November FY19 Journal Club

[Lu Lin]

I feel like we have pot smoking patients on daily bases. I agree with if they are symptomatic with wheezing and productive coughing, we should postpone the elective case. But most of time, when we encounter with a active user and emergency surgery, we just need to be vigilant and monitoring patient accordingly,

[emedina1]

I don't think that these patient's should be tested routinely for elective surgery. However, if they are symptomatic by all means they should be tested to determine baseline.
i agree with everyone else that AANA and APSF should not jump to any position on this regard before more research are done.

[Christine Velarde]

I do not think that we should cancel cases when a patient uses marijuana on a regular basis. I agree that if there are pulmonary symptoms/SOB or serve coughing a clinical choice to cancel the case may be made. We also have to worry about cyclical vomiting that can occur when a patient reduces their chronic use or stops cold turkey. As more states legalize marijuana more people will be willing to participate in a study to see the lasting effects of marijuana use. Providers who use marijuana should not be giving anesthesia. Someone may be considered impaired. Marijuana use is still not legalized on the federal level. I think there will be parameters made for patients by the AANA/ASA as soon as more data can be collected.

[Moishe Mayer]

Thanks for the article; very interesting read. Based on the article, it seems we should do a focused assessment to see if the patient is experiencing any CV or pulmonary symptoms. If not, there does not seem to be strong evidence to cancel a procedure. Even arrhythmias are reported to be transient without any increase in m & m noted. If the patient is not experiencing an MI, the CV issues seem manageable. Hyperreactive area do seem like an area of concern, but then again we proceed with adult patients that are prone to hyperreactive airway either because of asthmatic triggers or recent URI. A good dose of sevo and albuterol may suffice. As many have noted, there is not enough evidence regarding the clinical outcomes with marijuana use. Most of the information is theoretical.

[Belinda G]

1. I agree with Ben in that we take care of many patients that smoke cigarettes and Marijuana without pulmonary testing so I don't think this needs to change. However, if a patient arrives for surgery that seems sedated/intoxicated or gives any reason for cardiopulmonary concerns prior to anesthesia they should be addressed and worked up appropriately on a case by case basis keeping in mind the possibility of significant cardiopulmonary sequela with chronic use. Also important; keep in mind dosing considerations and altered metabolism of anesthetics in combination with Marijuana use.
2. it sounds like the jury is still out on recommendations for patient use of Marijuana form AANA and APSF. I personally don't think that any provider should give anesthesia under the influence of anything including Marijuana.

[Chuck Eder]

1. I don't think marijuana users should be treated any differently than cigarette smokers in the setting of surgery. I should be on a case by case basis for elective cases. Currently, we don't cancel cases that involve smokers simply because they were smoking prior to the prep process.

2. There still needs to be more research completed on the potential benefits of medical marijuana. One question I have, concerns the legal ramifications of using medical marijuana and working. how do employers handle their employees that use medical marijuana when completing their normal job description. Not only does it have health concerns, but legal ones as well.