First U.S. Surgery, Cannabis Guidance Released

Finally, detailed and informed advice regarding potential interactions between cannabis and anesthetics before, during and after surgery is taking shape.

first time guidelines Cannabis use and surgery timelines will be announced on January 3. American Society of Local Anesthesia and Pain Medicine (ASRA Pain Medicine), To date, he acknowledged that there is no “single document” that brings together all these concerns.

This guidance builds on known data and recommendations from the Cannabis and Cannabinoids Perioperative Use Guidelines Committee, a group of 13 anesthesiologists, chronic pain physicians, professionals, and patient advocates. Based on

Using a modified Delphi consensus methodology, the committee answered 9 questions and made 21 recommendations. They reached the required 75% or more agreement for recommendations, with all 21 recommendations reaching full consensus.

Recommendations include screening all patients prior to surgery. Postpone elective surgery for patients with altered mental status or decreased decision-making capacity at the time of surgery. Counsel regular users about the potential adverse effects of cannabis use on postoperative pain management. Counsel pregnant patients about the potential risks of fetal cannabis use.

Coping with surgery and cannabis concern

“Many of the perioperative risks and challenges associated with perioperative cannabis are well documented, including how to advise patients preoperatively, the effects of cannabis on anesthetics, and interactions between cannabis, opioids, and pain. However, there is no single document that summarizes all these concerns and provides evidence-based recommendations,” the document reads.

The document states, “The flexibility of this clinical practice guideline allows for individual-centered decision-making that takes into account the individual’s expected health outcomes and well-being within the context of various regulatory environments.” is aimed at.”

There were no recommendations for reducing cannabis administered by other nonsmoking routes before surgery, “because of the current lack of evidence.” Periodic tapering of cannabis and cannabinoids before, during, or after surgery. Use of intraoperative electroencephalogram (EEG) in patients taking cannabinoids. We also do not later adjust opioid prescriptions for surgical patients who use cannabinoids.

The authors noted broad recommendations for patients before surgery, but cautioned that surgery should be postponed for a minimum of two hours after smoking cannabis. Depending on the situation, it is recommended to gradually reduce the dosage before surgery.

However, most current recommendations advise patients to abstain from cannabis for a few days to 10 days before surgery. “Recent consensus-based guidelines recommend reducing cannabinoid use 7 days before surgery (less than 1.5 g/day of smoked cannabis, 300 mg/day of CBD oil, and 20 mg/day of THC oil). Take a tapering strategy within 6 days of elective surgery and do not attempt tapering the day before surgery.”

This document continues the scope of guidance. More conservative recommendations were recently provided, with the authors recommending cessation of oral cannabis intake for up to 10 days. ”

Can cannabis affect anesthesia?

Research still has a long way to go, but there is growing evidence pointing to potential interactions and effects of cannabis before or after surgery.

one study was announced in Baylor University School of Medicine A 2019 study showed that cannabis consumers may require more anesthesia than non-consumers, as well as many other potential interactions. increase. study No significant difference was seen before gastrointestinal surgery.

Cannabis can also be a problem at the dentist.I have a strong belief that cannabis interacts with novocaine A local anesthetic such as lidocaine.in one study As far back as 1976, THC had unwanted interactions with anesthetics.