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OfflineTiberjuggaligger
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Registered: 08/19/17
Posts: 622
Loc: USA
Last seen: 3 days, 13 minutes
Regular Marijuana Use Changes Anesthesia Needs
    #26978391 - 10/10/20 01:28 PM (18 days, 23 hours ago)

The recreational use of marijuana is currently legal in 11 states—Alaska, California, Colorado, Illinois, Maine, Massachusetts, Michigan, Nevada, Oregon, Vermont and Washington—and also in Washington, D.C. Several other states allow marijuana use for medicinal reasons. State legislative changes that have legalized marijuana have brought both medical opportunities and challenges. One challenge involves understanding the effect of cannabis on procedural anesthesia.

In a retrospective study published in the Journal of the American Osteopathic Association (2019; 119:307-311), investigators examined whether patients who regularly used cannabis required more anesthesia during endoscopy, and found that perhaps unsurprisingly, they did.

“The research does not suggest that people should not use cannabis,” said Mark A. Twardowski, DO, with Western Medical Associates in Grand Junction, Colo. “It just suggests that the use is not without consequences. One consequence is that more medications may be required for procedures. This increased dose may put people at a higher risk for respiratory suppression during endoscopic procedures.”

Propofol Requirements Doubled

In this single-center study, 250 medical records were reviewed from a single endoscopist practicing in Colorado, to minimize variability in sedation technique. The researchers investigated whether there was variation in relative amounts of sedation medication required in cannabis users versus nonusers. In Colorado, recreational cannabis use was legalized in 2012.

For sedation, cannabis users needed an average of 125.93 mcg of fentanyl, 9.15 mg of midazolam, and 44.81 mg of propofol, compared with nonusers who needed 109.91 mcg of fentanyl, 7.61 mg of midazolam, and 13.83 mg of propofol. The differences translated to an additional 14% of fentanyl, an additional 19.6% of midazolam, and a whopping 220.5% more propofol during endoscopy needed by cannabis users.

Dr. Twardowski, an internist who performs endoscopies, hypothesized that marijuana could increase anesthesia requirements based on anecdotal observation. “The information has galvanized what we thought we were seeing as a trend [in practice],” he said.

The findings have already influenced how Dr. Twardowski and his colleagues screen patients. “We are being careful to obtain cannabis use status from our patients and to recognize that we may need to use more medications in that population who regularly uses cannabis,” he said. Specifically, a nursing preprocedure question about cannabis use was added to patient intake forms in January 2015.

Looking forward, Dr. Twardowski said, “The next step for my team is to further investigate the relationships in a broader array of perioperative sedation, anesthetic and pain control medications to see if we can find any useful trends that may help guide future clinical practice. We will begin to evaluate the effects on a broader group of anesthetic agents in the next phase of the study.”

It remains unclear what effect regular cannabis use has on the need for opioids and other pain medications. “We do not know if regular users require higher doses of pain medications. This has not been well studied. We will begin to look at some of these issues in phase 2 of our study,” Dr. Twardowski said.

Response bias did not appear to be a limitation of the study. “We find that patients are generally honest about their use status since it is legal in Colorado. They are even more likely to be honest when they discover the information may have an effect on their medical care,” Dr. Twardowski said.

Up-to-date research indicates that the half-life of tetrahydrocannabinol (THC), the main active component of cannabis, is five to 13 days, with total excretion taking up to 25 days.

As for the mechanism underlying the effect of cannabis on anesthesia, experts hypothesize that THC may interact with specific cannabinoid receptors, potentially including opioid and benzodiazepine receptors. Consequently, the interaction of opioids or benzodiazepines with these receptors in patients who regularly use cannabis could be disrupted.

Historically, it has been difficult to study the effects of marijuana on dose requirements for sedatives because it is classified as a Schedule I drug by the Drug Enforcement Administration. A 2009 study, done in Australia, analyzed the induction dose of propofol necessary in patients using cannabis in 30 users versus 30 nonusers. The investigators concluded that cannabis use increased the need for propofol during anesthesia when employing a laryngeal mask.

Dr. Twardowski commented on the results of the study. “My medical opinion about cannabis is that it is a reality that we have to deal with. I am neither pro nor con, but I am frustrated—as everyone in health care should be—that a substance has been legalized for general consumption with almost no meaningful evaluation of its true medical effects, drug interactions, etc. The substance was demonized and therefore not able to be studied, then it was legalized without appropriate research.”

