Caring For the Patient Who Uses Cannabinoids
by Heather Ead, MHS, BScN, RN
nurse should be aware of how the drug works and the implications for patient assessment, monitoring, and health teaching. Screening for Cannabis use can help anticipate unpredictable responses to analgesics and other medications. In all phases of perianesthesia care, we can anticipate caring for patients who use cannabinoids more frequently. Keeping up to date with these trends empowers nurses with knowledge that helps us provide safe care and advocate for our patients.
Cannabinoids activate the cannabinoid receptors CB1 and CB2. The CB1 receptors are found mainly in the central nervous system, providing pain relief, muscle relaxation, and antiemetic effects, whereas the CB2 receptors are found largely in the peripheral tissues. CB2 receptors are known to have antiinflammatory and immune responses.2 The perianesthesia nurse may need to provide care for patients who have become accustomed to regular use of Cannabis and the benefits these drugs provide. However, the nurse should be mindful that Cannabis use does not confirm the presence of abuse or addiction. Instead an objective, nonjudgmental approach should be used to gather a health
history that includes the use of commonly used drugs such as alcohol, tobacco, and Cannabis.
pain, anorexia and cachexia, epilepsy, posttraumatic stress disorder, insomnia, headaches, inflammatory bowel disease, glaucoma, multiple sclerosis, and Parkinson’s disease.3 The list of therapeutic uses is anticipated to grow, reinforcing the
importance for nurses to be aware of misconceptions and stigmas that can be harmful to a therapeutic nurse-patient relationship.
greater postoperative hypothermia and shivering due to the antinociceptive effects of THC on the pathways involved with pain and temperature sensation.4 Although shivering may only be a minor annoyance for most patients, hypothermia can place increased physiological demands on the patient and lead to negative cardiovascular sequelae. Tachycardia, hypoxia, cardiac arrhythmias, and even myocardial infarct can be triggered in vulnerable patients.4 With knowledge of this
risk, the perianesthesia nurse can implement strategies in a proactive manner, such as use of a warming blanket during the Phase one recovery period.
tachycardia, and upper airway distress.1,5 Individuals who intake Cannabis by smoking the product (vs vaporizing or oral dosing) may also have a higher occurrence of stridor, airway distress, and postoperative laryngeal edema. This may be due to the presence of irritants found in Cannabis smoke, such as carbon monoxide.1 Having an accurate understanding of the patient’s preoperative Cannabis use will help to optimize pain management and manage unexpected fluctuations
in vital signs related to pain, shivering, or airway irritation.
combining Cannabis with prescribed pain medications. Common adverse effects that occur with Cannabis use are somnolence, dizziness, disorientation, and impairment of psychomotor skills, short-term memory, and judgment.6 These may lead to issues such as increased falls risk, oversedation, loss of recall of health teaching instructions, and accidents that cause harm to the patient or others (such as driving while impaired). One can see the serious risks of using Cannabis after discharge, particularly if combined with prescribed opioids. The physician may prescribe a reduced dose postoperatively, as appropriate for the patient, or put cannabinoids entirely on hold to achieve a balance of patient safety and comfort. For example, the patient who uses cannabinoids daily for fibromyalgia or a seizure disorder may have been instructed to reduce their Cannabis to a specific dose, versus the recreational user being advised to omit Cannabis use entirely until seen at a follow-up appointment with the physician. Overall, the understanding of the endocannabinoid
system and the physiological benefits of stimulating the cannabinoid receptors continue to be an area of interest, with need for further clinical studies.1,3 Although it is a complex and controversial topic, we can support the safety of our patients by taking time to learn and have a working knowledge of the endocannabinoid system, its receptors and the implications of Cannabis therapy on perianesthesia care. This knowledge will help nurses to continue to act as
advocates for our patients.
The ideas or opinions expressed in this editorial are those solely of the author and do not necessarily reflect the opinions
of ASPAN, the Journal, or the Publisher.
Heather Ead, MHS, BScN, RN, Trillium Health Partners, Mississauga, Ontario, Canada.
Conflict of interest: None to report.
Address correspondence to:
Partners, 100 The Queensway West, Mississauga, ON, Canada L5B1B8;
2018 by American Society of PeriAnesthesia Nurses
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3. Katz I, Katz D, Shoenfeld Y. Clinical evidence for utilizing cannabinoids. Isr Med Assoc J. 2017;19:71-75.
4. Sankar-Maharaj S, Chen D, Hariharan S. Postoperative shivering among cannabis users at a public hospital in Trinidad,
West Indies. J Perianesth Nurs. 2018;33:37-44.
physician. Can J Anaesth. 2016;63:608-624.
6. Turgeman I, Bar-Sela G. Cannabis use in palliative oncology: A review of the evidence for popular indications.
Isr Med Assoc J. 2017;19:85-89.
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