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Najafi L, Moasses Z, Bahmanpour S. The marijuana, cannabinoids, and female reproductive system. J Appl Toxicol 2024. [PMID: 38754862 DOI: 10.1002/jat.4630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 04/13/2024] [Accepted: 05/01/2024] [Indexed: 05/18/2024]
Abstract
The marijuana is considered as widely used recreational illicit drug that has become popular among women of reproductive age. It is believed that the marijuana use may have negative impacts on the female fertility. However, the exact mechanisms of its reproductive toxicity remain unclear. The studies suggest that the exogenous cannabinoids may interfere with endocannabinoid system and disrupt hypothalamic-pituitary-ovary axis. Consequently, it impacts the female fertility by disruption of normal secretion of ovarian sex hormones and menstrual cycles. However, other studies have shown that medical marijuana is useful analgesic agent for pain management. But, given that the wide range of cannabinoids side effects are reported, it seems that caution should be taken in the recreational use of these substances. In summary, this article aimed to review the possible impacts of marijuana and its derivatives on the main female reproductive organs and embryonic growth and development.
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Affiliation(s)
- Leila Najafi
- Department of Anatomical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zia Moasses
- Department of Anatomical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soghra Bahmanpour
- Department of Reproductive Biology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Anatomical Sciences, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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2
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Kallurkar A, Kaye AD, Shekoohi S. Marijuana Use, Vaping, and Preoperative Anesthetic and Surgical Considerations in Clinical Practice. Anesthesiol Clin 2024; 42:53-63. [PMID: 38278592 DOI: 10.1016/j.anclin.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
In recent years, marijuana and vaping have acquired widespread popularity, with millions of people using them for a variety of reasons, including recreational purposes. However, these practices have often overlooked the implications on surgery and the preoperative anesthesia considerations. Marijuana can influence a patient's response to anesthesia, alter postoperative pain management, and increase the risk of complications, whereas vaping can have negative effects on the respiratory system and hinder the body's ability to recover after surgery.
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Affiliation(s)
- Anusha Kallurkar
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA; Department of Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA.
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
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Bathula PP, Maciver MB. Cannabinoids in Treating Chemotherapy-Induced Nausea and Vomiting, Cancer-Associated Pain, and Tumor Growth. Int J Mol Sci 2023; 25:74. [PMID: 38203245 PMCID: PMC10779013 DOI: 10.3390/ijms25010074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Cannabis has been used as an herbal remedy for thousands of years, and recent research indicates promising new uses in medicine. So far, some studies have shown cannabinoids to be safe in helping mitigate some cancer-associated complications, including chemotherapy-induced nausea and vomiting, cancer-associated pain, and tumor growth. Researchers have been particularly interested in the potential uses of cannabinoids in treating cancer due to their ability to regulate cancer-related cell cycle pathways, prompting many beneficial effects, such as tumor growth prevention, cell cycle obstruction, and cell death. Cannabinoids have been found to affect tumors of the brain, prostate, colon and rectum, breast, uterus, cervix, thyroid, skin, pancreas, and lymph. However, the full potential of cannabinoids is yet to be understood. This review discusses current knowledge on the promising applications of cannabinoids in treating three different side effects of cancer-chemotherapy-induced nausea and vomiting, cancer-associated pain, and tumor development. The findings suggest that cannabinoids can be used to address some side effects of cancer and to limit the growth of tumors, though a lack of supporting clinical trials presents a challenge for use on actual patients. An additional challenge will be examining whether any of the over one hundred naturally occurring cannabinoids or dozens of synthetic compounds also exhibit useful clinical properties. Currently, clinical trials are underway; however, no regulatory agencies have approved cannabinoid use for any cancer symptoms beyond antinausea.
