P060: THE IMPACT OF CANNABIS USE AMONG PATIENTS UNDERGOING ANESTHESIA: A REVIEW
Dylan Irvine, DO1; Imani Thornton, MD1; John Williams, MD2; Tricia Meyer, PharmD3; Jeffrey Huang, MD4
1HCA Florida Westside Hospital; 2BSW Memorial Hospital; 3Texas A&M College of Medicine; 4Moffitt Cancer Center
Background: Cannabis use in the United States has risen significantly. Approximately 42% of adults 18 – 35, 29% of adults 35 – 50, and 21% of adults over 50 years of age have reported using cannabis products in 2023. This increase coincides with the legalization of medical cannabis in 47 states and recreational cannabis in 24 states as of February, 2024. As cannabis use becomes more prevalent, anesthesia providers must understand its potential cardiopulmonary, gastrointestinal, and central nervous system effects to safely manage patients perioperatively.
Methods: This review examines the pharmacological properties of cannabis, its effects on anesthesia, and key perioperative considerations for patients who use cannabis. It synthesizes current literature on cannabis pharmacokinetics, drug interactions, and potential anesthetic implications in the preoperative, intraoperative, and postoperative phases. Specific focus is placed on THC's interactions with the P450 enzyme system, cardiovascular risks, and its impact on anesthesia dosing, especially in relation to sedation and pain management.
Results: Cannabis users may experience a range of effects during anesthesia, including altered drug metabolism and increased anesthetic requirements. THC, primarily metabolized by the P450 enzyme system, may affect the function of anticoagulants as well as result in additive pharmacodynamic effects with sedative medications used in anesthesia administration. In the preoperative phase, a thorough cannabis history is critical to assess risks such as acute intoxication, cardiovascular issues, and withdrawal symptoms. Intraoperatively, cannabis users may require higher doses of certain anesthetics like sevoflurane, though evidence is limited and varies by study. Postoperatively, cannabis users are more likely to report higher pain scores, require more analgesics, and may experience withdrawal symptoms, which complicates pain management.
Conclusions: As cannabis use continues to rise, anesthesia professionals must be prepared for its diverse effects on perioperative care. Enhanced understanding of cannabis pharmacology and its potential interactions with anesthesia drugs will enable better risk mitigation strategies. Special attention should be given to preoperative cannabis use to prevent acute intoxication, manage cardiovascular risks, and address withdrawal symptoms. Intraoperative care should focus on potential drug interactions and the need for higher anesthetic doses, while postoperative care should prioritize effective pain management and monitoring for withdrawal. Continued research is needed to optimize perioperative management for cannabis users.