With the legalization of marijuana in far more states than not, there are considerations in the medical industry that didn’t formerly exist. One of the biggest involves the combination of cannabis and anesthesia.

As such, new guidelines recommend that heavy marijuana users inform their anesthesiologists of their use. In addition, anesthesiologists are also encouraged to ask.

It turns out that heavy users could be at more risk for heart problems if they’re using before surgery. They may also experience more pain during recovery.

The Newest Guidelines for Cannabis and Anesthesia

The American Society of Regional Anesthesia and Pain Medicine released the guidelines in early January in an effort to help practicing doctors who learned very little about the body’s reaction to marijuana in their training. (You know, because marijuana was – and still is – federally prohibited.)

When anesthetizing heavy marijuana users, anesthesiologists are increasingly at a loss about how to handle the mingling of cannabis and anesthesia. They simply don’t know what to do.

As such, the guidelines recommend that anesthesiologists ask patients more than just whether they use cannabis. They should be aware of how much, how often, how recently, what type of marijuana. Also, whether it was ingested or smoked will make a difference.

Some heavy cannabis users require more anesthesia to fall or stay asleep. They can become more irritated during recovery and if they’re acutely intoxicated with cannabis, this can cause confusing, increased heart rate, panic attacks, and an inability to consent to surgery.

As such, if a patient arrives high for an elective surgery, the guidelines suggest that it be postponed. If it’s not an elective surgery, then the anesthesiologist is aware of the risks and can recommend more monitoring during recovery.

Heavy Hitters Beware

Anesthesiologists aren’t just there to put the patient to sleep. They’re crucial in post-surgical pain management and tend to have a multi-modal approach in order to minimize side effects.

While it’s well-established that a low dose of THC helps reduce pain and treat nausea, in high doses it can increase pain and cause nonstop vomiting (a condition known as cannabinoid hyperemesis syndrome). And not just after surgery. More emergency rooms are encountering these conditions as a result of excessive cannabis use.

So when it comes to managing pain after surgery, it’s in the best interest of a heavy user to inform the anesthesiologist. This will impact the use of other classes of medication such as an epidural or nerve blocks.

Furthermore, if a heavy user misses a regular dose (or two) during the procedure, he or she is also likely to feel more pain after the surgery. For this reason, an increasing number of anesthesiologists are ensuring that their patients receive counseling about cannabis before they go under the knife.

It’s a wacky world we call home.

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