type

Pre-Op Checklist for GLP-1 Users

What to Tell Your Surgical Team About Ozempic

Communication is critical. Here's exactly what to say and when:

At Pre-Op Appointment (1-2 Weeks Before Surgery)

Tell your anesthesiologist: "I take Ozempic (semaglutide) weekly for weight management. According to the ASA guidelines, I should stop this 24 hours before surgery. I plan to skip my injection if it's scheduled within 24 hours before my surgery. I wanted to make sure you're aware of this medication and any precautions you need to take."

Show them your Ozempic pen so it's real to them. They may ask follow-up questions: When did you last dose? How long have you been on it? Are you diabetic? These answers help them adjust anesthetic monitoring or techniques.

Day Before Surgery

Call your surgeon's office (if they didn't call you) and confirm: (1) fasting instructions (when to stop eating/drinking), (2) whether they have any special instructions about your Ozempic, (3) what time to arrive for surgery.

Day of Surgery (Pre-Op Area)

When the pre-op nurse asks about your medications, say: "I take Ozempic weekly. My last dose was [date]. I have not taken it for 24 hours as recommended before surgery." Hand them your medication list showing Ozempic.

When the anesthesiologist comes in, remind them: "I mentioned at pre-op that I take Ozempic. I last dosed on [date] and have stopped it 24 hours before surgery as recommended."

This repetition ensures all team members see the information and can account for it in their planning.

Pre-Op Checklist: 24 Hours Before Surgery

Use this day-before checklist to prepare:

• Confirm fasting time: Confirm exact time to stop eating (usually midnight) and stop drinking (usually 2 hours before surgery). Write it down.
• Plan transportation: Arrange someone to drive you home after surgery (you cannot drive after anesthesia). Confirm they can stay or return for pickup.
• Prepare your hospital bag: Bring insurance card, ID, any pre-op paperwork, current medications in original bottles, and phone chargers.
• Skip Ozempic if needed: If your weekly Ozempic injection is scheduled within 24 hours of surgery, skip it. Reschedule it for after surgery recovery. Write down the new planned injection date.
• Wear appropriate clothes: Wear loose, comfortable clothing that's easy to remove/replace (for hospital gown). Avoid complicated zippers/buttons.
• Shower if approved: Many surgeons recommend showering the night before surgery with a special antimicrobial soap. Confirm if yours does.
• Sleep well: Get adequate sleep the night before—rest is important for recovery.
• Bring medication list: Write a list of all your current medications (including Ozempic) with doses, to hand to pre-op staff.

Emergency Surgery: What If You Can't Stop in Time?

If you require emergency surgery before you can wait 24 hours after stopping Ozempic, don't panic. Your surgical team is prepared to manage this:

Anesthetic modifications: Your anesthesiologist will likely use rapid-sequence intubation (a faster technique to secure your airway), maintain your head elevated during induction, use cricoid pressure (gentle pressure on the trachea to prevent stomach contents from reaching the lungs), and may use additional monitoring or precautions.

Communicate clearly: Tell emergency room staff immediately: "I take Ozempic weekly. I have not stopped the medication, so gastric emptying may be delayed." Write this down and give it to multiple people.

Timing: If you took your Ozempic injection recently (last 24-48 hours), be very clear about when you took it. This helps your surgical team assess current gastric emptying status.

Risk vs. benefit: Your surgical team will weigh the aspiration risk against the urgency of your surgery. For true emergencies, the surgery benefits outweigh aspiration risk, and they'll proceed with enhanced precautions. Your communication helps them make informed decisions.

Restarting Ozempic After Surgery

The timing for restarting Ozempic depends on your surgery type and recovery:

Minor/Outpatient Surgery

You go home same day after minor procedures (endoscopy, minor skin surgery, dental surgery, etc.). You can typically resume Ozempic:

• If surgery was morning and you're eating solid food by evening, restart your next regular weekly injection as scheduled
• If surgery was afternoon/evening or you're having nausea, wait 3-7 days to restart your injection
• Ask your surgeon at discharge: "When can I resume my Ozempic injection?"

Moderate Surgery (1-3 Day Hospital Stay)

You'll spend 1-3 days in the hospital after moderately invasive procedures (gallbladder removal, appendectomy, hernia repair, etc.). Typically restart Ozempic:

• When you're discharged and eating regular diet without significant nausea
• Usually 5-10 days after surgery if you were hospitalized for multiple days
• Your surgeon will give discharge instructions; ask specifically about Ozempic restart timing

Major Surgery (Hospitalization >3 Days)

After major procedures (bowel resection, cardiac surgery, complex abdominal surgery, etc.), restart timing is more conservative:

• Wait 2-4 weeks post-op before restarting Ozempic
• You should be back on a regular diet, fully ambulatory, and past the acute recovery phase
• Call your prescriber 1-2 weeks post-op to get formal approval to restart and confirm timing

Post-Op Restart Timeline

Fasting Before Surgery on Ozempic

Standard pre-op fasting guidelines apply regardless of Ozempic. These are established to ensure your stomach is as empty as possible at the time of anesthesia:

• Solid food: Nothing to eat 6-8 hours before surgery (typically after midnight for morning surgery)
• Clear liquids: Typically allowed up to 2-3 hours before surgery (check with your surgeon—some allow up to 3 hours, others only 2)
• Non-clear liquids/milk: Avoid milk, creamy drinks, or thick liquids. Stick to water, apple juice, broth
• Medications: Take your regular home medications (except for special instruction) with small sips of water the morning of surgery, even while fasting

Your surgeon will provide specific fasting instructions at your pre-op appointment. Follow those exactly. Stopping Ozempic 24 hours beforehand reduces (but doesn't eliminate) aspiration risk; fasting is still critical.

Related Resources

Learn about other Ozempic side effects and management. Explore Ozempic dosing schedules. Understand GLP-1 contraindications and safety considerations.