HealthRX.com · Printable surgery planning sheet
Wegovy pre-op note and injection calendar
Fill this in with the surgical and anesthesia teams once a procedure date is set: the note they need (dose, last injection, hold decision), your injection dates around the procedure, and the questions and warning signs to bring on the day.
Note for the anesthesia team
Medicine and formWegovy (semaglutide): single-dose pen, FlexTouch, syringe or tablets
Current dose (mg) and usual injection day
Date of the last injection before the procedure
Date of the most recent dose increase
Hold decisioncontinue, hold (which injection), or not yet decided
Who made the decision, and when
Injection dates around the procedure
| Scheduled date | Taken or held | Dose (mg) | Nausea, vomiting, bloating or pain? | Notes |
|---|---|---|---|---|
What the label and the studies say
- Wegovy label: Wegovy slows stomach emptying and may raise the chance of food getting into the lungs during surgery; tell every provider about it before a planned procedure.[1]
- Wegovy label: the data cannot show whether changing fasting rules or pausing Wegovy reduces retained stomach contents.[1]
- ASA 2023: for weekly GLP-1 medicines, consider holding the dose a week before the procedure.[2]
- Endoscopy study: retained contents in 24.2% of semaglutide users against 5.1% of non-users, all fasted.[3]
- Ultrasound study: 56% against 19%, and the length of the pause made no measurable difference.[4]
On the day
- Tell the anesthesia team the date of your last Wegovy dose
- Mention any nausea, vomiting, bloating or stomach pain in the past few days
- Say whether you followed the fasting instructions you were given
- Bring this sheet and your full medicine list
Questions before the procedure
- Will you hold or continue my Wegovy, and which injection would I skip?
- If two or more weekly doses end up missed, at what dose do I restart?
- Will you check my stomach with ultrasound on the day if there is doubt?
- Who tells me when to restart after the procedure?
Call your surgical team before the procedure if
- You have severe stomach pain that will not go away, with or without vomiting.[1]
- You keep vomiting: fluid loss can lead to dehydration and kidney problems.[1]
Sources for the facts on this sheet
- Novo Nordisk, via DailyMed. Wegovy (semaglutide) injection, for subcutaneous use, and Wegovy (semaglutide) tablets, for oral use: prescribing information and Medication Guide. Effective 2026-06-18. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b
- American Society of Anesthesiologists. American Society of Anesthesiologists Consensus-Based Guidance on Preoperative Management of Patients (Adults and Children) on Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists. Accessed 2026-10-18. https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative
- Silveira SQ, da Silva LM, de Campos Vieira Abib A, et al. Relationship between perioperative semaglutide use and residual gastric content: A retrospective analysis of patients undergoing elective upper endoscopy. J Clin Anesth 2023. PMID 36870274. https://pubmed.ncbi.nlm.nih.gov/36870274/
- Sen S, Potnuru PP, Hernandez N, et al. Glucagon-Like Peptide-1 Receptor Agonist Use and Residual Gastric Content Before Anesthesia. JAMA Surg 2024. PMID 38446466. https://pubmed.ncbi.nlm.nih.gov/38446466/
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.