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Affiliation(s)
| | - M. Bruce Maciver
- School of Medicine, Stanford University, Palo Alto, CA 94305, USA;
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Wang Q, Zhao X, Jiang Y, Jin B, Wang L. Functions of Representative Terpenoids and Their Biosynthesis Mechanisms in Medicinal Plants. Biomolecules 2023; 13:1725. [PMID: 38136596 PMCID: PMC10741589 DOI: 10.3390/biom13121725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
Terpenoids are the broadest and richest group of chemicals obtained from plants. These plant-derived terpenoids have been extensively utilized in various industries, including food and pharmaceuticals. Several specific terpenoids have been identified and isolated from medicinal plants, emphasizing the diversity of biosynthesis and specific functionality of terpenoids. With advances in the technology of sequencing, the genomes of certain important medicinal plants have been assembled. This has improved our knowledge of the biosynthesis and regulatory molecular functions of terpenoids with medicinal functions. In this review, we introduce several notable medicinal plants that produce distinct terpenoids (e.g., Cannabis sativa, Artemisia annua, Salvia miltiorrhiza, Ginkgo biloba, and Taxus media). We summarize the specialized roles of these terpenoids in plant-environment interactions as well as their significance in the pharmaceutical and food industries. Additionally, we highlight recent findings in the fields of molecular regulation mechanisms involved in these distinct terpenoids biosynthesis, and propose future opportunities in terpenoid research, including biology seeding, and genetic engineering in medicinal plants.
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Affiliation(s)
| | | | | | | | - Li Wang
- College of Horticulture and Landscape Architecture, Yangzhou University, Yangzhou 225009, China; (Q.W.); (X.Z.); (Y.J.); (B.J.)
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Kayode A, Adrish S, Muhammad A, Amin R, Muhammad D, Rida Z, Alabi G, Okumede G, Kayode O. Therapeutic Uses of Medical Cannabis: An Overview of its Functions in Disease Management. JOURNAL OF MEDICAL SCIENCES 2023. [DOI: 10.3923/jms.2023.32.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
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6
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Gupta M, Anant G, Kumari M, Tiwari A, Kaur J, Ravi R. Effect of cannabis abuse over spinal anaesthesia: A case series. SERBIAN JOURNAL OF ANESTHESIA AND INTENSIVE THERAPY 2022. [DOI: 10.5937/sjait2208095g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Introduction: In the modern world, drug abuse is one of the fastest emerging social issues. Cannabinoid receptor agonists are becoming increasingly popular as abused substance due to their ease of cultivation and availability. Case report: We present a series of three cases who were scheduled for lower limb surgeries planned under spinal anaesthesia. All patients were consuming either cannabis or its products regularly for significant time periods. All subjects were reported with an experience of either failed or delayed effect after the block. Conclusion: The study concluded that the incidence of failure of the spinal anaesthesia seemed to be higher in the cannabis abusers than among the non-abusers. There was a slower onset and decreased duration of both sensory and motor block in addict patients, with increase requirements of doses of anaesthetic and analgesic agents as compare to non-addict patients.
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Gallagher JP, Twohig PA, Crnic A, Rochling FA. Illicit Drug Use and Endoscopy: When Do We Say No? Dig Dis Sci 2022; 67:5371-5381. [PMID: 35867192 PMCID: PMC9306238 DOI: 10.1007/s10620-022-07619-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 05/11/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Illicit drug use (IDU) is often encountered in patients undergoing elective ambulatory surgical procedures such as endoscopy. Given the variety of systemic effects of these drugs, sedation and anesthetics are believed to increase the risk of cardiopulmonary complications during procedures. Procedural cancelations are common, regardless of the drug type, recency of use, and total dosage consumed. There is a lack of institutional and society recommendations regarding the optimal approach to performing outpatient endoscopy on patients with IDU. AIM To review the literature for current recommendations regarding the optimal management of outpatient elective endoscopic procedures in patients with IDU. Secondary aim is to provide guidance for clinicians who encounter IDU in endoscopic practice. METHODS Systematic review of PubMed, CINAHL, Embase, and Google Scholar for articles presenting data on outcomes of elective procedures in patients using illicit drugs. RESULTS There are no clinically relevant differences in periprocedural complications or mortality in cannabis users compared to non-users. Endoscopy in patients with remote cocaine use was also found to have similar outcomes to recent use. CONCLUSIONS Canceling endoscopic procedures in patients with recent IDU without consideration of the type of drug, dosage, and chronicity may lead to unnecessary delays in care and increased patient morbidity. Healthcare systems would benefit from additional guidelines for evaluating the patient with recent illicit drug use for acute intoxication and consider proceeding with procedures in the non-toxic population.
