Surgeons need to know their patients use cannabis because it affects every phase of surgical care | Research

The takeaway

Cannabis use affects preoperative counseling, anesthesia dosing, postoperative pain and nausea, wound healing, and drug interactions with common surgical medications, yet most patients do not disclose use to their surgeons.

Surgeons, anesthesiologists, perioperative nurses, and patients who use cannabis and face upcoming surgery.

What the researchers found

Cannabis users may require higher anesthesia doses due to tolerance, face increased rates of myocardial ischemia, and experience prolonged sedation. Postoperative effects include potentially increased pain, nausea, and vomiting. Topical cannabinoids may improve wound healing. Significant drug interactions exist with anticoagulants. Cannabis use disorder is associated with increased perioperative morbidity and mortality.

Why it matters

With cannabis use rising and many patients not disclosing it, surgeons may be managing anesthesia, pain, and medications without knowing about a substance that affects all of these. The consequences range from inadequate anesthesia to dangerous drug interactions.

The numbers in context

Higher anesthesia tolerance documented. Increased myocardial ischemia risk. Prolonged sedation effects. Significant drug interactions with anticoagulant medications. CUD associated with increased perioperative morbidity and mortality.

How the study worked

Clinical review published in JAMA Otolaryngology synthesizing evidence on how cannabis use affects surgical care phases, including preoperative, intraoperative, and postoperative considerations.

What this study cannot tell us

Review format with mixed-quality underlying evidence. Many effects described as potential or inconsistent across studies. Focused on otolaryngology context but findings apply broadly. Does not provide quantified risk estimates for most outcomes.

How to read the evidence

Published in JAMA Otolaryngology with comprehensive scope, though underlying evidence quality varies and many associations lack consistent support.

When this study was published

2024 publication.

The bigger picture

Cannabis is no longer a niche concern in surgical medicine. As use becomes more common and legal, every surgical specialty needs protocols for screening, disclosure, and adjusted care plans for cannabis users.

Questions still open

Should cannabis use be a standard preoperative screening question alongside tobacco and alcohol?
What is the optimal preoperative cannabis cessation period to minimize anesthesia complications?

Common questions

Should I stop using cannabis before surgery?

The review suggests preoperative counseling for tapering cannabis use. Cannabis can increase anesthesia requirements, affect heart function, interact with medications, and potentially affect pain management. Disclosure to your surgical team is important for safe care planning.

How does cannabis interact with surgical medications?

Cannabis, particularly CBD, inhibits enzymes that metabolize many drugs. The most clinically significant interactions in surgical settings involve anticoagulants (blood thinners), where cannabis can alter drug levels and increase bleeding or clotting risk.

Read the original research

Surgery-Related Considerations in Treating People Who Use Cannabis: A Review.

JAMA otolaryngology-- head & neck surgery, 150(10), 918-924

View on PubMed ↗Publisher’s paper ↗

Citation

Mims, Mark M; Parikh, Aniruddha C; Sandhu, Zainab; DeMoss, Noah; Mhawej, Rachad; Queimado, Lurdes. (2024). Surgery-Related Considerations in Treating People Who Use Cannabis: A Review.. JAMA otolaryngology-- head & neck surgery, 150(10), 918-924. https://doi.org/10.1001/jamaoto.2024.2545