Marijuana Use and Its Impact on Outpatient Anesthesia.

Area of Science:

• Anesthesiology
• Pharmacology
• Cannabinoid Science

Background:

• Cannabis is a widely used psychoactive substance with increasing prevalence.
• Modern cannabis products exhibit diverse tetrahydrocannabinol (THC) concentrations and administration routes.
• This poses unique challenges for anesthesia providers managing cannabis-using patients.

Purpose of the Study:

• To review current evidence on cannabis pharmacology, pharmacokinetics, and physiological effects.
• To outline perioperative considerations for the anesthetic management of patients using cannabis.
• To guide safe anesthetic practices for cannabis consumers.

Main Methods:

• Comprehensive literature review of scientific evidence.
• Analysis of cannabis pharmacology, including phytocannabinoids like THC and CBD.
• Examination of cannabinoid receptor (CB1, CB2) interactions and downstream signaling.

Main Results:

• Chronic cannabis use leads to CB1 receptor downregulation, contributing to tolerance and dependence.
• Physiological effects include neuropsychiatric, cardiovascular, and respiratory changes, alongside delayed gastric emptying.
• Cannabis use is linked to increased anesthetic (e.g., propofol) requirements and altered responses to other analgesics, with chronic users reporting higher postoperative pain.

Conclusions:

• Cannabis use significantly influences anesthetic dosing, airway management, cardiovascular stability, and postoperative pain control.
• Individualized anesthetic planning, thorough preoperative evaluation, and vigilant monitoring are crucial.
• Further research is necessary to develop evidence-based perioperative guidelines for cannabis-using patients.