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Affiliation(s)
- John P. Gallagher
- Department of Internal Medicine, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE 68198 USA
| | - Patrick A. Twohig
- Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE 68198 USA
| | - Agnes Crnic
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON K1Y 4E9 Canada
| | - Fedja A. Rochling
- Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE 68198 USA
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9
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Cannabinoids-based Medicine Pharmacology, Drug Interactions, and Perioperative Management of Surgical Patients. Adv Anesth 2021; 38:167-188. [PMID: 34106833 DOI: 10.1016/j.aan.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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King DD, Stewart SA, Collins-Yoder A, Fleckner T, Price LL. Anesthesia for Patients Who Self-Report Cannabis (Marijuana) Use Before Esophagogastroduodenoscopy: A Retrospective Review. AANA JOURNAL 2021; 89:205-212. [PMID: 34042571 PMCID: PMC8764743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Increasing numbers of patients are using cannabis before procedures that require anesthesia. This study set out to examine the impact of cannabis use on anesthetic agent requirements, associated cardiac and respiratory morbidity, and overall satisfaction levels in patients undergoing esophagogastroduodenoscopy (EGD). This involved a retrospective review of patients undergoing EGD at a single center. Fortyseven, self-reported cannabis users were identified and 23 were successfully cross-matched with control participants for comparison purposes. The Wilcoxon signed rank test was used to evaluate differences in propofol administration between the 2 groups, and the McNemar test was used to test for differences in fentanyl and ketamine administration. No statistically significant differences were observed in propofol, fentanyl, or ketamine administration in the cannabis group compared with the control group. No adverse cardiac or respiratory events were reported within 30 days for either group. This study was specific to EGD procedures of short duration, and larger studies are needed to confirm results of no consequence in cannabis users undergoing anesthesia. Future studies should consider cannabis users who undergo anesthesia for diverse procedure types of various durations.
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Affiliation(s)
- Daniel D King
- is an assistant clinical professor at Northeastern University in Boston, Massachusetts, and a staff nurse anesthetist at Good Samaritan Medical Center in Brockton, Massachusetts.
| | - Scott A Stewart
- is the chair of the Department of Anesthesiology at Good Samaritan Medical Center in Brockton, Massachusetts
| | - Angela Collins-Yoder
- is a clinical professor in the Capstone College of Nursing at The University of Alabama. She is also a critical care nurse specialist at Sacred Heart in Pensacola, Florida
| | - Tara Fleckner
- is a project coordinator in the Tufts Clinical and Translational Science Institute at Tufts University in Boston, Massachusetts
| | - Lori Lyn Price
- is a senior statistician in the Tufts Clinical and Translational Science Institute at Tufts University
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11
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The effect of oral Δ-9-tetrahydrocannabinol on the minimal alveolar concentration of sevoflurane: A randomised, controlled, observer-blinded experimental study. Eur J Anaesthesiol 2021; 38:58-63. [PMID: 32833854 DOI: 10.1097/eja.0000000000001295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Cannabis has increasingly been used for medical and recreational purposes. The main pharmacological compound in cannabis is tetrahydrocannabinol (THC), which has sedative, anxiolytic and analgesic effects. In some animal models, THC has also been shown to reduce the minimum alveolar concentration (MAC) of halothane and cyclopropane, but its effect on sevoflurane, currently the most commonly used inhalational anaesthetic agent, has not been investigated. OBJECTIVE To investigate the effect of THC on the MAC of sevoflurane in rats. METHODS Observer-blinded, randomised controlled trial. SETTING Centre for Biomedical Research of the Medical University of Vienna, 2019. INDIVIDUALS Thirty-eight adult Wistar rats. INTERVENTIONS The rats were allocated randomly into one of two groups. Group A received THC 10 mg kg and group B received the corresponding volume of placebo via gastric gavage (administration through a tube placed in the distal oesophagus). The rats were then individually anaesthetised in an airtight sevoflurane-flooded chamber, and the MAC in both groups was determined using Dixon's up-and-down method. Blood samples were drawn to measure serum concentrations of THC. MAIN OUTCOME MEASURES The primary outcome was the MAC of sevoflurane in Groups A and B. RESULTS The bootstrap estimate of the MAC of sevoflurane was 2.1 (95% confidence interval 1.8 to 2.4) vol% in the THC group and 2.8 (95% confidence interval 2.7 to 2.9) vol% in the placebo group, corresponding to a significant MAC reduction of 26% in response to THC. CONCLUSION Gastric administration of THC 10 mg kg significantly reduced the MAC of sevoflurane by 26%. TRIAL REGISTRATION Not applicable.
