In the past few decades, societal acceptance and legalization of marijuana have increased. Despite centuries of cannabis use for both recreational and medicinal purposes, scientific knowledge of marijuana is limited. In this changing environment, anesthesia providers need preoperative guidelines to assess patients who are medicinal, recreational, or chronic cannabis users and up-to-date information about potential interaction with anesthesia.

Recent renewed research interest has produced many studies that yield beneficial information for improved care of patients who use cannabis. However, much of this information has not made its way to evidence-based practice improvements.

“During my research I discovered that there was no current information regarding specific evidence needed to inform the cannabis user, especially the chronic or medicinal user,” said JoVanna Eisenbarth, DNAP, CRNA. “Patients presenting for surgery or procedures requiring anesthesia are reporting cannabis use more often; it’s important for anesthesia providers to be able to care for this population.” Eisenbarth, also a doctoral candidate from Shelton, Wash., has noted the rise in patients reporting cannabis use since Washington state legalized recreational marijuana. She will be presenting on the topic of preoperative cannabis abstinence guidelines on Monday, Sept. 24, at the American Association of Nurse Anesthetists Annual Congress in Boston.

Cannabis effects remain inconsistent due to the varying amounts of use, dosing, and (marijuana) plant preparations. The physiological effects of cannabis differ between the acute and chronic as tolerance is created. Because cannabis interacts with common anesthetic medications, acute and recreational users may suffer more deleterious physiologic effects of concern to the anesthesia provider.

Perioperative patients who abstain from using cannabis in preparation for surgery may experience withdrawal symptoms. The symptoms most often manifest in the chronic or heavy cannabis user who suddenly abstains from use. Symptoms of cannabis withdrawal include anger, agitation, anxiety, aggression, nausea, and muscle cramps. Cannabis abstinence can result in an increase or return of symptoms or disorders that cannabis is often used to treat.

“In an effort to provide the safest and best care for patients, providers must weigh the potential harm with the potential benefit for cannabis abstinence,” said Eisenbarth.

—Newswise