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Post by clawry on Jul 31, 2021 14:32:00 GMT -5
This month's journal article is presented by Kelsie St. Hill. The title is Anesthesia for Patients Who Self-Report Cannabis (Marijuana) Use Before Esophagogastroduodenoscopy: A Retrospective Review. This is a very interesting article that examines anesthesia dosing requirements for patients who use cannabis and side effects of cannabis that should be considered prior to providing an anesthetic. Here is a link to the article. Here are 2 questions to stimulate discussion of this topic: 1. What are some of the effects of cannabis that the article mentions? 2. Do you have any concerns about a patient or a planned anesthetic after you learn that your patient is using cannabis?
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Post by Jessica Switzman on Aug 2, 2021 9:46:19 GMT -5
1. The article mentioned cannabis effecting the respiratory, cardiovascular and GI systems; specifically causing a increase in airway secretions, tachycardia and delayed gastric emptying as some examples.
2. I do have concerns regarding patients that use cannabis on a regular basis. During my preop, I always ask pts about cannabis, ETOH and other drug use. I don't necessary alter my anesthetic plan but often use ketamine with these patients and expect their enzymes (regarding elimination) to be elevated.
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Post by Katya on Aug 4, 2021 9:03:04 GMT -5
1. Effects of cannabis are tachycardia, airways irritation, increase of respiratory secretions, delayed gastric emptying. 2. my concerns with these patients are possibility of using other substances (ETOH, cocaine), cardiac and respiratory issues as well as emergence delirium. I don't change my anesthetic but I frequently use ketamine and Propofol infusion if appropriate.
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Post by Kels on Aug 5, 2021 15:51:13 GMT -5
1.) Increase in HR and airway secretions are some of the effects of cannabis
2.) Like Katya, I too wonder if the folks using cannabis could be using other substances . I also tend not to change my anesthetic
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Post by Anne McNulty CRNA on Aug 6, 2021 11:20:56 GMT -5
S.E of cannabis include airway inflammation with coughing , and wheezing, tachycardia and preconditioning the myocardium to adverse events( as per article.) I have never had an adverse cv event in a cannabis using pt. Another S E I have read about but this article did not address is increased myoclonic movements from the Propofol in pt that use cannabis. The patients in this study did not require a higher dose of Propofol due to their cannabis usage. I do not make any specific changes to my anesthetic plan due to patients using cannabis. I observe pt response and treat accordingly. I believe that we will be using more drugs in the future that will be developed from cannabis research. I always keep in mind that cannabis slows gastric emptying and the incidence of aspiration can exist. ,
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Post by Jennifer Hannon on Aug 9, 2021 12:26:31 GMT -5
1) Side Effects of cannabis mentioned in the article are tachycardia, airways irritation, increase of respiratory secretions, delayed gastric emptying. 2). My concern with patients using cannabis products include the possibility of them using other substances and cannabis laced with Fentanyl now, cardiac and respiratory issues as well as withdrawal issues presenting if they abstained for surgery. I don't change my anesthetic much because the side effects may be another source as well, but I frequently use ketamine and Propofol infusion in daily enthusiasts. I think like cigarette smoking and other illegal activities, the reporting isn't always entirely honest, and so as a practitioner I have an estimate of use in my head based on chart review and preop interview. Asking your patient if they have seen Pineapple Express, and gauging their response is a good measurement of daily enthusiast
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Post by Monica Douglas on Aug 11, 2021 12:20:05 GMT -5
1. What are some of the effects of cannabis that the article mentions?
Cannabis has effects on the gastrointestinal, cardiovascular and respiratory systems. The article states that patients who use cannabis are risk of developing cannabinoid hyperemesis syndrome, which causes a delay of gastric emptying. This presents an increased risk of aspiration while under anesthesia. The most common reported side effect is tachycardia which is suspected to result from vasodilation. A respiratory side effect of cannabis is airway irritation and the disruption of mucous membranes, resulting from smoking toxic chemicals that are in cannabis.
2. Do you have any concerns about a patient or a planned anesthetic after you learn that your patient is using cannabis?
I would be more mindful an anticipating airway irritation when manipulating the airway. I also would be mindful of delayed gastric emptying, especially with GYN and laparoscopic procedures.
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Dahlia Rouchon, CRNA
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Post by Dahlia Rouchon, CRNA on Aug 12, 2021 13:47:30 GMT -5
Great article! Thank you. In response to your inquiry 1. The article mentions to make note of cannibis users for tachycardia, delayed gastric empytying risk, hyperemesis syndrome, bronchospasm and laryngospasm. 2. For EGD my concern would be increased use of propofol, therefore I may set my rate at 175mcg/kg/min and induce with 100mg depending on the patient weight, age and co-morbidities. If in addition to these interventions and the patient is considered light, I would add a small amount of fentanyl. This article is applicable to any GA for induction as well. I have seen I needed to add IA+N2O with large doses of IV induction for GETA as the patient did not transition into GA with 500mg of propofol and 100mcg fentanyl. Definitely something we may see more often. THank you!
