Heavy marijuana use should be disclosed before surgery, new guidelines say

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Heavy marijuana use should be disclosed before surgery, new guidelines say
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Cannabis use, particularly when it's regular and heavy, can leave patients in more pain than normal after surgery, and getting high just before an operation can put a patient at risk for heart problems, even a heart attack, said Dr. Samer Narouze.

Some heavy marijuana users may require more anesthesia to fall asleep or keep them asleep, he said. Heavy use may leave patients more agitated during recovery, and someone acutely intoxicated with cannabis may feel confused, have a racing heart and panic episodes, and cannot appropriately consent to surgery, Narouze said.

"If the anesthesiologist is aware of the risks," he said,"they can put the pieces together and manage the patient well."Anesthesiologists always consider"multi-modal" approaches to pain management to minimize side effects, said Dr. Peter Yeh, an anesthesiologist at the University of California San Francisco. But in a regular, heavy marijuana user, he pays extra attention to other classes of medications, including nerve blocks or an epidural.

Narouze said edibles increase the risk for hyperemesis because they take longer to lead to a high, so people think they haven't yet eaten enough. Smoking causes a quick high that also fades rapidly, while edibles take longer to have their longer-lasting effect. A heavy cannabis user might also miss one or two regular doses during a long surgery and recovery, leading to more pain, Narouze said.

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