Marijuana and Anesthesia: What You Need to Know

Marijuana Use and Anesthesia

Before undergoing anesthesia, it is important to consider the potential impact of marijuana use on the anesthesia process. Two key aspects to consider are the impact on anesthesia dosage and the associated cardiovascular risks.

Impact on Anesthesia Dosage

Regular users of marijuana generally require larger doses of anesthesia medicines to achieve the same degree of sedation compared to non-users. For example, in endoscopic procedures, regular marijuana users (daily to weekly) need over three times as much propofol to achieve adequate sedation compared to non-users.

A study involving esophagogastroduodenoscopy (EGD) procedures found that cannabis users did not require significantly different amounts of propofol, fentanyl, or ketamine compared to non-users. No adverse cardiac or respiratory events were reported within 30 days for either group [2]. However, it is important to note that individual responses to anesthesia may vary, and additional research is needed to fully understand the impact of marijuana use on anesthesia dosage.

Cardiovascular Risks

Marijuana use before surgery can pose cardiovascular risks. Cannabis can raise heart rate and lower blood pressure. When consumed close to anesthesia, especially within an hour or two of surgery, it can lead to serious complications like heart attack or ischemia, particularly in patients with heart disease.

It is crucial for individuals with a history of heart disease or cardiovascular issues to disclose their marijuana use to their healthcare providers before undergoing anesthesia. This information allows the medical team to take appropriate precautions and tailor the anesthesia plan to ensure patient safety.

Understanding the impact of marijuana use on anesthesia dosage and the associated cardiovascular risks is essential for both patients and healthcare providers. Open communication between patients and their medical team is crucial to ensure the best possible anesthesia experience and minimize potential complications.

Preoperative Considerations

Before undergoing surgery, individuals who use marijuana should be aware of the potential adverse effects and considerations associated with cannabis use. These considerations are important to ensure a safe and successful surgical experience.

Adverse Effects of Cannabis Use

The use of cannabis can have various adverse effects on the body, which can impact the perioperative period. Cannabis users may experience gastrointestinal effects such as nausea and vomiting, which could prompt the need for certain procedures like esophagogastroduodenoscopy (EGD) studies. It is crucial to disclose cannabis use to the healthcare team to ensure appropriate management and minimize potential risks.

Recommendations for Surgery

It is recommended that patients refrain from using marijuana on the day of surgery to prevent complications. This includes avoiding smoking, inhaling, or consuming edible marijuana, following the guidelines for preoperative fasting. Marijuana use before surgery can increase the risk of complications such as breathing problems during anesthesia, increased postoperative pain, and higher opioid use during and after surgery.

Anesthesiologists need to be aware of marijuana use before surgery as it can impact the dosage requirements for anesthesia medications. Regular users of marijuana generally need larger doses of anesthesia medicines to achieve the same degree of sedation. For instance, regular marijuana users (daily to weekly) may require over three times as much propofol to achieve adequate sedation for endoscopies compared to non-users. This information is crucial for the anesthesiologist to ensure appropriate medication dosing and patient safety.

Marijuana use, particularly when inhaled, can lead to serious complications of anesthesia, such as increased postoperative pain and higher opioid use during and after surgery. This puts regular marijuana users at risk for opioid use disorder after surgery. It is essential for patients to communicate their marijuana use to their healthcare providers to ensure appropriate pain management strategies and minimize potential complications.

In summary, individuals using marijuana should be aware of the potential adverse effects and considerations for surgery. It is important to disclose marijuana use to the healthcare team to ensure proper preoperative management, appropriate anesthesia dosage, and to minimize potential risks and complications. Following the recommendations and guidelines provided by healthcare professionals can contribute to a safer surgical experience and smoother recovery.

Perioperative Management

When it comes to the perioperative management of patients who use marijuana, there are several important considerations regarding anesthetic implications and potential postoperative complications.

