If you smoke pot, lay off before surgery; you could wake up early

Photo illustration from OR Management

Regular users of marijuana may need up to three times more anesthetic to keep them unconscious during surgical procedures, so they need to tell surgical personnel about it, say doctors who have studied the phenomenon. And a preliminary study suggests that cannabis users have more pain after surgery.

"Why this might be is, like anasthesia itself, something of a mystery," reports The Economist. "The problem is magnified by a growing number of Americans getting high," with recreational cannabis legal in 20 states. "A 2021 federal survey found that 18.7% of people age 12 or older had used marijuana in the past year," The Wall Street Journal reports.

"More doctors say they are asking about marijuana use—and urging honesty—before surgeries or procedures because habitual users may need more anesthesia and painkillers," the Journal reports. "It isn’t clear if the anesthesia complication is largely limited to people who use THC, the main psychoactive component of marijuana and what causes the high, or also extends to people who take cannabidiol, or CBD. The latter doesn’t produce the high that THC does and is sometimes used as a remedy for pain, sleep or anxiety. Many cannabis products such as edibles contain a combination of the two."

Published studies of the problem have been limited, mainly because federal law thwarts studies of cannabis. Studies have focused on endoscopy, a procedure in which a long tube with a lens and a light is passed down the throat to the digestive tract. A study in Ontario found that daily users of cannabis needed more profopol, a common surgical sedative, than weekly or monthly users.

"Smoking weed before surgery can make patients confused, irritable and sometimes even violent when they wake up," The Economist reports. "A working paper presented in October, which has yet to be peer-reviewed, suggests that weed can hinder recovery, too. Of the nearly 35,000 Cleveland Clinic patients assessed, those who used marijuana within 30 days of their operation experienced 14% more pain in the day after surgery and took 7% more prescription opioids to ease it." A study published in 2018 "found that cannabis users had higher pain scores and consumed 25% to 37% higher quantities of opioids compared with nonusers," The Wall Street Journal reports.

The American Society of Regional Anesthesia and Pain Medicine said in January that pregnant women should be discouraged from smoking cannabis, "and non-emergency surgeries should be postponed by at least two hours if the patient comes in blitzed. A slew of other new reports warn anaesthesiologists of the mounting risks," The Economist reports. "The common perception that marijuana eases nerves works against doctors. Some people seem to be getting stoned before they arrive at the hospital in order to calm themselves down. New users may be particularly likely to smoke for such a purpose. For a better experience, patients should forgo the parking-lot hit."

Nurse anesthetists no longer need to be supervised in Ky.

Kentucky will be the 17th state to opt out of a federal requirement that requires nurse anesthetists to be supervised by a physician, a move that Gov. Steve Beshear said will increase flexibility and efficiency in operating rooms.

The Kentucky Hospital Association applauded the effort. "Certified registered nurse anesthetists are an extremely important part of health-care delivery in Kentucky, particularly in the rural areas of the state," said Mike Rust, KHA president. "This opt-out will ensure patient access to quality anesthesia care."

"We've consulted with the Cabinet for Health and Family Services and health care providers, and this is clearly a change we need to make to improve access to critical medical care," Beshear said. "In cases like this, where the federal requirement is an obstacle to some of the best options for delivery of high-quality health care, we're pleased to take this step to opt out."

A 2010 report that analyzed Medicare data for 1999 to 2005 and published in the journal Health Affairs found no evidence opting out of the oversight requirement resulted in more patient deaths or complications. (Read more)