Marijuana and Anesthesia: Explore The Intriguing Link

Cannabis Use and Anesthesia

When it comes to the relationship between cannabis use and anesthesia, there are several key considerations that anesthesiologists must take into account. This section will explore the impact of cannabis on anesthetic requirements as well as the potential for cardiac and respiratory events during anesthesia.

Impact on Anesthetic Requirements

Research suggests that cannabis use may impact anesthetic requirements, particularly in terms of induction and maintenance doses. A study conducted on patients undergoing esophagogastroduodenoscopy (EGD) procedures found that self-reported cannabis users did not require significantly different amounts of propofol, fentanyl, or ketamine compared to non-users of cannabis. In another study, it was observed that chronic cannabis users may require higher induction doses of propofol, and higher doses of volatile agents may be needed for maintenance of anesthesia [2].

It is important for anesthesiologists to closely monitor patients who use cannabis, as individual variations in response to anesthesia may occur. Adjustments to the dosage and administration of anesthetic agents may be necessary to ensure adequate sedation and pain control during surgical procedures.

Cardiac and Respiratory Events

The potential for cardiac and respiratory events during anesthesia is a critical concern for anesthesiologists. However, studies have shown that there are no significant differences in adverse cardiac or respiratory events within 30 days for both cannabis users and non-users undergoing EGD procedures. This indicates that cannabis use alone may not be a strong predictor of adverse events during anesthesia.

However, it is important to note that the effects of cannabis on the cardiovascular and respiratory systems can vary depending on the individual and the amount and frequency of cannabis use. Anesthesiologists should consider the potential respiratory and cardiovascular effects of cannabis when planning and administering anesthesia to patients who use cannabis regularly.

By closely monitoring patients who use cannabis and considering potential variations in anesthetic requirements and the risk of cardiac and respiratory events, anesthesiologists can ensure the safe and effective administration of anesthesia to individuals who use cannabis. Further research is needed to fully understand the impact of cannabis on anesthesia and to establish best practices for patient care in this context.

Cannabis Legalization and Usage

As the legal landscape surrounding cannabis continues to evolve, it is important to understand the current status of its legality and the trends in cannabis consumption.

Legal Status in the US

Marijuana remains illegal at the federal level in the United States. However, there has been a significant shift in legislation at the state level. As of now, cannabis is regulated for legal medical use in 36 states and for recreational use in 16 states, including the District of Columbia.

The legal status of cannabis varies from state to state, with some states decriminalizing possession, while others have implemented more comprehensive legislation allowing for medical or even recreational use. It is important to note that despite state-level legalization, cannabis remains illegal under federal law.

Trends in Cannabis Consumption

Cannabis is one of the most commonly used illicit drugs in the United States, and its usage has been on the rise in recent years. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the rate of cannabis use within one year among individuals aged 12 and older increased from 10.9% in 2008-2009 to 14.5% in 2016-2017. This represents a significant increase in cannabis consumption across the country.

The use of cannabis varies from state to state, reflecting the different legal frameworks in place. In states where both medical and recreational use are legal, such as Massachusetts, the rate of cannabis use has shown a substantial increase. In Massachusetts, the rate of cannabis use within one year among individuals aged 12 and older increased from 14.6% to 20% between 2008-2009 and 2016-2017.

As legalization and acceptance of cannabis continue to grow, it is important for healthcare professionals, including anesthesiologists, to stay informed about the legal status and trends in cannabis consumption. This knowledge helps in providing appropriate care and understanding the potential impact of cannabis on anesthesia and perioperative management.

Effects of Cannabis on the Body

When examining the relationship between cannabis and anesthesia, it is important to understand the effects of cannabis on the body, particularly its impact on the respiratory and cardiovascular systems, as well as its potential for developing tolerance to anesthetic agents.

Respiratory and Cardiovascular Effects

Cannabis use can have notable effects on the respiratory and cardiovascular systems. Patients who smoke cannabis may experience airway inflammation and mucosal injury, leading to an increased incidence of coughing, wheezing, and phlegm production. These respiratory effects can pose challenges during anesthesia and airway management [1].

In terms of the cardiovascular system, cannabis consumption can elicit tachycardia (increased heart rate) and precondition the myocardium to adverse events. These effects can have implications for the administration of anesthesia, as anesthesiologists need to closely monitor cardiovascular parameters and adjust their management strategies accordingly.

Tolerance to Anesthetic Agents

Another important consideration when it comes to cannabis use and anesthesia is the potential development of tolerance to anesthetic agents. Chronic cannabis users may develop tolerance to the neurocognitive effects of the drug. However, it remains unclear whether cross-tolerance exists between cannabis and anesthetic agents.

This potential tolerance to anesthetic agents can impact the dosages required for induction and maintenance of anesthesia in patients who use cannabis. Research suggests that cannabis users may require higher induction doses of propofol, and higher doses of volatile agents may be necessary for the maintenance of anesthesia [2]. Anesthesiologists should carefully consider these factors when planning and administering anesthesia to patients who use cannabis.

Understanding the respiratory and cardiovascular effects of cannabis, as well as the potential for tolerance to anesthetic agents, is crucial for anesthesiologists in providing safe and effective care to patients who use cannabis. By considering these effects and adjusting anesthesia management strategies accordingly, anesthesiologists can ensure optimal outcomes for patients undergoing surgery or other medical procedures.

Considerations for Anesthesiologists

Anesthesiologists play a crucial role in managing patients before, during, and after surgery. When it comes to patients who use cannabis, there are specific considerations that anesthesiologists need to keep in mind to ensure optimal patient care.