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12
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Everett L, Foley AJ, Scholl AT, Petrovic MA. Perioperative and anaesthetic considerations of marijuana use. J Perioper Pract 2021; 32:190-195. [PMID: 33779402 DOI: 10.1177/1750458921991117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The psychoactive substance cannabis is the most-commonly used drug around the world, and its use is becoming more prevalent globally. Additionally, it is becoming available in an increasing variety of forms. As such, it is imperative that perioperative practitioners have an understanding of the drug, its effects, and its implications in perioperative care. There is currently a lack of a standardised approach to a patient who uses cannabis, and prospective studies prove difficult given the current legal status of cannabis. This literature review seeks to provide information regarding cannabis and its use. Specifically, we explore the systemic effects of marijuana as well as perioperative and anaesthetic implications so that safer, more effective care may be administered.
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Affiliation(s)
- Lauren Everett
- School of Medicine, University of Miami at Holy Cross Hospital, Fort Lauderdale, FL, USA
| | - Adam J Foley
- College of Medicine, University of Central Florida, Orlando, FL, USA
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Hyland SJ, Brockhaus KK, Vincent WR, Spence NZ, Lucki MM, Howkins MJ, Cleary RK. Perioperative Pain Management and Opioid Stewardship: A Practical Guide. Healthcare (Basel) 2021; 9:333. [PMID: 33809571 PMCID: PMC8001960 DOI: 10.3390/healthcare9030333] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 12/20/2022] Open
Abstract
Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a "roadmap" for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.
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Affiliation(s)
- Sara J. Hyland
- Department of Pharmacy, Grant Medical Center (OhioHealth), Columbus, OH 43215, USA
| | - Kara K. Brockhaus
- Department of Pharmacy, St. Joseph Mercy Hospital Ann Arbor, Ypsilanti, MI 48197, USA;
| | | | - Nicole Z. Spence
- Department of Anesthesiology, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA;
| | - Michelle M. Lucki
- Department of Orthopedics, Grant Medical Center (OhioHealth), Columbus, OH 43215, USA;
| | - Michael J. Howkins
- Department of Addiction Medicine, Grant Medical Center (OhioHealth), Columbus, OH 43215, USA;
| | - Robert K. Cleary
- Department of Surgery, St. Joseph Mercy Hospital Ann Arbor, Ypsilanti, MI 48197, USA;
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Famiglietti A, Memoli JW, Khaitan PG. Therapeutic Application of Cannabis in Medicine and Its Relevance to Thoracic Surgery. Ann Thorac Surg 2020; 112:665-671. [PMID: 33248994 DOI: 10.1016/j.athoracsur.2020.08.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/12/2020] [Accepted: 08/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cannabis is the most commonly used illicit substance in the United States. As cannabis use rises in popularity and its legalization continues to expand, the scientific community must address the controversy between beneficial and adverse effects of cannabis consumption. METHODS We performed a comprehensive literature review to study the medicinal and pathologic effects of cannabis use, with emphasis on its association with cancer pathophysiology and thoracic surgery. RESULTS We found evidence that cannabis products often contain carcinogenic materials and that their use is associated with the development of certain head and neck cancers, but not lung cancer. Indeed, several in vitro and in vivo studies have demonstrated that cannabis may have a therapeutic role in cancer given the antiproliferative effects of its active compounds such as δ-9-tetrahydrocannabinol. Cannabis-derived products have also been shown to be effective treatments for chronic pain, neuropathy, spasticity, and as antiemetics. CONCLUSIONS We acknowledge that additional studies are required to elucidate the long-term effects of cannabis products and that many potential biases and limitations exist in the literature due to self-reporting and limited survey studies. Appropriate stewardship over cannabis use among our patient population will likely determine its full implications in both oncologic and perioperative outcomes.
