Considerations for Cannabinoids in Perioperative Care by Anesthesiologists

Abstract

Increased usage of recreational and medically indicated cannabinoid compounds has been an undeniable reality for anesthesiologists in recent years. These compounds’ complicated pharmacology, composition, and biological effects result in challenging issues for anesthesiologists during different phases of perioperative care. Here, we review the existing formulation of cannabinoids and their biological activity to put them into the context of the anesthesia plan execution. Perioperative considerations should include a way to gauge the patient’s intake of cannabinoids, the ability to gain consent properly, and vigilance to the increased risk of pulmonary and airway problems. Intraoperative management in individuals with cannabinoid use is complicated by the effects cannabinoids have on general anesthetics and depth of anesthesia monitoring while simultaneously increasing the potential occurrence of intraoperative hemodynamic instability. Postoperative planning should involve higher vigilance to the risk of postoperative strokes and acute coronary syndromes. However, most of the data are not up to date, rending definite conclusions on the importance of perioperative cannabinoid intake on anesthesia management difficult.

Serum level of total histone 3, H3K4me3, and H3K27ac after non-emergent cardiac surgery suggests the persistence of smoldering inflammation at 3 months in an adult population

“…We did not observe an effect of opioids on pre- or post-surgical changes in histone modification. Other compounds, such as cocaine and cannabinoids, were not studied since patients that have taken these compounds would be disqualified from surgery [ 66 ]. Several other medications, such as antidepressants, hydralazine, anti-seizure, and others, were also not surveyed [ 30 ].…”

Cannabinoid Analgesia in Postoperative Pain Management: From Molecular Mechanisms to Clinical Reality

“…Studies indicate that 10–20% of individuals aged 18–25 years may use cannabis weekly or more frequently. Due to its slow elimination from the body, these cannabinoids may persist in the tissues for weeks, potentially interacting with various anesthetic agents and affecting their efficacy [ 471 , 472 ]. Additionally, cannabis use may be associated with higher pain scores and poorer quality of sleep in the early postoperative period [ 410 , 412 ].…”

“…Therefore, a systematic preoperative inquiry regarding cannabis use is highly recommended. In cases of recent cannabis use, postponing elective surgery is advisable to minimize potential complications [ 471 , 472 ].…”

New Psychoactive Substances: Major Groups, Laboratory Testing Challenges, Public Health Concerns, and Community-Based Solutions

“…Five major synthetic cannabinoids categories include eicosanoids, classical cannabinoids, aminoalkylindoles, nonclassical cannabinoids, and hybrid cannabinoids. Classical cannabinoids are tetrahydrocannabinol analogs which are based on dibenzopyran ring and include dronabinol and nabilone [111]; HU-210 is among the common synthetic classical cannabinoids. Nonclassical cannabinoids include cyclohexylphenols.…”

“…Nonclassical cannabinoids include cyclohexylphenols. Hybrid cannabinoids are a combination of the structural features of classical cannabinoids and nonclassical cannabinoids [111]. Aminoalkylindoles have structural dissimilarity to tetrahydrocannabinol and include phenylacetylindoles (JWH-250), benzoylindoles (AM-2233), and naphthoylindoles (JWH-018) [24,101].…”