Documenting Cannabis-Related Morbidity

To enhance patient care and safety, it's important for anesthesiologists to document and publish case reports or series of suspected cannabis-related perioperative morbidity and mortality. This documentation plays a vital role in creating best practices for the care of this growing patient population. By sharing these experiences and insights, anesthesiologists can contribute to the collective knowledge and understanding of the potential risks and complications associated with cannabis use in the perioperative period.

Best Practices for Patient Care

When it comes to patients who use cannabis, anesthesiologists need to be aware of the potential effects and risks associated with cannabis consumption. The following best practices can help guide patient care:

1. Preoperative Assessment: Anesthesiologists should inquire about a patient's cannabis use, including the frequency and method of consumption, before surgery. This information is crucial in assessing the patient's risk factors during surgery and recovery.
2. Airway and Respiratory Considerations: Patients who smoke cannabis are known to experience airway inflammation, mucosal injury, and increased incidence of coughing, wheezing, and phlegm production. This can predispose them to airway complications during anesthesia. Anesthesiologists should be vigilant in monitoring and managing any respiratory issues that may arise.
3. Cardiovascular Monitoring: Cannabis consumption can elicit tachycardia and precondition the myocardium to adverse events. Anesthesiologists should closely monitor cardiovascular parameters during surgery to ensure patient safety.
4. Timing of Cannabis Use: It is recommended to delay elective surgery until at least two hours after the patient's last use of cannabis, particularly smoking, to minimize the risk of adverse cardiovascular events.
5. Postoperative Management: Anesthesiologists should be aware of potential withdrawal symptoms associated with cannabis use and develop appropriate management strategies. Close monitoring of pain control and potential interactions with other medications is crucial for optimal postoperative care.

By adhering to these best practices, anesthesiologists can ensure the safety and well-being of patients who use cannabis during the perioperative period. Ongoing research and collaboration among healthcare professionals will continue to contribute to our understanding of the impact of cannabis on anesthesia and guide future recommendations and guidelines.

Preoperative Cannabis Use

When it comes to preoperative cannabis use, there are certain risks and considerations that both patients and healthcare professionals should be aware of. This section will delve into the potential risks during and after surgery, as well as the management of withdrawal symptoms associated with cannabis use.

Risks During and After Surgery

Smoking marijuana shortly before surgery can increase the risk of experiencing a heart attack during or after the procedure. As a result, guidelines from the American Society of Anesthesiologists advise physicians to delay elective surgery until at least two hours after the patient's last use of marijuana. This precaution is aimed at minimizing the potential cardiovascular complications that can arise during the perioperative period.

Moreover, research suggests that individuals who regularly use cannabis may experience heightened levels of pain and nausea after surgery compared to non-users. Prolonged exposure to cannabis may lead to increased sensitivity to pain due to cannabinoid receptors in the spine. Therefore, it is important for patients to disclose their cannabis use to their healthcare team to ensure appropriate pain management strategies are in place.

Patients who use cannabis should be aware of the potential gastrointestinal effects related to cannabis use, such as cannabinoid hyperemesis syndrome, which may prompt further diagnostic procedures like esophagogastroduodenoscopy (EGD) studies. It is important to note that performing EGDs without an endotracheal tube or protected airway may predispose patients to airway complications.

Withdrawal Symptoms and Management

Individuals who use cannabis, particularly those who use it frequently, may experience withdrawal symptoms after surgery. However, it is important to note that the risk of withdrawal is minimal for those who solely use products containing CBD, without the psychoactive component THC [3].

When discussing cannabis use with an anesthesiologist, patients should inquire about the likelihood of experiencing withdrawal symptoms and the planned approach for managing them if they were to occur. Open communication and transparency between patients and healthcare providers are crucial in ensuring the best possible outcomes and patient comfort during the perioperative period.

Research Gaps and Future Studies

While there have been studies conducted on the relationship between marijuana use and anesthesia, there are still gaps in our understanding. Further research is needed to provide a more comprehensive understanding of this topic. In particular, two areas warrant attention: the need for larger studies and exploring different procedure types.

Need for Larger Studies

To confirm the findings of existing studies and to gain a more accurate understanding of the effects of cannabis use on anesthesia, larger-scale studies are necessary. These studies should involve a diverse range of patients and take into account various procedure types and durations. By expanding the scope of research, we can obtain more robust and generalizable results.

Larger studies can help identify any potential correlations between cannabis use and anesthetic requirements, as well as any associated cardiac and respiratory events. By examining a broader patient population, researchers can better understand the impact of cannabis on anesthesia in different contexts, providing valuable insights for anesthesiologists and healthcare professionals.

Exploring Different Procedure Types

While some studies have focused on specific procedures such as esophagogastroduodenoscopy (EGD) (NCBI), it is important to expand research to include a variety of procedure types. Different procedures may have unique considerations and characteristics that could influence the effects of cannabis on anesthesia.

By exploring a wider range of procedure types, researchers can uncover potential differences in anesthetic agent requirements, as well as any associated cardiac and respiratory morbidity. This knowledge can help anesthesiologists tailor their approach to patients who use cannabis, ensuring safe and effective care.

Understanding the implications of cannabis use on anesthesia across diverse procedure types is crucial for delivering optimal care to patients. It allows healthcare professionals to develop tailored protocols and guidelines that address the specific needs and risks associated with different procedures.

By conducting larger studies and exploring different procedure types, we can advance our understanding of the relationship between marijuana use and anesthesia. This knowledge will contribute to the development of evidence-based practices and guidelines, enabling healthcare professionals to provide safe and effective anesthesia care to patients who use cannabis.

References

• [1]: https://www.ncbi.nlm.nih.gov
• ‍[2]: https://www.ncbi.nlm.nih.gov
• ‍[3]: https://www.asahq.org