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Affiliation(s)
- Amber Famiglietti
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Jessica Wang Memoli
- Division of Interventional Pulmonology, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Puja Gaur Khaitan
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC; Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC.
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Ladha KS, McLaren-Blades A, Goel A, Buys MJ, Farquhar-Smith P, Haroutounian S, Kotteeswaran Y, Kwofie K, Le Foll B, Lightfoot NJ, Loiselle J, Mace H, Nicholls J, Regev A, Rosseland LA, Shanthanna H, Sinha A, Sutherland A, Tanguay R, Yafai S, Glenny M, Choi P, Ladak SSJ, Leroux TS, Kawpeng I, Samman B, Singh R, Clarke H. Perioperative Pain and Addiction Interdisciplinary Network (PAIN): consensus recommendations for perioperative management of cannabis and cannabinoid-based medicine users by a modified Delphi process. Br J Anaesth 2020; 126:304-318. [PMID: 33129489 DOI: 10.1016/j.bja.2020.09.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022] Open
Abstract
In many countries, liberalisation of the legislation regulating the use of cannabis has outpaced rigorous scientific studies, and a growing number of patients presenting for surgery consume cannabis regularly. Research to date suggests that cannabis can impact perioperative outcomes. We present recommendations obtained using a modified Delphi method for the perioperative care of cannabis-using patients. A steering committee was formed and a review of medical literature with respect to perioperative cannabis use was conducted. This was followed by the recruitment of a panel of 17 experts on the care of cannabis-consuming patients. Panellists were blinded to each other's participation and were provided with rater forms exploring the appropriateness of specific perioperative care elements. The completed rater forms were analysed for consensus. The expert panel was then unblinded and met to discuss the rater form analyses. Draft recommendations were then created and returned to the expert panel for further comment. The draft recommendations were also sent to four independent reviewers (a surgeon, a nurse practitioner, and two patients). The collected feedback was used to finalise the recommendations. The major recommendations obtained included emphasising the importance of eliciting a history of cannabis use, quantifying it, and ensuring contact with a cannabis authoriser (if one exists). Recommendations also included the consideration of perioperative cannabis weaning, additional postoperative nausea and vomiting prophylaxis, and additional attention to monitoring and maintaining anaesthetic depth. Postoperative recommendations included anticipating increased postoperative analgesic requirements and maintaining vigilance for cannabis withdrawal syndrome.
