Anesthesiologists Need To Know All About Patients' Cannabis Use Before Surgery

According to guidelines released by the American Society of Regional Anesthesia (ASRA) and Pain Medicine, patients undergoing procedures requiring anesthesia should be asked about cannabis use.

“Before surgery, anesthesiologists should ask patients if they use cannabis — whether medicinally or recreationally — and be prepared to possibly change the anesthesia plan or delay the procedure in certain situations,” said Samer Narouze, M.D., Ph.D., senior author and ASRA Pain Medicine president.

The guidelines recommend anesthesiologists screen all patients for marijuana use, including asking about the type of cannabis product they use as well as how, the amount, how recently and how often.

First U.S.-Based Guidelines On Perioperative Management Of Cannabis

The first-ever U.S. guidelines were developed in response to the increased use of cannabis over the last two decades and concerns that it can potentially interact with anesthesia and lead to complications, reported the Chronic Magazine.

Narouze noted it is necessary to counsel patients about the possible risks and effects of cannabis.

"(...) Even though some people use cannabis therapeutically to help relieve pain, studies have shown regular users may have more pain and nausea after surgery, not less, and may need more medications, including opioids, to manage the discomfort," Narouze said. "We hope the guidelines will serve as a roadmap to help better care for patients who use cannabis and need surgery.”

However, there is insufficient evidence to guide ventilation settings during surgery in patients who have recently smoked cannabis.

The guidelines are based on an extensive review and experiences from the organization’s ‘Perioperative Use of Cannabis and Cannabinoids Guidelines Committee’ composed of 13 experts, including anesthesiologists, chronic pain physicians and patient advocates, per a news release.

Methods

The committee addressed nine questions and made 21 recommendations. “Recommendation grades were based on the United States Preventive Services Task Force (USPSTF) process that assigns a letter (an A, B, C, or D grade or an I for insufficient) based on the strength of the evidence and the balance of benefits and harms.”

The total number of recommendations achieved full consensus.

Recommendations include:

• Screening all patients before surgery,
• Postponing elective surgery in patients who have altered mental status or impaired decision-making capacity at the time of surgery,
• Counseling frequent, heavy users on the potentially negative effects of cannabis use on postoperative pain control and
• Counseling pregnant patients on the risks of cannabis use to the unborn child, per the guidelines.

Image by ASRA

The American Society of Anesthesiologists reviewed the guidelines and is in agreement with their recommendations and affirms their value for anesthesiologists and surgeons.

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Photo: Courtesy Of Luis Melendez On Unsplash