Anesthetic Implications

The use of marijuana can have implications for anesthesia care. Regular users of marijuana generally require larger doses of anesthesia medicines to achieve the same degree of sedation compared to non-users. For example, regular marijuana users (daily to weekly) may need over three times as much more propofol to achieve adequate sedation for endoscopies compared to non-users.

Marijuana use may also interact with other medications and affect heart rate and arterial pressure. It increases sympathetic activity, leading to an elevation in heart rate, cardiac output, and blood pressure. At higher doses, the parasympathetic system takes over, potentially resulting in bradycardia and hypotension [3].

Postoperative Complications

Marijuana use before surgery can increase the risk of several postoperative complications. Inhaled marijuana, in particular, has been associated with serious complications of anesthesia, such as increased postoperative pain and higher opioid use during and after surgery. This puts regular marijuana users at a higher risk for opioid use disorder after surgery [1].

Patients who regularly use cannabis may experience more pain and nausea after surgery compared to non-users. They might require different types or higher doses of medication to manage postoperative discomfort. It's important to note that cannabis is not an FDA-approved option for pain management in the hospital setting.

Additionally, there is a risk of experiencing cannabis withdrawal symptoms, especially for frequent users, after surgery. However, the risk is minimal for individuals using products containing CBD only.

It's crucial for healthcare providers to be aware of a patient's marijuana use before surgery to take appropriate measures to manage anesthesia and mitigate potential complications. Communication and disclosure regarding cannabis use are essential for ensuring patient safety and delivering optimal perioperative care.

Pharmacological Interactions

When it comes to marijuana use and anesthesia, there are important pharmacological interactions to consider. These interactions can have implications for anesthesia care, including the need for higher anesthetic doses.

Effects on Anesthesia Care

Marijuana use can impact the effects of anesthesia, leading to the need for higher doses of certain medications. Regular users of marijuana generally require larger doses of anesthesia medicines to achieve the same degree of sedation compared to non-users. For example, regular marijuana users (daily to weekly) may need over three times as much propofol to achieve adequate sedation for endoscopies compared to non-users.

Furthermore, marijuana use can interact with other medications administered during anesthesia, potentially affecting heart rate and arterial pressure. It's important for anesthesiologists to be aware of a patient's marijuana use to adjust anesthesia dosages accordingly and ensure optimal care during surgery.

Higher Anesthetic Doses needed

The effects of marijuana on the cardiovascular system can also impact anesthesia care. Marijuana use increases sympathetic activity while reducing parasympathetics, leading to elevation in heart rate, cardiac output, and blood pressure. At higher doses, the parasympathetic system takes over, resulting in bradycardia and hypotension.

In addition, marijuana's effects peak approximately one hour after initiation and can last for 2-4 hours. It increases cardiac workload, myocardial infarctions, strokes, and pulmonary complications. It can also cause airway obstruction, requiring higher anesthetic dosages for successful placement of laryngeal airways. It is generally advised to abstain from marijuana use within 72 hours of general anesthesia to minimize potential complications.

The need for higher anesthetic doses in individuals who use marijuana underscores the importance of disclosing marijuana use to the anesthesiologist before surgery. This information allows the medical team to tailor the anesthesia plan to the individual's needs and ensure optimal safety and efficacy during the procedure.

Understanding how marijuana use can affect anesthesia care and the potential need for higher anesthetic doses is crucial for both patients and healthcare professionals involved in surgical procedures. Open communication and disclosure of marijuana use are essential to ensure the best possible outcomes and minimize potential risks and complications.

Patient Information and Disclosure

When it comes to undergoing surgery, it is crucial for patients to provide accurate and complete information about their cannabis use to their healthcare providers. This disclosure allows the healthcare team to make informed decisions and minimize potential risks and complications associated with marijuana and anesthesia.

Communicating Cannabis Use

Patients should openly communicate with their healthcare providers, including anesthesiologists, about their cannabis use. The American Society of Anesthesiologists advises patients to share this information before surgery to ensure appropriate evaluation and instructions can be provided. It is important to note that the information shared is strictly used for surgical planning and recovery and is kept confidential.

