Marijuana Use and the Surgical Patient

We just recognized the nurses who care for patients and families during the pre-operative and post-operative periods. Much has changed since the first surgery of a leg amputation on a child living on the island of Borneo, documented during the Stone Age, approximately 31,000 years ago (Maloney et al., 2022). It wasn’t until 1842 that ether was reported as being used as an anesthetic (Abhyankar & Jessop, 2022). The world has come a long way since then. Globally, approximately 310 million surgeries are performed annually; 40 to 50 million occur in the United States and 20 million in Europe (Dobson, 2020). Some of the most common surgeries performed in the U.S. today are appendectomy, breast biopsy, carotid endarterectomy, cataract surgery, cesarean section, and cholecystectomy (John Hopkins, 2025). Each stage of the surgical process brings unique care rendered by the interprofessional team. One aspect we want to focus on is the use of cannabis/marijuana and the surgical patient. With many states legalizing this product, healthcare workers must know how it affects the body. 

It Begins in the Pre-operative Phase

In the pre-operative phase, one of a nurse’s primary responsibilities is to conduct a thorough patient assessment. This is especially critical to ensuring patient safety. Preparation begins well before the procedure, requiring nurses to review medications, drug and alcohol use, and allergies, coordinate necessary diagnostic tests such as X-rays, scans, and blood work, and obtain written consent from the patient or their healthcare proxy for both preoperative evaluations and the surgery itself.

One essential aspect of this assessment is reviewing the patient’s smoking history. Whether the patient is a current or former smoker—or uses vaping products—this information is crucial, as smoking can significantly impact surgical outcomes.  In addition, the use of marijuana has become legal in many states and or is legal for medicinal purposes. Though marijuana is purported to have analgesic and sedative benefits, it is not without risk. The American College of Surgeons (AMS, 2025) highlights several known and potential dangers of marijuana and how the use of this product can impact surgical procedures.

Smoking marijuana before surgery has the potential to cause the following issues:

1.      Swelling of the uvula for up to 24 hours.

2.      Increase one's risk for difficulty breathing.

3.      Increases risk for aspiration due to choking or gagging - leads to pneumonia.

4.      This could lead to difficult intubation, and one may need more medication to be intubated.

5.      Weaning from the ventilator after surgery may be more challenging, requiring the patient to stay on the vent longer.

6.      Chronic marijuana vaping can cause inflammation of the lung tissue, which can increase the risk of respiratory infections.

7.      Marijuana reduces oxygen in the blood and thus can affect surgical wound healing.

8.   Pain control may be disrupted with marijuana use, and the need for additional pain medication may be required in the post-op period. 

Marijuana Cessation Before Surgery

The American College of Surgeons recommends that a patient refrain from using marijuana products at least 72 hours before their surgical procedure. 

Ensuring Safe and Effective Surgical Care

Surgery is a complex journey that extends beyond the operating room, requiring careful attention at every stage—from preoperative preparation to intraoperative management and postoperative recovery. By recognizing patients' potential challenges during each phase, healthcare professionals can enhance safety, improve outcomes, and provide compassionate, patient-centered care.

As medical advancements evolve, so should our commitment to refining best practices, educating patients, and addressing their unique needs. Nurses should stay informed about the care of surgical patients, as you never know when you may be in charge of their care. 

References

Abhyankar, R.S., & Jessop, K.M. (2022).  From craft to profession: The development of modern anesthesiology. Part II. Missouri Medicine. 119(1), 14-20.

American College of Surgeons. (2025). Marijuana and surgery. https://www.facs.org/for-patients/preparing-for-surgery/marijuana-and-surgery

Dobson G. P. (2020). Trauma of major surgery: A global problem that is not going away. International Journal of Surgery (London, England), 81, 47–54. https://doi.org/10.1016/j.ijsu.2020.07.017

John Hopkins Medicine. (2025). Health: Common surgical procedures. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/common-surgical-procedures

Maloney, T.R., Dilkes-Hall, I.E., Vlok M, et al.  (2022). Surgical amputation of a limb 31,000 years ago in Borneo. Nature. 609(7927), 547-551. doi:10.1038/s41586-022-05160-8