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Post by Kristen Horsman on Nov 1, 2018 9:58:53 GMT -5
The November journal club article is presented by Katya Podin. The article reviews the effects of marijuana on an anesthetic. This is particularly relevant in the culture today of legalized marijuana and medical marijuana use.
Here is the link to the article.
The questions to encompass within your response:
1. Since marijuana has significant effect on pulmonary and CV system. Should the patient be tested or postponed for elective procedures?
2. What do you think the AANA and APSF positions should be on medical marijuana use by patients and providers?
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Post by Aileen Mendez on Nov 1, 2018 12:44:06 GMT -5
I assume that if the patient is truly symptomatic from Marijuana use, like wheezing,having chest pain, SOB would help to guide your cancellation of an elective procedure. I believe that we care for daily smoke pot than actually admit it. the other day i had a peds patient and his parents both smelled so badly of marijuana, so should we be concerned of the child exposure like second hand smoke? I was concerned of the parents actual ability of giving informed consent because they were "high" thoughts?
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kty67
New Member
Posts: 22
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Post by kty67 on Nov 1, 2018 14:10:51 GMT -5
I am not sure what we can do if we are concern about parents ability to drive child home. May be we should contact a social worker and evaluate situation before taking a child or an adult patient to OR. Apparently, medical marijuana can be prescribed to 18 years old. So, many teenagers can't have alcohol but have legal excess to marijuana.
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Post by Soo-Ok Kim on Nov 2, 2018 9:09:05 GMT -5
1. As it was described in the article, this should be case by case since the effects of Marijuana are still not concrete. Depending on the length, the amount of Marijuana use or the type of surgical procedure, the careful screening will be needed. Also, during the preop interview session, the clear information of the use of this should be obtained and risks involved should be communicated with the patient and family.
2. It is hard to stand on particular position on the information available so far on this. Maybe, the practice guideline can be proposed.
Thank you for brining this to our attention since we may encounter more and more patients who are on this. One peds patient who had refractory seizure was on marijuana since that was the only med working to control her seizure.
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Post by jkim54 on Nov 2, 2018 9:57:42 GMT -5
1. The importance of a thorough H&P and preoperative evaluation is vital to determining how a patient's marijuana use can affect their response to anesthesia. Depending on the extent and nature of their use, a thorough cardiac and pulmonary work up should be highly considered, much like a patient with moderate to severe cardiac disease and/or pulmonary comorbidities would receive. As a provider, being aware of the possible side effects and complications related to marijuana use is crucial in avoiding potential intraop and postop events for the patient.
2. Since much more research needs to be done in the area of marijuana use and potential complications with anesthesia, the AANA and APST should promote more education and dialogue in this area in order to inform all anesthesia providers of best practice models.
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Post by Jennifer Hannon on Nov 2, 2018 14:07:44 GMT -5
1) I don't think I would necessarily cancel a case for marijuana use. Not too many people accurately report the amount used. Even alcohol. With it being legalized we may see more accurate reporting, but I still think there will be an old stigma in reporting it to medical people for awhile. Also THC can be in the hair follicle for months after usage, so how reliable is the testing equipment? I am more concerned with the amount of people that will be on the roads with medical "green" cards, as formentioned by Aileen.
2) That's a tough Q Katya! I Ping-Pong in my response even as I type it. On one hand, any sedating substance use can augment anesthesia, but now with a green card it's legalized and prescribed. Patients take Xanax the night before/morning of for anxiety, and it doesn't change the AANA position. But, are green cards being issued for everything ailment right now, since this is a new booming market? More education and research is definitely needed.
I think we all agree that an impaired provider cannot work. I think the approach would be the same as alcohol for a provider, in that its acceptable to legally use at home, but once it affects your work, one may have a problem and need help/assistance.
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Post by LarSharVeA Bennett on Nov 5, 2018 9:43:18 GMT -5
I do not subscribe to the practice of testing patients for marijuana nor do I believe that elective cases should be cancelled simply because of one's use of cannabis. Not only is this additional testing costly, moving forward with cancellations could decrease revenue. Pay more, profit less is a miasma of government cheese to even the rudimentary economist.
I loosely agree with the AMA's perspective; I would have to see their statement in full to endorse it. Moving forward however, I am more interested in learning how medical marijuana could improve the lives of people living with chronic illnesses. According to the article, 22 million people are using it. It would be sage to research how it affects anesthetics and disseminate the findings so that evidenced based plans of care could be implemented.
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Post by Jessica Hadley on Nov 6, 2018 13:24:42 GMT -5
1. Thank you for this article, there was some good information regarding the interactions between marijuana and anesthesia I was not aware of. I do not believe we should be routinely screening patients for marijuana use (especially without their consent) nor do I think we should automatically cancel procedures for people who have used marijuana recently.
