COLORADO SPRINGS — The legalization of marijuana in Colorado has had many impacts across society, both positive and negative, depending on who you talk to. But however you feel about it, it’s having an impact on the medical field when it comes to people who use marijuana going under anesthesia during surgeries.
The American Society of Regional Anesthesia and Pain Medicine recently published guidelines recommending that patients undergoing anesthesia be asked about about cannabis use – how much they use, whether they ingest or smoke it, and how often. The answers can help anesthesiologists know whether they might have to adjust the amount of medicine used to put someone to sleep.
Anesthesiologists hold a special place in medicine, as they help us forget or have no awareness of some pretty difficult procedures. Dr. Jennifer Kollman is the senior medical director of anesthesia for UCHealth’s southern Colorado region, and she tells pharmacology is a magical thing in her world, but it’s a two-way street. These days, anesthesiologists are seeing more patients who are requiring a lot more anesthesia medication to get the care they need while in surgery.
The motto of the American Society of Anesthesiologists is vigilance, and paying attention is something Dr. Kollman prides herself on. She tells me it’s one of the things that drew her to the specialty. “I honestly didn't think that I was going to like my anesthesia rotation in medical school.” Turns out, she very much enjoyed it. “Everything I give patients takes less than 30 seconds to work - so I get instant gratification. I can quickly see how well the patient's doing so it's really very fulfilling.”
Asking a patient about their recreational drug use, legal or not, is something that’s always been important for anesthesiologists to discuss with patients.
Dr. Kollman says, “We started doing it long before marijuana was even legalized in Colorado. Most anesthesiologists have noticed that it takes a lot more anesthesia to keep some patients asleep, and it tends to correlate with cannabis use.”
How much more? Dr. Kollman explains, “If I were to do an anesthetic on someone who was a regular cannabis user, I might need 100 mL’s of propofol to get them to sleep and keep them asleep. Whereas a non-cannabis user may need 10 to 20 mL’s, so the difference is pretty major.”
Even if people aren’t honest in their pre-op visits about their drug habits, anesthesiologists have other tools they use to constantly monitor to keep their patients safe.
If someone isn’t honest about their drug use, Dr. Kollman says this: The body doesn’t lie. “We'll usually figure it out once they're asleep because their body will tell us, and their level of consciousness will tell us. We use people's body type body and weight in order to get a rough estimate of what we're going to need to dose a patient going into a procedure. Then we also take into account their different physiology, the things that are going on with their organ systems and what type of surgery that they're having. Beyond that we use their vital signs while they are under. How's their heart doing? Is their rate too fast or too slow? What's their blood pressure doing? So the body really tells us what it needs. When we think somebody has ingested a substance that is mind-altering, so their brain might not react normally under anesthesia and use the normal cues, then we go to brain waves to try and help us determine exactly where that person is in their level of consciousness.”
Besides the amount of anesthesia necessary to put marijuana users under, Dr. Kollman says sometimes the more difficult challenge comes post-op, after the surgery, when it comes to managing pain.
“We have receptors in our body that are cannabinoid receptors and we naturally make some cannabinoid substances. When we use exogenous - or extra cannabinoids as far as marijuana or CBD - then we fill those receptors up. They can also cross-react with opioid receptors, so people don't respond well to our normal pain medications. They won't respond well to opioids and even some of the other medications that we use.”
Dr. Kollman also says in the future there may be guidelines of what to do in terms of marijuana use before you have surgery, but for now don’t make any changes without discussing it with your doctor.
“I think it's something that we'll be doing more of in our pre-anesthesia testing clinics before people get to surgery and they'll have that conversation two or three days beforehand. There is not quite enough evidence yet to tell people to stop cold turkey or to taper, and there's some conflicting reports whether it works, whether it needs to be. Seven days, whether it needs to be 14 days, so we need more research on that. It'll really depend on the person and on their coexisting conditions.”
And when it comes to any drug use, even alcohol or tobacco, always be honest with doctors about your habits so they can give you the best care possible. A good doctor will always encourage you and never shame you.
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