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Affiliation(s)
- Karim S Ladha
- Department of Anesthesia and Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Alexander McLaren-Blades
- Department of Anesthesia and Pain Management, Toronto General Hospital and University of Toronto, Toronto, ON, Canada
| | - Akash Goel
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA
| | - Michael J Buys
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Paul Farquhar-Smith
- Department of Anaesthetics, The Royal Marsden NHS Foundation Trust, London, UK
| | - Simon Haroutounian
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
| | - Yuvaraj Kotteeswaran
- Department of Anesthesia, Northern Ontario School of Medicine, Sudbury, Thunder Bay, ON, Canada
| | - Kwesi Kwofie
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada; Acute Care Program, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Division of Brain and Therapeutics, University of Toronto, Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Nicholas J Lightfoot
- Department of Anaesthesia and Pain Medicine, Counties Manukau Health, Auckland, New Zealand
| | - Joel Loiselle
- Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Hamish Mace
- Department of Anaesthesia, Pain and Perioperative Medicine, Fiona Stanley Fremantle Hospital Group, Melville, Australia; University of Western Australia, Perth, Australia
| | - Judith Nicholls
- Department of Anaesthesia, Intensive Care and Pain, Cayman Islands Health Services Authority, George Town, Cayman Islands
| | | | - Leiv Arne Rosseland
- Department of Research and Development, Division of Emergencies and Critical Care, University of Oslo, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Avinash Sinha
- Department of Anesthesia, McGill University, Montreal, QC, Canada
| | | | - Rob Tanguay
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Sherry Yafai
- Releaf Institute, Santa Monica, CA, USA; John Wayne Cancer Institute, Santa Monica, CA, USA
| | - Martha Glenny
- Department of Anesthesia and Pain Management, Toronto General Hospital and University of Toronto, Toronto, ON, Canada
| | - Paul Choi
- Department of Anesthesia and Pain Management, Toronto General Hospital and University of Toronto, Toronto, ON, Canada
| | - Salima S J Ladak
- Department of Anesthesia and Pain Management, Toronto General Hospital and University of Toronto, Toronto, ON, Canada
| | | | - Ian Kawpeng
- Department of Anesthesia and Pain Management, Toronto General Hospital and University of Toronto, Toronto, ON, Canada
| | - Bana Samman
- Department of Anesthesia and Pain Management, Toronto General Hospital and University of Toronto, Toronto, ON, Canada
| | - Rajbir Singh
- Department of Anesthesia and Pain Management, Toronto General Hospital and University of Toronto, Toronto, ON, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital and University of Toronto, Toronto, ON, Canada; Centre for Cannabinoid Therapeutics, Toronto, ON, Canada.
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17
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Gupta A, Haritha D, Sinha R. Persistent intraoperative arrhythmias due to cannabis: Report of two cases. Indian J Anaesth 2020; 64:S210-S212. [PMID: 33162605 PMCID: PMC7641057 DOI: 10.4103/ija.ija_324_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/11/2020] [Accepted: 05/17/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Anju Gupta
- Department of Anesthesiology, Pain and Critical Care, AIIMS, New Delhi, India
| | - Damarla Haritha
- Department of Anesthesiology, Pain and Critical Care, AIIMS, New Delhi, India
| | - Renu Sinha
- Department of Anesthesiology, Pain and Critical Care, AIIMS, New Delhi, India
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18
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Kraft B, Stromer W. Der Einfluss von Cannabis und Cannabinoiden auf Anästhesie und Analgesie in der perioperativen Phase. Schmerz 2020; 34:314-318. [DOI: 10.1007/s00482-020-00449-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Goudra B, Singh PM. Critical Analysis of Guidelines for Providing Sedation to Patients Undergoing Gastrointestinal Endoscopy Procedures. Anesth Essays Res 2019; 13:601-607. [PMID: 32009702 PMCID: PMC6937897 DOI: 10.4103/aer.aer_135_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 12/11/2022] Open
Abstract
In spite of growing numbers of gastrointestinal endoscopic procedures performed under deep sedation, guidelines are lacking. Hypoxemia and aspiration continue to be the main source of morbidity. Anesthesia providers have tried to address these concerns by modifying their technique and employing newer or improvised devices. In addition, preprocedural evaluation poses many challenges. In many centers, workload pressures determine the time available to perform such an evaluation. A comprehensive history and examination similar to a major surgical procedure is often not possible. As a result, a focused history and examination is essential. This should be followed by an appropriate explanation of risks before obtaining consent. A plan should be in place to manage complications such as aspiration. This paper provides a succinct review of the above aspects.
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Affiliation(s)
- Basavana Goudra
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Preet Mohinder Singh
- Department of Anesthesiology, Washington University in Saint Louis, St. Louis, Missouri, USA
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Kuerbis A. Substance Use among Older Adults: An Update on Prevalence, Etiology, Assessment, and Intervention. Gerontology 2019; 66:249-258. [DOI: 10.1159/000504363] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/26/2019] [Indexed: 11/19/2022] Open
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