Purpose of review Growing numbers of patients, consuming cannabinoids admitted to surgery, create a challenge to anesthesia providers. This review provides a summary of recent literature related to cannabis and anesthesia, with specific recommendations to the anesthetic management of medical cannabis consumers. Recent findings At present, cannabis has found its way to public consensus in many countries and is penetrating slower to different medical fields. We relate and discuss recent findings investigating effects of cannabis consumption on the various aspects including perioperative measures, post-operative pain, PONV, cardiovascular stability, and anesthesia monitoring. Summary Recent surveys estimate that 10–20% of adult populations have consumed cannabis in the past year. Medical cannabis consumers are a newer group of cannabis users. Anesthesia providers have to update their knowledge on cannabis and possible anesthetic interaction. It is unreasonable to make recommendations that apply to the whole heterogeneous group of cannabis users, but is easier with the more homogenous group of Medical cannabis users, characterized by frequent use and relatively high cannabis doses, combined with good knowledge of administered composition and protocol, as well as adverse and withdrawal effects. Anesthesia providers have to know the effects and modify anesthetic plan accordingly. We provide perioperative anesthetic recommendations related to medical cannabis consumers. Collecting information of the effects of medical cannabis use in perioperative setting will further create a highly useful database for anesthetics in the close future.
In Reply We are delighted that the Laparoscopic Elective Sigmoid Resection Following Diverticulitis (LASER) trial 1 has generated discussion. First, we would like to thank Schultz et al for their excellent comments. We agree that the premature termination of the trial is a limitation, which was acknowledged in the original publication. The termination of trial followed strictly the prespecified termination criteria stated in the study protocol. Although we could have perhaps considered continuing the trial regardless, we want to remind readers that the recruiting had been ongoing for 4 years already at the time the trial hit midway. The inclusion criteria of the trial were chosen to cover the patient population that might be considered to be treated either conservatively or surgically. Similar inclusion criteria were also used in Diverticulitis Recurrences or Continuing Symptoms: Operative Versus Conservative Treatment (DIRECT) trial 2 allowing future meta-analyses to be carried out effectively. Differences regarding Gastrointestinal Quality of Life Index (GIQLI) scores are explained by the fact that the mean differences in GIQLI scores are calculated only for patients who answered both baseline and 6-month questionnaires as stated in the Figure. 1 We thank Schultz et al for proposing analyzing quality of life in more detail in future publications.We thank Acuna et al for their comment regarding minimal clinically important difference, which is around 7 points for the GIQLI. We agree that the lower boundary of 95% CI crosses this line and the results thus have some degree of imprecision. However, the results are similar to those found in DIRECT trial, 2 strengthening the findings.We thank Lumley et al for reviewing our trial in their journal club. Indeed, the null hypothesis was that there is no difference between the groups and all the tests were carried out 2-tailed. We agree that open-label study without sham surgery and with subjective end point is subject to placebo effect, as we have pointed out in the original article. For this exact reason, objective outcomes were chosen as secondary outcomes. Quality-of-life studies are always difficult to carry out because they rely on patients answering and returning questionnaires in a timely manner. The reality is that the answer rate is always below 100%. Lumley et al imply that lack of primary outcome data in the conservative group would be a significant source of bias. We would like to remind readers that the primary outcome was assessable in 37 patients in the surgical group and 35 patients in the conservative group. We are not very concerned about this difference of 2 patients.Finally, we thank Birindelli et al for their comments. Fistula and stricture were indeed exclusion criteria and no such patients were included as it is clear that such condition is usually not amenable to conservative treatment. There is still an ongoing debate whether a diverticular abscess indicates an elective sigmoid resection, [3][4][5][6] and as there is no solid evidence to back up ...
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