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Avoiding unnecessary resource use and controlling emissions are important approaches to reduce the environmental impact of perioperative care. Updated Canadian Anesthesiologists’ Society guidelines re-emphasize specific strategies that include choosing reusable, reprocessable equipment rather than single-use disposable items, recycling materials when feasible, and responsibly using inhalation anesthetic agents (e.g., low fresh gas flow during delivery; minimizing use of desflurane and nitrous oxide; selecting alternative techniques such as total intravenous anesthesia [TIVA] or neuraxial or regional anesthetic approaches when appropriate).1

In December 2022, the American Society of Anesthesiologists and the Anesthesia Patient Safety Foundation published a joint statement updating recommendations about preoperative COVID-19 testing.2 Instead of routine preoperative universal COVID-19 testing in asymptomatic patients, they now recommend preoperative screening for symptoms of COVID-19 and contact with patients with COVID-19, robust infection control measures, and targeted testing taking into account community incidence of COVID-19 and facility ability to distance patients. Asymptomatic screening may be associated with unnecessary procedure delays and additional cost and is unlikely to provide benefit if infection prevention strategies are used.

ASRA Pain Medicine (ASRA) has developed a new guideline for managing the perioperative patient on cannabis and cannabinoids, given the increasing number of such patients.3 Among the recommendations, all patients reporting chronic use of cannabinoids should be counseled on the potential risks of continued perioperative use. Elective surgery should be postponed in patients with altered mental status or impairment of decision-making capacity due to acute cannabis intoxication; even in the absence of overt intoxication, a delay of at least two hours after smoking cannabis is recommended to avoid a possible increased risk of myocardial infarction.