Does Cannabis Increase Your Anesthesia Requirements?

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cannabis and anesthesia

We have offered patients anesthesia with their procedures for years. However, being in Colorado where the term “Rocky Mountain High” isn’t just a song lyric, I’ve noticed a trend. Patients who use cannabis products tend to require MUCH more anesthesia to be put to sleep. So is this a thing? Let’s dig in.

What Is IV Anesthesia?

Many patients who are getting more extensive injection-based procedures or things like a colonoscopy will want to get IV anesthesia. This is usually medication to make the patient relaxed or feel less pain. This is different than general surgical anesthesia where a breathing tube is inserted and gases are used to keep the patient asleep.  That’s called endotracheal anesthesia. The IV procedure type of anesthesia is often called “Twilight” or “IV Sedation” and this whole category is also known as “MAC” (Monitored Anesthesia Care).

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When Is Anesthesia Needed?

When we have many areas to treat or the procedure requires injections where the patient needs to remain still or the procedure would be more painful, we offer the patient this type of IV anesthesia. The good news is that most patients require set amounts of medication to stay asleep based on body type, age, and genetics. However, recently, we have been noticing a trend that others have been seeing as well. Patients who use cannabis products regularly require much more medication.

 Our Observations

A good example of what I’m talking about is a case from this week. Before we get there, it’s critical to learn something about how common IV anesthesia medications work. Let’s dive into this issue.

The two most common medications used for IV anesthesia are Versed and Fentanyl. Versed is a valium-like drug that can make you sleepy. Fentanyl is a narcotic pain medication that can help with pain.

Most patients would take about 4 mg of Versed and 100 micrograms of Fentaly to be sleepy or asleep. This week we had a woman who was about 100 pounds and took 10mg of Versed and 400 micrograms of Fentaly to be sleepy. Why? She was a frequent user of cannabis products.

What did she take? A THC tincture every day.

Is There Research on All of This?

Are our observations supported by actual research? Yep. Several studies support that cannabis users require more medications for anesthesia (1,2). Anesthesia only becomes more dangerous when the patient is abusing cannabis (3).

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Is Cannabis Bad?

NO. I’ll support any natural medication that can keep patients off narcotics and other medications. I think overall, cannabis likely has fewer side effects than prescription medications.

The upshot? I’m a fan of cannabis products, however, every physician and patient needs to understand that they can dramatically change the anesthesia requirements for patients. So just FYI to my patients!

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References:

(1) Kraft B, Stromer W. Der Einfluss von Cannabis und Cannabinoiden auf Anästhesie und Analgesie in der perioperativen Phase [The effects of cannabis and cannabinoids on anesthesia and analgesia during the perioperative period]. Schmerz. 2020 Aug;34(4):314-318. German. doi: 10.1007/s00482-020-00449-x. PMID: 32125500.

(2) Lynn RSR, Galinkin JL. Cannabis, e-cigarettes and anesthesia. Curr Opin Anaesthesiol. 2020 Jun;33(3):318-326. doi: 10.1097/ACO.0000000000000872. PMID: 32371642.

(3) Goel A, McGuinness B, Jivraj NK, Wijeysundera DN, Mittleman MA, Bateman BT, Clarke H, Kotra LP, Ladha KS. Cannabis Use Disorder and Perioperative Outcomes in Major Elective Surgeries: A Retrospective Cohort Analysis. Anesthesiology. 2020 Apr;132(4):625-635. doi: 10.1097/ALN.0000000000003067. PMID: 31789638.

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