New Guidelines Suggest Disclosure Of Heavy Marijuana Use Prior To Surgery!

Anesthesiologists should inquire about patients’ cannabis and marijuana usage before surgery, according to new recommendations made by a national industry group. This month, the American Society of Regional Anesthesia and Pain Medicine published the updated recommendations. The organization’s president is Dr. Samer Narouze, director of the Center for Pain Medicine at Western Reserve Hospital in Cuyahoga Falls.

According to the guidelines, anesthesiologists should inquire about their patients’ cannabis use, including how much, how frequently, and how recently they used it. They should also find out if they smoked or consumed their Cannabis.

The recommendations include delaying elective surgery if a patient shows up impaired and warning expectant mothers about the dangers of marijuana use to their unborn child. In this month’s Healthy Actions column, which features a local medical expert every month to discuss a relevant medical topic, Narouze joins us.

What Are the New Guidelines for Marijuana Use and Surgery?

We assembled a group of experts from various anesthesiology practice backgrounds and patient advocates, and they came to a consensus on this study. We decided it was time to provide anesthesiologists and surgeons with guidelines on how to treat patients who are using cannabis, whether it is marijuana in its recreational or medical form when they arrive for a surgical procedure.

Why Are Guidelines Needed for Cannabis Use Before an Operation?

More patients are consuming cannabis, particularly for recreational purposes, and most states have some sort of cannabis legalization in place. As a result, there is an increase in the number of cannabis-using patients who show up for surgery. We’ve also observed that, compared to a decade ago, the THC potency in the cannabis that is currently on the market is significantly higher.

However, we are yet unsure of all the possible interactions between THC and anesthetics and other drugs. The possibility of significant interactions was thus heightened by this. A lot of observations on interactions that occurred during anesthesia came from practicing doctors.

They don’t know which patients are using cannabis, but some of them behave differently in the recovery area. More vomiting, violence, or discomfort could result from that. We formed a task force to develop policies as a manual on how to handle these circumstances as a result of all those elements.

How Soon Will Anesthesiologists Use These Recommendations?

I believe that some institutions already have local regulations in place. These are the first cannabis treatment instructions issued in the United States before surgery. When it was first launched, I had hoped it would be put into use right away. I’d anticipate widespread adoption. (After reviewing the recommendations, the American Society of Anesthesiologists agreed with them.)

How Were You Involved in The Formulation of These Rules?

It took approximately two years to create these specific rules. Animal sciences and basic sciences make up the majority of the literature that is now available. Unfortunately, the clinical evidence is still primarily observational in nature. I would anticipate more research as there are more palatable uses for cannabis.

The recommendations may be updated as we gather more information. As states, including Ohio, started looking into legalizing medicinal cannabis, my own interest in the topic began to grow about five or six years ago. On cannabis and pain, I published a book.

The majority of doctors in practice in this nation are not very knowledgeable about cannabis, and the legalization of cannabis is actually progressing faster than the science that we are aware of. The pharmacology of cannabis has just lately been included in the curricula of several medical institutions.

What Are Some Problems That Can Happen with Heavy Cannabis Use and Surgery?

Not every patient who consumes cannabis will experience negative effects, I assert. Some patients who kept their surgeons in the dark didn’t experience any issues. But we were able to isolate three patient groups who might not benefit the most from anesthetic during surgery. The first group includes patients who arrive for surgery while severely drunk.

If you recently smoked a lot of cannabis, especially considering how potent the TCH is and the possibility that you switched shops, you might not know what the cannabis actually contains. In this case, you might arrive at the hospital while experiencing some paranoia or delusions, or you might not be able to give good, informed consent.

In these situations, we advise delaying surgery until a new assessment of the patient is possible. The second category consists of heavy cannabis users who have cannabis use disorder. Chronic cannabis use can lead to cannabis tolerance in these individuals, and we know from the literature that cannabis tolerance can lead to increased pain after simple procedures even in the recovery area. We would advocate using a multi-modal strategy to test out various drugs, nerve blocks, or regional anesthetics.

The third group includes heavy smokers. According to research, a substantial occurrence of an elevated heart rate occurs within the first two hours after smoking a joint. Heart attack risk factors include arrhythmias and excessive blood pressure. During the anxiety of the operation, there is a risk for you. We advise delaying surgery for at least two hours.

Do the New Guidelines Recommend Drug Testing to Screen Patients Before Surgery?

This is an excellent question. We advise questioning for screening, but we advise asking direct questions. The majority of patients in states that permit recreational cannabis use won’t consider that an illicit substance, and in states where it is not legalized, the patient doesn’t want to disclose and get in trouble. Most surveys will ask if someone is using an illicit (or illegal) drug, but most patients in those states won’t consider that an illicit substance.

We advise asking direct, non-disclosive inquiries. We didn’t discover enough data to suggest routine urine testing of the patient just yet. Many estimates of marijuana use levels may not be correct, and its effects might last for weeks following consumption.

You Don’t Want a Patient High from Either Medical or Recreational Marijuana Before Surgery, Correct?

Yes. It is typically a small or controlled dose that is carefully supervised while using medicinal marijuana. Instead of being smoked or vaped, most are consumed as edibles. We do advise patients to speak with their treating physician to determine if they may stop using them or if there are any alternatives to be utilized before surgery. Finally, Dyer receives his 2020 unemployment tax refund. If you’re still waiting, amend the return.

When Ought Marijuana Use Be Checked on Patients Before Surgery?

An anesthesiologist or doctor can talk about these concerns then as most institutions have a patient evaluated a few days before surgery.

Are these guidelines for days leading up to the surgery or can there be any levels of marijuana in a patient at the time of surgery?

Because the clinical evidence has only recently begun to accrue in the literature over the past few years, we did not develop guidelines for weaning or quitting. We might revise the instructions. However, for the time being, you shouldn’t do an elective operation if the patient is severely intoxicated.

What Are Other Potential Complications from Surgery with Heavy Cannabis Use?

Cannabis users and some anesthetic drugs may have a cross-tolerance, making them less effective or requiring more. Blood thinners and THC can interact in a few different ways. Although bleeding is uncommon, a patient may be at a higher risk. Additionally, there might be instances of too low blood pressure in the healing area.

Can You Explain What Hyperemesis Is?

Yes. It is constant vomiting brought on by heavy cannabis consumption. THC reduces nausea and vomiting in modest doses, but with large quantities, especially immediately, you have increased vomiting. Emergency room doctors frequently encounter this in states where recreational marijuana use is permitted.

This is a wonderful occasion to talk about the differences between ingesting marijuana and smoking it. As opposed to smoking, which typically has an immediate effect, eating produces hyperemesis more frequently. Edibles take a few hours to start working, but they are frequently favored over smoking, especially by doctors who prescribe them.

Young patients typically take a modest amount and experience nothing, as is typical. So they carry on eating without experiencing a rush. They believe it is safe to eat more, but within hours, everything will start to take effect, sending them to the ER with a negative conclusion. Reasonable data suggests that medical marijuana will remain popular. It is our responsibility to inform both patients and clinicians on how it should be used safely.

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