Review of cannabis use and propofol anesthesia: recent insights and clinical implications

We examine recent evidence and clinical implications of pharmacological interactions between cannabis and propofol, perioperative considerations for propofol administration, including dosing adjustments and cardiovascular effects, summarize current recommendations, and propose future research directions.

Recent studies revealed associations between chronic cannabis use and higher propofol dose administered for procedural sedation and general anesthesia. While several pharmacokinetic and pharmacodynamic pathways have been proposed to explain these associations, no evidence currently supports causality, and the underlying mechanisms remain unknown. Other clinically relevant considerations for propofol anesthesia in patients who use cannabis include cardiovascular stability, mainly encountered with acute intoxication, and postoperative recovery. Current clinical guidelines recommend universal preoperative cannabis use assessment, postponing elective surgery in acutely intoxicated patients, considering propofol adjustments based on clinical assessment, and providing patient counseling about potential adverse effects.

Current evidence supports the necessity for individualized anesthetic management of cannabis users, advocating comprehensive preoperative assessments, cautious dose adjustments, vigilant intraoperative monitoring, and proactive postoperative management strategies. Further research is needed to corroborate causality, confirm and guide dose adjustment needs, determine perioperative cannabis tapering effects, and elucidate the underlying explanatory mechanisms to establish precise clinical guidelines and ensure patient safety.