anesthesia and cannabis
anesthesia and cannabis

You Can't Knock Me Out! Cannabis Users Need Twice the Anesthesia To Go Under Before Surgery

If You’re A Cannabis User And Have Upcoming Surgery, Read This

Posted by:
DanaSmith on Friday Apr 19, 2019


cannabis anesthesia

If You’re A Cannabis User And Have Upcoming Surgery, Read This


There’s a lot of heated debate regarding the impact of cannabis on people who are undergoing surgery.


This area is one of the least studies in the medical cannabis community, so it’s good to always stay on the safe side.


A new study out of Colorado has just revealed some insight into cannabis and how it affects a patient’s threshold for anesthesia prior to surgery. Researchers analyzed 250 medical records coming from Colorado state patients who had endoscopies done. Endoscopy is a procedure that involves transmitting a camera through the throat or other orifices to give doctors a more accurate view of what’s going on inside your body. The researchers specifically analyzed medical records of patients following 2012, which was the year that recreational cannabis was made legal in Colorado. Even if cannabis wasn’t going to be sold in retail outlets until 2014, legal recreational marijuana meant that patients would be more upfront about their cannabis use to doctors.


They found that patients who consumed cannabis daily or weekly were less sensitive to many different types of anesthetic drugs compared to patients who never used it. What was interesting was they discovered that it required a 14% higher dose of fentanyl, 220% more propofol, and 20% more midazolam to effectively sedate the patients for the endoscopy. Because the nature of the procedure means that very sensitive orifices in the body will be affected during endoscopy, a good amount of anesthesia is needed for proper sedation.


Lead author and osteopathic internal physician Mark Twardowski explained that in short, anecdotal evidence reveals that cannabis-using patients need more sedation for surgery. Even though this is the first study of its kind, and despite its small sample size because they only assessed a total of 25 cannabis users, it’s the first to suggest that there might be a problem with this. If a patient needs more sedation, this could pose a health risk not because cannabis has side effects but because anesthetia has side effects too when taken in high doses.


“Some of the sedative medications have dose-dependent side effects, meaning the higher the dose, the greater likelihood for problems,” Twardowski said in a statement. “That becomes particularly dangerous when suppressed respiratory function is a known side effect.”


“Cannabis has some metabolic effects we don’t understand and patients need to know that their cannabis use might make other medications less effective. We’re seeing some problematic trends anecdotally, and there is virtually no formal data to provide a sense of scale or suggest any evidence-based protocols,” he explains.

Need For More Studies


Cannabis is still a Schedule 1 substance in the United States, and this prevents doctors from getting the necessary research done to have a thorough look at the problem.


The study also says that between 2007 to 2015, there was a 43% increase in cannabis consumption in the United States alone. Meanwhile, 13.5% of adults used cannabis in this time, and there’s been the most significant increase in cannabis intake among people aged 26 and up. There’s clearly no slowing down cannabis legalization, but this also presents a good opportunity for researchers to collect more meaningful data.


The researchers also suggest that it’s important to be specific about the questions one asks patients. “This study really marks a small first step,” Dr. Twardowski explains. “We still don’t understand the mechanism behind the need for higher dosages, which is important to finding better care management solutions.”


Dr. Twardowski and his team are working on a follow-up study to identify the differences for sedative requirements and anesthesia plus a study on post-procedure pain management for cannabis users compared to non-users.


There are a few other studies that share the same findings, indicating that if you have surgery, this may as well be the one time you shouldn’t be smoking cannabis beforehand. A 2005 paper, which was published in Current Opinion in Anesthesiology says, “The combination of marijuana with other sedative hypnotic drugs may enhance depression of the central nervous system.” When this happens, patients experience an alarming reduction in breathing. There are also other studies that reveal that cannabis can extend the effect of anesthesia, meaning that you may be sedated for far longer than intended.



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