Can You Take CBD Oil Before Surgery

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Regular marijuana users who need surgery should disclose their use ahead of the procedure, because of its effects on the body and on the anesthesia medications required for sedation. Taking CBD to help manage post-operative pain is safe to do, just be sure to check any contraindications with other medicines you are already taking post…

Coming clean: Your anesthesiologist needs to know about marijuana use before surgery

Given the increasing prevalence and legalization of marijuana, many patients have come to think that marijuana use is not worth mentioning to their physicians. After all, they reason, I would not necessarily tell my doctor that I had a glass of wine last night, so why should I disclose that I smoked marijuana yesterday? Unfortunately, this reasoning is flawed. Because marijuana has a variety of effects on the body and on anesthesia medicines, it is crucial that anyone undergoing a preoperative evaluation disclose their marijuana use. Don’t worry that your anesthesiologist is judging you. That’s not our job! Our job is to understand your health and body in order to provide you with the safest and most pain-free procedure. This information is part of your confidential medical record, and accurate information is crucial to helping doctors provide good care.

Marijuana can affect the type and amount of anesthesia

The way(s) you use marijuana (smoking, edibles, etc.), how often you use, and how much all can affect how your body responds to anesthesia. Since marijuana and anesthesia both affect the central nervous system, people who use marijuana regularly may need different amounts of anesthesia medicines. In order to know which medicines and how much to use, your doctor needs to know ahead of time how much and how often you use marijuana.

Regular users of marijuana generally need larger doses of anesthesia medicines in order to achieve the same degree of sedation. If you don’t tell your anesthesiologist how much marijuana you smoke, he or she may underestimate how much anesthesia will be needed for you to “go to sleep” and stay asleep during your procedure. For example, compared to nonusers, regular marijuana users (daily to weekly) need over three times as much more propofol to achieve adequate sedation for endoscopies. That is a huge increase in dose that your doctor would want to be prepared to administer.

The higher anesthesia dose required for regular marijuana users can lead to an increased risk of complications, such as decreased blood pressure and delayed awakening from anesthesia.

Marijuana use before surgery can increase the risk of complications

Other side effects of regular marijuana use can lead to serious complications of anesthesia. Inhaled marijuana can affect your lungs and increase phlegm, coughing, wheezing, and the risk of respiratory infections. These lung issues can lead to breathing problems during your anesthetic, such as increased airway sensitivity when the breathing tube is put into or taken out of the airway. This may feel like an asthma attack, with a sensation of difficulty breathing and decreased oxygen getting into the lungs. Regular users of marijuana can also have increased postoperative pain, which leads to higher opioid use during and after surgery. This puts regular marijuana users at risk for opioid use disorder after surgery.

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Don’t use marijuana the day of surgery — especially edibles

No matter how worried you are about your procedure, don’t use marijuana to relax — you may end up with your surgery rescheduled or with serious complications. Regardless of how often you usually use marijuana, anesthesiologists agree that you should skip it completely on the day of surgery. You should not smoke or inhale marijuana the day of your surgery, and certainly you should avoid any edible marijuana the day of surgery, since the American Society of Anesthesiologists’ guidelines for preoperative fasting do not allow any solid food for six to eight hours prior to anesthesia, in order to decrease the risk of food getting inhaled into your lungs. This can lead to aspiration pneumonia, a very serious complication that may cause death in some patients.

The physical effects of marijuana can increase the risk of complications, especially if consumed within an hour or two of anesthesia. Marijuana can raise your heart rate and lower your blood pressure. These changes are even more serious in patients with heart disease. In selected patient populations, this combination of decreased blood pressure and increased heart rate can cause ischemia (lack of blood supply) to the heart muscle, commonly known as a heart attack.

There are still many unknowns about marijuana

Your anesthesiologist needs accurate information about your marijuana use in order to plan safe anesthesia, and we know that no one should use marijuana on the day of surgery. Because of marijuana’s classification as a drug of abuse, we cannot do medical research on marijuana without legislation to allow that research, and this includes research about how marijuana affects surgical procedures and aspects of anesthesia. The American Society of Anesthesiologists (ASA) has urged the federal government to allow medical studies and has endorsed bills to expand research in marijuana.

Your anesthesiologist just wants to keep you safe

The ASA has a list of eight things that you should tell your physician and anesthesiologist before surgery, and the use of marijuana is one of them. Please don’t be afraid to disclose your use of marijuana to your physician, as it will not affect what we think of you. You will help us manage and adjust your anesthetic, prevent complications, and keep you as safe and healthy as possible.

