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By Linda Carroll
A new study suggests that patients undergoing surgery may need higher levels of anesthesia if they consume marijuana regularly.
After reviewing the medical records of 250 Colorado patients undergoing colonoscopy and other endoscopic procedures, the researchers determined that regular marijuana users needed more anesthesia than those who did not. did not use cannabis, according to the study published in the Annals of the American Osteopathic Association. In fact, researchers found that marijuana users needed more than twice the amount of propofol, a powerful anesthetic, compared to others.
"Although the use of marijuana has been legalized for recreational and medical purposes in many states, it is a very poorly studied substance," said Dr. Mark Twardowski, author Main of the study, specialist of internal medicine in private practice in Colorado. "So we can not say that it has no effect on other drugs and substances that patients could use. Our study demonstrates that this seems to have at least an effect on the classes of drugs used for sedation in simple endoscopic procedures. "
Twardowski usually starts with a low dose of sedative medications and increases the amount until the patient is relaxed, awake, and comfortable during the procedure.
"Usually, you know that you need more if the patient tells you that he feels uncomfortable or if you notice them start to wince or move on the table," he said. he explains.
"Knowing if a person is using marijuana regularly could affect how we proceed with anesthesia.
Twardowski had the idea of his study after noting that marijuana users seemed to be demanding a higher level of sedation, he said. Together with his colleagues, he reviewed files of patients who underwent endoscopic surgery between January 1, 2016 and December 31, 2017 – a period when cannabis was legal – in an endoscopy center located in the Department of Surgical Services. of a Level III trauma hospital in a small facility. Colorado City.
Of the 250 patients examined in the study, 25 were regular cannabis users. When the researchers compared the recordings of the 25 patients with those of non-users, they found that an increase in the levels of the three sedatives had been necessary to obtain the correct level of anesthesia. Compared to non-users, regular marijuana users needed:
Twardowski said his findings underscore the importance for patients to inform their surgeons of marijuana use.
"Knowing if a person is using marijuana regularly could affect how we proceed with anesthesia," he said.
The fear, says Twardowski, is that increasing these medications could end up "increasing the risk of cutting the patient's breathing – while still not controlling the pain."
The new discoveries did not surprise Dr. Ajay Wasan, professor of anesthesia and psychiatry at the University of Pittsburgh School of Medicine and vice-president of pain medicine at the Department of Anesthesia at the University Medical Center. University of Pittsburgh.
"Any kind of brain-altering substance can have an effect on another brain-altering drug," said Wasan.
Although the new study only concerns 25 cannabis users, "it is entirely compatible with other similar small earlier studies," said Wasan after reading the research. "All together, they suggest that long-term marijuana use has an impact on the care of anesthesia."
Studies like this add to the growing evidence of emerging health issues that recreational marijuana use may have, Wasan said.
"We receive all these signals from different parts of the health system. An important message is that we need to use California and Colorado as learning labs, "he said.
As cannabis was designated by the DEA as Schedule 1 drug alongside substances such as LSD, heroin and MDMA, researchers have not had the opportunity to conduct a thorough investigation of marijuana. Dr. Anthony Watkins, assistant professor of surgery at Weill Cornell Medicine and a surgeon specialized in abdominal transplantation at the New York-Presbyterian / Weill Cornell Medical Center, undeniably needs more research on cannabis.
"We know that there are some medications commonly prescribed to patients whose marijuana can decrease or increase the breakdown," Watkins said.
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