Cannabis Users Face Specific Risks During Surgery That Anesthesiologists Should Know | Research

The takeaway

A review of 17 studies found that chronic cannabis users face increased risks of heart attack after surgery, greater postoperative pain and opioid use, potential bronchospasm, and drug interactions with anticoagulants.

Anesthesiologists, surgeons, perioperative nurses, and cannabis users facing upcoming surgery.

What the researchers found

Preoperative screening for chronic cannabis use was recommended due to increased risk of postoperative myocardial infarction, higher postoperative pain and opioid requirements, risk of bronchospasm requiring ventilation adjustments, and potential interactions between cannabinoids and anticoagulant medications.

Why it matters

With cannabis use increasing, anesthesiologists are encountering more patients who use regularly. Knowing the specific perioperative risks allows for better preoperative screening, intraoperative management, and postoperative pain protocols.

The numbers in context

209 records screened, 17 included. Literature span: 2003-2023. Key risks identified: postoperative MI, increased opioid use, bronchospasm, anticoagulant interactions.

How the study worked

Review following PRISMA 2020 guidelines, searching Medline and Cochrane Library databases for reports published 2003-2023. Of 209 records identified, 17 articles were included covering perioperative management of long-term cannabis users.

What this study cannot tell us

Only 17 studies met inclusion criteria, suggesting limited high-quality evidence. Most included studies were observational or case reports. Cannabis products vary widely in composition, making generalization difficult. Review covered only two databases.

How to read the evidence

Systematic search with PRISMA methodology, but limited number of included studies and mostly low-quality evidence base.

When this study was published

Published 2025, reviewing literature from 2003-2023.

The bigger picture

As cannabis becomes legal in more jurisdictions, perioperative cannabis management is transitioning from an occasional concern to a routine consideration. Standardized screening protocols and clinical guidelines will likely be needed, similar to existing protocols for tobacco and alcohol use.

Questions still open

How long before surgery cannabis users should abstain to reduce perioperative risk
Whether CBD-only products carry the same perioperative risks as THC-containing products

Common questions

Should I tell my anesthesiologist about cannabis use?

Yes. This review found that chronic cannabis use can affect how your body responds to anesthesia, pain medications, and blood thinners. Disclosure allows your medical team to adjust their approach for safer care.

Why might cannabis users need more pain medication after surgery?

Regular cannabis use may lead to cross-tolerance with opioid pain medications. The endocannabinoid system and opioid system overlap in pain processing, so chronic activation of one can reduce the effectiveness of drugs targeting the other.

Read the original research

Perioperative management of the patient on cannabis and cannabinoids: A review.

Journal of perioperative practice, 35(10), 456-462

View on PubMed ↗Publisher’s paper ↗

Citation

Scheuermann, Maria; Hans, Guy; Wildemeersch, Davina. (2025). Perioperative management of the patient on cannabis and cannabinoids: A review.. Journal of perioperative practice, 35(10), 456-462. https://doi.org/10.1177/17504589251320804