Image: BraunS/Getty Images

About the Author

David Hepner, MD, MPH , Contributor

David Hepner, MD, MPH, is medical director of the Weiner Center for Preoperative Evaluation at the Brigham and Women’s Hospital, and associate professor of anesthesia at Harvard Medical School. He is an associate faculty member of … See Full Bio

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Medical Marijuana: Facts about cannabis, THC, and CBD

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What You Need to Know about Taking CBD and Surgery

Cannabidiol (CBD) is widely taken mainly for its anti-anxiety and anti-inflammatory properties. In fact, many people even take it as a daily supplement in order to prevent disease.

But can you take it if you have upcoming surgery? The answer isn’t a clear yes or no, so let’s take a deep dive into the specifics so you’re armed with knowledge to make an informed decision. There’s much more to surgery than we think we know, so read on.

Talk To Your Doctor First

The most important first step you must do if you have upcoming surgery is to disclose to your doctor, surgeon, and anesthesiologist that you are taking CBD. Hopefully, you’re working with medical professionals that are already educated about CBD, and regardless of what they tell you, it’s best that you should follow their advice.

Disclosing your cannabis and CBD usage before surgery to a doctor is extremely important because it will have an impact on the overall surgery as well as their recovery plan for you.

Before Surgery

You should also keep in mind that for safety, a great deal of supplements and medications, CBD and Vitamin D included, should be discontinued at least 48 hours prior to surgery. The presence of CBD in the blood can cause it to thin, which is why medical professionals always tell patients to discontinue it before surgery. This is even more important if you are already taking blood-thinning medication.

The reason behind this is that blood thinners can cause bleeding time and would healing to be prolonged during and after surgery. Additionally, though while we know CBD and cannabis are safe on their own, there can be contraindications when combined with other kinds of medications including anesthesia.

It’s understandable that you may want to medicate with CBD to help manage the anxiety before a surgery. So while it is safe to take it beforehand, it’s always best to discontinue CBD and all other medications at least 2 days, or even longer if you can. You can assume that CBD will be safe to use until you are told to discontinue other normal food, beverages, and medications by your surgeon.

Increased Anesthesia and Opioid Levels

Studies show that cannabis consumers required more anesthesia and opioids compared to nonusers, during surgery.

One study in particular found that using cannabis prior to surgery caused pain levels to increase. “There is some evidence that cannabis may be beneficial for chronic and nerve pain. However, early research suggests that this is not the case for acute pain such as for surgery of a broken leg,” explains lead author Dr. Ian Holmen. The study found that subjects who used cannabis before they went into surgery reported higher pain levels and needed more opioids as well as anesthesia.

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“This study shows that it is important for patients to tell their physician anesthesiologist if they have used cannabis products prior to surgery to ensure they receive the best anesthesia and pain control possible, including the use of non-opioid alternatives,” says Holmen.

Though the results aren’t necessarily fatal, disclosure of your use is still important. “We want to know if there might be a need for more anesthesia,” Holmen says. “The last thing we want to do is to be under-dosing if someone is going to have an increased requirement. The more information we have, the more we can react and monitor to keep a patient safe during a procedure.”

Remember that your anesthesiologist is legally obliged to give you the best possible care for your surgery. If they recommend that you stop consuming cannabis or CBD beforehand, this is only for your safety and well-being. They will absolutely not allow surgery if you are intoxicated, including high from cannabis; in some occasions they may even have to postpone

Post Operation: Benefits of CBD

Once you come out of surgery, it’s normal to experience pain in the areas that were worked on during the surgery. That’s why at the end of a surgical procedure, doctors will provide you with some kind of prescription medication to help speed up recovery and mitigate pain CBD contains powerful anti-inflammatory properties, which is why it’s the go-to medication for many who need to manage pain, post-surgery included.

Taking CBD to help manage post-operative pain is safe to do, just be sure to check any contraindications with other medicines you are already taking post op. CBD taken in a variety of ways can help manage secondary symptoms of post-surgery pain including headaches, arthritis, muscle pains, and more. It also does a terrific job at relieving muscle and joint pain while improving sleep, which is necessary to helping you recover well after surgery.

Speaking of sleep, getting some shut-eye can be especially difficult after surgery when you have bandages, stitches, wounds, and casts. And in order to get that deep, restful, healing sleep that you need, CBD does the job.

CBD is a known antibiotic, which means that it can help enhance the healing process by getting rid of any microorganisms that may enter the body during recovery. Your immunity is much lower than usual after surgery, and this is another aspect where CBD can help post op.

How to Consume CBD

The most effective ways to consume CBD are through tinctures, oils, and edibles. These forms are known to be more potent and deliver fast-acting, long-lasting pain relief. CBD is safe and there is no chance that you can take too much for it to be risky, however, if it’s your first time consuming CBD, always start with a low dose.

As always, it’s important to consult your doctor if you want to include CBD in post-operative care. Though it is considered a neutral supplement, CBD can still interact with other kinds of medications.

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