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Post by kelseyleonard on Aug 17, 2021 14:27:08 GMT -5
1. Side Effects of cannabis are tachycardia, airways irritation, increase of respiratory secretions, delayed gastric emptying, possibility for laryngospasm and/or bronchospasm.
2. My concerns is that often times patients under report the amount and types of illicit drugs they use. If they are using cannabis there is a possibility they are using other drugs as well. In regards to EGD, I am more concerned about the risk for airway secretions and delayed gastric emptying. There is a higher probability of laryngospasm in these patients so keeping them deep enough is of greater importance. While we traditionally used straight propofol, I may consider adding another drug like fentanyl or ketamine depending on the patient.
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Post by Amy Schutter on Aug 22, 2021 10:03:28 GMT -5
1. Side effects of Cannabis use as mentioned in this article is respiratory system-Airway inflammation, increased phlegm production, coughing and wheezing. Cardiovascular system-tachycardia and increased myocardial oxygen demand. GI System-Delayed Gastric emptying. 2. As mentioned previously, I am always mindful of potential use of other recreational drugs when a patient admits to cannabis use. However, I do not typically alter my anesthetic for patients that use cannabis.
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Post by Matthew Soladay on Aug 24, 2021 8:26:28 GMT -5
Nice article choice, I agree that we are seeing both an increased incidence as well as normalization of marijuana use. I believe the stigma around admitting use for patients has been reduced, although I would still expect selective admission by some patients. It appears we have many of the same concerns during the anesthetic as tobacco smokers.
I have been out of Adult Endo cases for quite some time but I do find it interesting that many people are using ketamine now in these patients. In peds the most common adjuncts for patients with higher sedative dosing requirements are fentanyl and dexmedetomidine. For us, Vaping is more likely, but most children wont admit to marijuana or vaping. During these anesthetics we can be surprised by significantly sensitive upper airway reflexes without any documented history of recent illness or reactive airway disease. Fentanyl works very well. We try to avoid ketamine as a sedative unless the indication is very strong like cardiac dysfunction or complex pain syndromes/management. What kind of ketamine dosing are people using for adult endo?
In peds, patients on antiepileptics are very common to 'chew' through many of our medications.
I wonder if oral ingestion/edibles increase anesthetic requirements as well. I imagine it would.
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Post by Soo-Ok Kim on Aug 25, 2021 11:40:51 GMT -5
1. What are some of the effects of cannabis that the article mentions? airway inflammation, mucosal injury, increased incidence of wheezing, phlegm production, tachycardia, and preconditions the myocardium to adverse events.
2. Do you have any concerns about a patient or a planned anesthetic after you learn that your patient is using cannabis? Because of the increased airway reactivity, I may give more propofol than the patient who don't use marijuana and may add fentanyl if pt is young and muscular to make the deeper anesthetic. I wouldn't use ketamine, although it was suggested in the article, since I see more cons than pros for a quick procedure like EGD such as delayed wake up and possible hallucination. I prefer pts to get to their baseline as soon as the procedure is completed.
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Post by aileenm4 on Aug 27, 2021 12:21:02 GMT -5
good article and important since marijuana use is on the up swing. 1. airway inflammation, mucosal injury, increased coughing, wheezing, increase phlegm production, cross tolerance to other anesthetic agents observed 2. I consider these factors as I care for teens who admit using marijuana and treat them like how I would cigarette smokers.
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Post by Lu Lin on Aug 30, 2021 19:08:11 GMT -5
1. What are some of the effects of cannabis that the article mentions?
Cannabis has effects on the gastrointestinal, cardiovascular and respiratory systems. The most common reported side effect is tachycardia which is suspected to result from vasodilation. A respiratory side effect of cannabis is airway irritation and the disruption of mucous membranes, resulting from smoking toxic chemicals that are in cannabis.
2. Do you have any concerns about a patient or a planned anesthetic after you learn that your patient is using cannabis?
I will anticipate airway irritation when manipulating the airway. I will also be mindful of delayed gastric emptying, especially with GYN and laparoscopic procedures.
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Post by Jessica Hadley on Aug 31, 2021 11:05:41 GMT -5
1. What are some of the effects of cannabis that the article mentions?
Cannabis can cause a range of effects on several organ systems. These include tachycardia, airway irritation, increased mucous production, wheezing, and delaed gastric emptying.
2. Do you have an concerns about a patient or planned anesthetic after you learn the patient is using cannabis?
Yes, I would be more alert for airway complications such as laryngo/bronchospasm and ensure the patient is very deeply anesthetized prior to airway manipulation. I would also be prepared to treat tachycardias as the patients are preconditioned to adverse myocardial events. In addition, patients may require higher doses of anesthetics. However, this article did not find patients who were using cannabis required significantly increased amounts of propofol for EGD.
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