Management of the Perioperative Patient on Cannabis and Cannabinoids

Publication Date: January 3, 2023
Last Updated: January 31, 2023

Question 1: Should all surgical and procedural patients requiring anesthesia be screened for cannabinoids preoperatively and if so, what information should be obtained?

  • Statement: Cannabinoids are the most commonly used recreational drugs in the USA and other countries, and the use of cannabinoids, both recreational and medicinal, may result in physiologic derangements. They may have interactions with other medications and treatments in the perioperative period. Level of Certainty: Moderate
  • Recommendation 1: Universal screening for cannabinoids should be performed prior to surgery and should include type of cannabis or cannabinoid product, time of last consumption, route of administration, amount, and frequency of use. Grade A
  • Recommendation 2: Universal toxicology screening for cannabinoids is not currently indicated based on insufficient available evidence. Grade D

Question 2: What evidence exists to guide the decision to continue or stop cannabinoids perioperatively and/or postpone elective surgery?

  • Statement 1: Acute effects of cannabis use can result in altered mental status and impairment of decision-making capacity. Hence, the frequency and the timing of the last dose of cannabis usage are important. Level of Certainty: High
  • Statement 2: Smoking cannabis can cause increases in heart rate and blood pressure that is prominent within the first 1–2 hours of usage. Level of certainty: High
  • Statement 3: Smoking cannabis may lead to a higher risk of perioperative acute MI within the first 1–2 hours. Level of certainty: Moderate
  • Statement 4: Smoking cannabis may have deleterious effects on airway resistance and respiratory adverse events. Level of certainty: Moderate
  • Statement 5: There is a lack of published data on the perioperative cardiovascular effects following other routes of cannabinoid administration. Level of certainty: Moderate
  • Recommendation 1: Patients should be counseled on the potential risks of continued perioperative cannabinoids. Grade B
  • Recommendation 2: We recommend postponing elective surgery in patients who have altered mental status or impairment of decision-making capacity due to acute cannabis intoxication. Grade A
  • Recommendation 3: We recommend delaying elective surgery for a minimum of 2 hours after cannabis smoking because of increased perioperative risk of acute MI . Grade C
  • Recommendation 4: With other cannabinoids routes (non-smoking) of administration, consider weighing the risks and benefits before proceeding with elective surgery given the temporal association of cannabis usage and adverse cardiovascular effects. There is a lack of published data to recommend a specific duration. Grade I

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Management of the Perioperative Patient on Cannabis and Cannabinoids

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