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An expert panel unveiled a preoperative cannabis use assessment tool to aid in planning informed, individualized anesthesia and analgesia patient care.

An expert panel has created a preoperative cannabis use assessment tool to aid healthcare professionals in planning informed, individualized anesthesia and analgesia care for patients. The team published the finalized Cannabis Use and Behaviors Assessment Tool (CUBAT) online in the Journal of PeriAnesthesia Nursing.

Rationale for a Dedicated Screening Instrument

Growing evidence indicates that perioperative pharmacodynamics differ between cannabis users and non‑users.

“[P]reliminary studies point toward differences in anesthetic responses between people who use cannabis and those who do not,” noted study author Daniel D. King, DNP, CRNA, CPPS, CNE, of Rosalind Franklin University, and colleagues. “For example, during endoscopic procedures, regular cannabis use may necessitate significantly higher doses of propofol, fentanyl, and midazolam to achieve adequate sedation levels.”

Cannabis use can also affect patient awareness or recall from unintentional subanesthetic dosing and complicate airway management through upper airway mucus accumulation and inflammation.

Development Process & Expert Consensus

To address these challenges, two physicians, five certified registered nurse anesthetists, and one student registered nurse anesthetist—averaging 25.3 years of healthcare experience—synthesized current evidence to create CUBAT. The multidisciplinary panel reached 100% consensus on the instrument’s content by its second revision before publishing the final version.

Seven Core Questions Capture Critical Details

CUBAT comprises seven concise questions that elicit recent cannabis use, frequency, primary consumption method, product concentration/contents, underlying reasons for use, and any adverse reactions or withdrawal symptoms. This structured inquiry provides anesthesia professionals with the data needed to anticipate altered drug requirements and airway considerations, thereby enabling individualized perioperative plans.

Emphasis on Respectful Patient Dialogue

“Notably, the importance for health care providers to create a safe and non-judgmental environment for their patients to discuss their cannabis use openly was emphasized by the expert panel,” the authors wrote. “While the introduction of the CUBAT into clinical practice may increase provider knowledge and comfort in assessing cannabis use during the preanesthesia evaluation, the tool also uses neutral language to maintain respect for patients using cannabis.”

Alignment With National Recommendations

In 2023, the American Society of Regional Anesthesia and Pain Medicine recommended universal screening for cannabinoids before surgery, including the type, dose, last use, route, and frequency, according to the paper.

“The CUBAT includes all these variables and provides example language for providers to use with patients,” the authors wrote.

Future Validation & Implementation

Despite the rising prevalence of cannabis use, CUBAT is the first instrument tailored to preanesthesia assessment. Early users in a pilot study deemed it straightforward and intuitive.

“The tool should be incorporated in clinical practice,” the study team concluded, “and subsequent validation studies are needed.”