By disclosing cannabis use, patients allow the healthcare team to consider the potential impact of marijuana on anesthesia and adjust their approach accordingly. This includes taking into account factors such as the frequency and method of cannabis use, as well as any specific concerns or symptoms experienced.

Potential Risks and Complications

Understanding the potential risks and complications associated with marijuana use before surgery is crucial for both patients and healthcare providers. Smoking marijuana shortly before surgery, for example, could increase the risk of heart attack during or after the procedure. Guidelines from the American Society of Regional Anesthesia and Pain Medicine recommend abstaining from smoking marijuana until at least two hours after the last use.

Patients who regularly use cannabis may experience more pain and nausea after surgery compared to non-users. They might require different types or higher doses of medication to manage postoperative discomfort. It's important to note that cannabis is not an FDA-approved option for pain management in the hospital setting.

Furthermore, there is a risk of experiencing cannabis withdrawal symptoms, especially for frequent users, after surgery. However, minimal risk is associated with developing withdrawal symptoms for individuals using products containing CBD only. It is crucial for patients to be aware of these potential complications and discuss them with their healthcare providers to ensure appropriate care and management.

By communicating cannabis use and potential risks with their healthcare providers, patients can work together with the medical team to enhance surgical planning, minimize complications, and optimize the overall surgical experience. Open and honest communication is essential for ensuring patient safety and well-being throughout the surgical journey.

Surgical Outcomes and Recovery

When considering the surgical outcomes and recovery of individuals who are chronic users of marijuana, healthcare professionals must take several factors into account. These considerations include the potential effects of marijuana use on pain management, medication requirements, and postoperative complications.

Considerations for Chronic Users

Chronic users of marijuana may experience unique challenges during the recovery process. It's important to note that regular users of marijuana generally require larger doses of anesthesia medicines to achieve the same degree of sedation as non-users. For example, regular marijuana users (daily to weekly) may require over three times as much propofol to achieve adequate sedation for endoscopies compared to non-users.

Additionally, the use of inhaled marijuana before surgery can lead to serious complications during anesthesia. These complications may include increased postoperative pain and higher opioid use during and after surgery, which can put regular marijuana users at an increased risk for opioid use disorder after surgery. The sympathetic activity induced by marijuana use can also affect cardiovascular function, leading to changes in heart rate, blood pressure, and cardiac output.

Best Practices for Care

To ensure optimal surgical outcomes and recovery for chronic users of marijuana, healthcare providers should consider the following best practices:

1. Communication: It is crucial for patients to openly disclose their marijuana use to their healthcare team. This information allows the medical professionals to make informed decisions regarding anesthesia, pain management, and postoperative care.
2. Pain Management: Chronic users of marijuana may experience increased pain and nausea after surgery compared to non-users. As a result, they may require different types or higher doses of medication to effectively manage postoperative discomfort. However, it's important to note that cannabis is not an FDA-approved option for pain management in the hospital setting.
3. Individualized Care: Each patient's medical history, marijuana usage pattern, and surgical needs should be carefully evaluated to develop a personalized plan for anesthesia, pain management, and postoperative recovery. This approach ensures that the patient receives the most appropriate and effective care based on their unique circumstances.

By considering the specific needs of chronic marijuana users and implementing best practices for care, healthcare providers can navigate the challenges associated with surgery and promote positive surgical outcomes and recovery. Open communication and personalized care are essential elements in ensuring the safety and well-being of patients who use marijuana regularly.

References

• ‍https://www.health.harvard.edu/blog/coming-clean-your-anesthesiologist-needs-to-know-about-marijuana-use-before-surgery-2020011518642
• ‍https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8764743/
• ‍https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139487/
• ‍https://www.asahq.org/madeforthismoment/preparing-for-surgery/risks/cannabis-surgery-made-moment/