—Naveed Saleh, MD, MS


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OfflineHolybullshit
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Registered: 01/06/19
Posts: 565
Last seen: 13 hours, 20 minutes
Re: Regular Marijuana Use Changes Anesthesia Needs [Re: Tiberjuggaligger]
    #26978454 - 10/10/20 02:28 PM (18 days, 22 hours ago)

Aren't dosage levels during anesthesia usually calibrated by evaluating vital signs, oxygen level, and responsiveness anyways? Some people require more, some less, I don't see how cannabis being the reason for requiring higher doses is all that important if this is the only "complication" manifested by its use.

Sure it may be helpful to know going in that a patient may require higher doses, but I don't see how it presents any real challenges. No decent anesthesiologist would ever assume any patient is at the proper depth of anesthesia just because they were administered a dose that usually works on others.

Anesthesia of obese patients is far more complicated and risk-laden but I don't see doctors expressing "frustration" that fast food and soda are legal.

If the medical community wants to be frustrated about the unknown medical effects of certain compounds legal use then environmental toxins like PFAS and endocrine disruptors found in plastics and cosmetics seem like much better targets.

He may not be pro or con regarding the use of cannabis, but it seems he comes down squarely on one side regarding its legality. But maybe he should consider the impact keeping substances like cannabis illegal has on the health of those unfortunate enough to be prosecuted for their possession.


Edited by Holybullshit (10/10/20 02:43 PM)


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OfflinePeyote Road
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Registered: 09/02/15
Posts: 3,519
Loc: Great Lakes State
Last seen: 19 hours, 30 minutes
Re: Regular Marijuana Use Changes Anesthesia Needs [Re: Holybullshit]
    #26978536 - 10/10/20 03:24 PM (18 days, 21 hours ago)

Quote:



Anesthesia of obese patients is far more complicated and risk-laden but I don't see doctors expressing "frustration" that fast food and soda are legal.




Well the hospital I used to work at banned the sale of soda, so I'm not so sure about that.


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The path of the herbalist is to open ourselves to nature in an innocent and pure way. SHe in turn will open her bounty and reward us with many valuable secrets. May the earth bless you. - Michael Tierra


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OfflineHolybullshit
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Registered: 01/06/19
Posts: 565
Last seen: 13 hours, 20 minutes
Re: Regular Marijuana Use Changes Anesthesia Needs [Re: Peyote Road]
    #26978842 - 10/10/20 07:13 PM (18 days, 17 hours ago)

Completely the same as wanting people to surrender their freedom and/or money for possessing it.

Doctors may be frustrated that people consume junk food, but I've never seen anything to indicate the medical community is upset about its legality.


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InvisiblePsychoReactive
CocaTea.com
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Registered: 05/22/09
Posts: 2,372
Loc: Cocalero
Re: Regular Marijuana Use Changes Anesthesia Needs [Re: Holybullshit]
    #26983480 - 10/13/20 04:30 PM (15 days, 20 hours ago)

Anyone use CBD oil for aches and pains? Any good?


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OfflineOggy
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Registered: 12/05/14
Posts: 1,273
Loc: Planet Remulak
Last seen: 11 days, 20 hours
Re: Regular Marijuana Use Changes Anesthesia Needs [Re: PsychoReactive]
    #26984863 - 10/14/20 12:38 PM (15 days, 4 minutes ago)

well that's terrifying.

anesthetics are one of those things that doctors don't fully understand and can cause irreparable damage to people if given incorrect amounts.


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OfflineHolybullshit
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Registered: 01/06/19
Posts: 565
Last seen: 13 hours, 20 minutes
Re: Regular Marijuana Use Changes Anesthesia Needs [Re: Oggy]
    #26986588 - 10/15/20 10:04 AM (14 days, 2 hours ago)

But they aren't going to just automatically administer more because one reported cannabis use, they will aim for the same level of anesthesia as always...there could be some unforeseen side effects of larger doses that are totally independent to the depth of sedation, but I doubt they are dangerous especially considering how infrequently one is likely to be put under.

If anything I'd imagine the larger risk would be not being anesthetized enough, not being ODed. And just because this info is just now being made available doesn't mean cannabis users haven't been being successfully anesthetized without complications for decades.

Tolerance is tolerance, unless the compounds are significantly mutagenic/genotoxic or carinogenic and even then acute use isn't that much of a worry.


Edited by Holybullshit (10/20/20 09:27 AM)


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