Best Practice|Articles in Press

Preoperative Preparation and Guidelines for Cannabis-Using Patients Undergoing Elective Surgery

Published:January 04, 2023DOI:



      Appropriate preoperative screening techniques are needed to safely provide anesthesia to increasing numbers of cannabis using surgical patients.


      This was a quasi-experimental quality improvement project.


      Preoperative identification of cannabis users by registered nurses (RNs) and certified registered nurse anesthetists (CRNAs) was compared to baseline identification rates. CRNAs’ compliance with evidenced base guidelines was recorded. Perioperative medication requirements were recorded and compared between cannabis-users and non-cannabis users.


      Identification of cannabis users by CRNAs conducting preanesthetic assessments increased from 4.08% to 14.36% while RN identification improved from 11.22% to 13.81%. Compliance with identification guidelines was 69.2% among CRNAs. There were no differences in anesthetic requirements, complications, or postanesthesia care unit (PACU) length of stay between cannabis users and non-users.


      Preoperative identification of cannabis users allows for safer, more effective perioperative care by CRNAs, registered nurses, and surgical staff.


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      1. Washington State Department of Health. Washington state health assessment. 2018

        • Huson HB
        • Granados TM
        • Rasko Y.
        Surgical considerations of marijuana use in elective procedures.
        Heliyon. 2018; 4: e00779
        • Horvath C
        • Dalley CB
        • Grass N
        • Tola DH.
        Marijuana use in the anesthetized patient: history, pharmacology, and anesthetic considerations.
        AANA J. 2019; 87: 451-457
        • Echeverria-Villalobos M
        • Todeschini AB
        • Stoicea N
        • Fiorda-Diaz J
        • Weaver T
        • Bergese SD.
        Perioperative care of cannabis users: a comprehensive review of pharmacological and anesthetic considerations.
        J Clin Anesth. 2019; 57: 41-49
        • American Society of Anesthesiologist (ASA)
        Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologist task force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration*.
        Anesthesiology. 2017; 126: 376-393
        • Goel A
        • McGuinness B
        • Jivraj NK
        • et al.
        Cannabis use disorder and perioperative outcomes in major elective surgeries: a retrospective cohort analysis.
        Anesthesiology. 2020; 132: 625-635
        • Li J
        • Ma H
        • Liao R
        • Huang Y
        • Chen G.
        Preoperative screening for illicit drug use in patients undergoing emergency surgery: a prospective observational study.
        Sci Rep. 2018; 8: 7405
        • Bryson EO
        • Frost EAM.
        The perioperative implications of tobacco, marijuana, and other inhaled toxins.
        Int Anesthesiol Clin. 2011; 49: 103-118
        • McAfee J
        • Boehnke KF
        • Moser SM
        • Brummett CM
        • Waljee JF
        • Bonar EE.
        Perioperative cannabis use: a longitudinal study of associated clinical characteristics and surgical outcomes.
        Reg Anesth Pain Med. 2021; 46: 137-144
        • Budworth L
        • Prestwich A
        • Lawton R
        • Kotzé A
        • Kellar I.
        Preoperative interventions for alcohol and other recreational substance use: a systematic review and meta-analysis.
        Front Psychol. 2019; 10: 34
        • Beaulieu P.
        Anesthetic implications of recreational drug use.
        Can J Anaesth J Can Anesth. 2017; 64: 1236-1264