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Jan. 3 (UPI) -- Worried about Americans' increasing use of marijuana, which may interact with anesthetics and other drugs and hamper pain control, a U.S. medical society issued new guidance Tuesday calling for screening all patients for cannabis use before surgeries that require anesthesia. The guidelines were published in Regional Anesthesia & Pain Medicine, a BMJ journal.
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The American Society of Regional Anesthesia and Pain Medicine, which issued the recommendations, said this is first-of-its-kind guidance on how to manage cannabis use before, during and after surgery.
This could affect the care of millions of Americans, since roughly 10% of the U.S. population uses cannabis at least monthly.
Dr. Samer Narouze, the medical society's president and senior author of the guidelines, told UPI in a phone interview that studies have shown frequent or heavy cannabis users may experience more pain and nausea after surgery, not less, and may require more medications, including opioids, to manage pain.
"Every day, you're encountering a patient in the [operating room] who's been smoking cannabis," Narouze said. "This is a daily occurrence. This is the norm now to see patients presenting for surgery who are using cannabis, whether medicinally or recreationally."
Patients are routinely asked about illicit drug use before surgery, but most states allow cannabis use, and it doesn't fall into that category, so such information may not be disclosed to the medical team, he said.
The guidelines suggest that anesthesiologists ask patients before surgery if they use cannabis medicinally or recreationally, and note that doctors should be prepared to change the anesthesia plan or delay the surgery in certain situations.
Under the recommendations, anesthesiologists are urged to screen all patients for cannabis use, asking about the type of product, how it was used (whether smoked or eaten), the amount taken, how recently it was used and the frequency of use.
The guidance suggests delaying surgery at least two hours after a person last smoked cannabis because of an increased risk of myocardial infarction, tachycardia or other heart arrhythmias in the recovery room, Narouze said.
Also, he said, surgery for a cannabis user who shows signs of acute intoxication and mental status changes should be cancelled because the patient cannot give informed consent.
The reviewers cited strong scientific evidence to support 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.
However, the guidance stops short of suggesting universal toxicology screening of patients for cannabinoids based on current lack of evidence.
The new recommendations arose from extensive review of the medical literature and the experiences of a 13-member working group that included anesthesiologists, chronic pain physicians and a patient advocate.
In October 2020, the American College of Surgeons held a virtual meeting at which experts underscored the importance of helping patients stop tobacco, vaping and marijuana use before undergoing an operation.