2. I agree with Jen's response that an intoxicated provider should not be providing anesthesia. However, I am not sure how I feel regarding a provider who is using medical marijuana for a legitimate condition at home when not on duty.
The AANA does not have a statement regarding alcohol use that I am aware of, so I'm not sure they could necessarily take a stance one way or the other if a provider is responsibly and legally using marijuana.
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Post by Wai-Ling Lo on Nov 9, 2018 10:12:30 GMT -5
1. Since marijuana has significant effect on pulmonary and CV system. Should the patient be tested or postponed for elective procedures?
We don't routinely test everyone for drug screen/toxicology. I don't think we should treat marijuana any differently. However, a thorough preop history and assessment is vital. If patient looks intoxicated or has CV and pulmonary symptoms, further investigation will be warranted. Moreover, we should well inform pt of the potential risk of anesthesia associated with marijuana use.
2. What do you think the AANA and APSF positions should be on medical marijuana use by patients and providers?
I too agree that more research/information is needed on how marijuana can affect anesthesia before we all jump into any conclusion. As for providers, I agreed with everyone that impaired providers should not be providing anesthesia.
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Post by Jackie Howell on Nov 11, 2018 12:39:19 GMT -5
Since marijuana has significant effect on pulmonary and CV system. Should the patient be tested or postponed for elective procedures?
I agree with previous posts on this thread. We don’t routinely test for drug screening and those labs can be costly without a real change in how we would manage the patient. I feel that knowing a patients drug use/history is only one piece of the puzzle in creating the safest and best anesthetic plan. The patients physical assessment, H&P, what type and duration of surgery should all be considered.
2. What do you think the AANA and APSF positions should be on medical marijuana use by patients and providers?
I agree that anesthesia providers can’t be under the influence of marijuana or any other drugs that can delay their reaction time and cloud their judgement. I’m not sure how I feel about anesthesia providers using marijuana recreationally or for a medical condition outside of work.
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Post by kels on Nov 12, 2018 10:12:14 GMT -5
1. Since marijuana has significant effect on pulmonary and CV system. Should the patient be tested or postponed for elective procedures? I agree that a well done H and P should be performed but I think I would be more inclined to hold off on costly tests and proceed with the case if everything checks out ok for the physical . To me the consent process is a really important time where conversations can be had about the risks that were stated in this article and you never know, maybe the patient would choose to hold off on the marijuana and come back at a later time( for an elective procedure)
2. What do you think the AANA and APSF positions should be on medical marijuana use by patients and providers? I think more studies/information is needed before taking a stance
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Post by Ben Waldbaum on Nov 15, 2018 14:53:01 GMT -5
1. Patients should be treated no different than a cigarette smoker. When indicated, as with a smoker, preoperative pulmonary workup is appropriate for certain patients. The same standard can be applied to the regular marijuana user. Remember, many smokers have no pulmonary workup prior to surgery.
2. There is little conclusive evidence of the benefits of medical marijuana. Additionally, due to the carcinogens and pulmonary risk, any endorsement has to undergo a careful analysis of the risks/benefits. At this time, there is not enough data to make such an analysis and hence the AANA and APSF should hold off any endorsement.
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Post by Jocelyn Datud on Nov 15, 2018 15:55:12 GMT -5
1. I agree with the others. Now that marijuana use is being common, it is very important to ask this information during the interview process and deal with it in a case to case basis. I've noticed that most of the patients that I had recently, were very open about their marijuana use. Also, information about marijuana use should be included during the pre-op instructions.
2. What do you think the AANA and APSF positions should be on medical marijuana use by patients and providers? More research should be done in relation to this topic. If it impairs judgment, providers should not be allowed to work while under the influence of it.
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nanci
Junior Member
Posts: 57
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Post by nanci on Nov 21, 2018 13:34:45 GMT -5
1. I don't think at this time we should be cancelling cases. We can certainly inquire as to the frequency and last use and adjust the anesthetic as appropriate if needed, however not sure if you would get a solid reliable answer from some of our patients about their use.
2. Since even the AMA is suggesting that the NIH facilitate more research and even the FDA has not officially approved its use for specific disease processes, I think it would be presumptuous for the AANA to come out with a position statement about medical marijuana use by patients without some solid evidence to support such.
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Post by jswitzman on Nov 27, 2018 17:30:52 GMT -5
1. We should not cancel cases. Many other substances that pts use; i.e ETOH and Tobacco, effect CV and Pulmonary systems. As providers we need to be aware of the Anesthetic Implications Marijuana presents; the article was a good review.
2. AANAs position is that CRNAs should not be giving Anesthesia if under the influence of Marijuana. APSF feels the same way. I do not know their positions on patients using Marijuana and receiving Anesthesia.
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