Weight-loss drugs can complicate anesthesia in patients with obesity

The Newest Weight Loss Miracle Drug — Coming Soon to an O.R. Near You
Sunday, 11 a.m.-12 p.m.
Upper Level 8

Providing anesthesia or treating pain in patients who are overweight or obese can be difficult, and it can be complicated if the patient is using weight-loss drugs, especially drugs that may contain opioid antagonists. These issues will be discussed today in “The Newest Weight Loss Miracle Drug — Coming Soon to an O.R. Near You.”

“I have found that anesthesiologists at-large often are uncertain how to dose anesthetic medications in this population, mainly because of the lack of literature,” said Stephanie B. Jones, M.D., moderator of the session, which will be presented from 11 a.m. to noon today in Upper Level 8. “Also, three weight-loss drugs have been approved by the FDA in the last year. One contains naltrexone, which is an opioid antagonist and affects our practice.”

During the session, Dr. Jones, Associate Professor at Harvard Medical School and Vice Chair for Education at Beth Israel Deaconess Medical Center, Boston, will present “Pharmacologic Implications of Obesity.” Jessica A. Darnobid, M.D., will present “Weight Loss Drugs — Potential Interactions.”

“In my presentation, I will talk about the basics of pharmacokinetics and pharmacodynamics,” Dr. Jones said. “This will include some of the anesthetic drugs we use and how the dosing should or should not be altered to appropriately and safely care for the obese patient.”

Dr. Darnobid, an anesthesiologist at HealthAlliance Hospital, Leominster, Massachusetts, will review the three medications newly approved for weight loss — lorcaserin, phentermine/topiramate, and a combination of naltrexone and bupropion (Contrave).

“We will discuss Contrave in the context of a patient coming in for a non-elective procedure, so you can’t just hold the drug for a few days,” Dr. Jones said. “How do you administer an anesthetic when she recently had a dose of an opioid antagonist? We will discuss the alternatives in multimodal analgesia within that context.

“None of these drugs are brand new; it is the indication that is new. People need to be looking for them on a patient’s medication list and understanding what the ramifications are. This is to make anesthesiologists aware of the alternate indications of these drugs so we can take them into account when planning for anesthetic and postoperative pain management.”

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