High quantities: Evaluating the association between cannabis use and propofol anesthesia during endoscopy

Abstract

Background Endoscopy under propofol sedation has become a routine procedure. Given the number of Canadians undergoing an endoscopy annually, as well as the pervasive use of cannabis by many patients, understanding the effect of cannabis use on the propofol dose at endoscopy is highly relevant. We aimed to evaluate the association between cannabis exposure and the propofol dose needed to achieve adequate sedation at endoscopy. Methods A case-control study of individuals undergoing endoscopy was conducted at a single outpatient endoscopy clinic in London, Ontario between 2014 and 2017. Cases included all individuals with any self-reported cannabis exposure, while controls included all individuals without any self-reported history of cannabis use. Dose of propofol administered by a single anesthetist was collected on each subject as well as additional demographic and procedure-related covariates. Results Three hundred and eighteen participants were included (cases, n = 151; controls, n = 167). Cannabis exposure was associated with an increase in propofol dose (cases 0.33 mg/kg/minute ±0.24; controls, 0.18 mg/kg/minute ±0.11; p<0.0001). Cannabis exposure remained an independent predictor of propofol dose on multivariate linear regression accounting for other important covariates (p<0.0001). Daily cannabis users required a higher propofol dose than weekly or monthly users. Three procedural sedation-related complications occurred in the cannabis-exposed group, while none occurred in the unexposed group. Conclusion Our data suggest that cannabis use is significantly associated with the quantity of propofol needed for sedation at endoscopy. Further study is needed to better understand the molecular basis for this possible drug-drug interaction.

Illicit Drug Use and Endoscopy: When Do We Say No?

“…Cannabis use has been associated with significantly elevated induction doses of propofol in patients undergoing general anesthesia, although the required dose widely varies by study [ 17 , 22 , 23 ]. This finding was also demonstrated in three of four studies evaluating cannabis use and outcomes during endoscopy [ 17 , 18 , 20 ]. In the study by Imasogie, 2021, cannabis users required on average 0.33 mg/kg/min of propofol compared to 0.18 mg/kg/min for non-users, with 61% of variability directly attributable to cannabis use.…”

“…All studies were retrospective. Four of the studies compared frequent cannabis use with endoscopic outcomes [ 17 – 20 ], and one evaluated recent cocaine ingestion [ 21 ]. No studies assessed endoscopic outcomes in heroin, methamphetamine, or polysubstance users.…”

Anaesthetic safety with undisclosed substance misuse during electroconvulsive therapy

“…In terms of medical risks during ECT, acute alcohol withdrawal can be life threatening and haemodynamic response to methamphetamine withdrawal can be unpredictable in the presence of cannabis. 3 Daily cannabis use is known to increase the dose of Propofol required for induction, 2 and also the resulting higher doses of anaesthesia can create problems during the emergence from anaesthesia after ECT, including prolonged sedation or agitation and haemodynamic instability.…”

“…Substance misuse can hamper the effectiveness of electroconvulsive therapy (ECT). 1 It can make anaesthetic induction challenging 2 and increase the risk of haemodynamic instability, 3 but no reports of induction-related difficulties exist in relation to ECT. We describe a case to illustrate this issue.…”

Effect of cannabis use on propofol requirement for ICU sedation

“…the authors concluded that to achieve satisfactory clinical response, higher doses of propofol are required in cannabis users. in addition, imasogi et al [5] implemented a case-control study on the correlation between cannabis use and propofol anaesthesia during endoscopy. in total 318 members participated (cases, n = 151; controls, n = 167) in this study.…”