Perioperative Management of the Pediatric Patient on Medicinal Marijuana: What Anesthesiologists Should Know

Flannery, Kaitlin M; D'Souza, Genevieve; Agarwal, Rita

doi:10.1213/ane.0000000000003956

Cited by 11 publications

(7 citation statements)

References 27 publications

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“…Prescribed cannabinoids: Although uncommonly prescribed, Sativex and Epidyolex are licensed for use in the UK as of November 2019 (NICE 2019). However, for paediatric patients in the US on FDA-approved synthetic cannabinoids, prescribed doses are advised to be continued on the day of surgery (Flannery et al 2019). Care should be taken, however, as there is a concern with the additive effects of sedatives, especially benzodiazepines (Flannery et al 2019).…”

Section: Discussion: Anaesthetic and Perioperative Implications Of Ma...mentioning

confidence: 99%

Perioperative and anaesthetic considerations of marijuana use

Everett

Foley

Scholl³

et al. 2021

Journal of Perioperative Practice

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The psychoactive substance cannabis is the most-commonly used drug around the world, and its use is becoming more prevalent globally. Additionally, it is becoming available in an increasing variety of forms. As such, it is imperative that perioperative practitioners have an understanding of the drug, its effects, and its implications in perioperative care. There is currently a lack of a standardised approach to a patient who uses cannabis, and prospective studies prove difficult given the current legal status of cannabis. This literature review seeks to provide information regarding cannabis and its use. Specifically, we explore the systemic effects of marijuana as well as perioperative and anaesthetic implications so that safer, more effective care may be administered.

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Section: Discussion: Anaesthetic and Perioperative Implications Of Ma...mentioning

confidence: 99%

Perioperative and anaesthetic considerations of marijuana use

Everett

Foley

Scholl³

et al. 2021

Journal of Perioperative Practice

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“…45 Recent cannabis use is associated with increased risk of perioperative acute myocardial infarction (MI), while chronic use may be associated with increased postoperative pain and postoperative nausea and vomiting (PONV). 40,46 To date, there are no published studies that investigated cardiac issues specifically among adolescents who vaped. 47 Studies in adolescents who use e-cigarettes have found a higher incidence of asthma, wheezing, or chronic bronchitis symptoms including chronic cough, phlegm, or bronchitis.…”

Section: The Youth Vaping Epidemic and Rise In Cannabis Usementioning

confidence: 99%

Substance Use Disorders in Adolescents and Young Adults: History and Perioperative Considerations From the Society for Pediatric Pain Medicine

Kitzman

Mesheriakova

Borucki

et al. 2023

Anesthesia &Amp; Analgesia

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Substance use disorders (SUDs) are on the rise in children and young adults in the United States. According to reports, over 40 million people aged 12 and older had a diagnosed SUD in 2020. 1 A recent report from the Centers for Disease Control and Prevention (CDC) found that overdose death in children aged 10 to 19 years old increased 109% from 2019 to 2021. 2 Given the rapidly increasing prevalence of SUD, anesthesiologists will almost certainly encounter children, adolescents, and young adults with a history of recreational drug use or nonmedical use of prescription opioids in the perioperative period. Since the perioperative period can be a particularly challenging time for patients with SUD, anesthesiologists can tailor their perioperative care to reduce rates of relapse and can serve as both advocates and educators for this vulnerable patient population. This article examines the history of SUD and physiology of substance use in children, adolescents, and young adults, including reasons why young people are more susceptible to the addictive effects of many substances. The coronavirus disease 2019 (COVID-19) pandemic impacted many aspects of life, including increased social isolation and shifted dynamics at home, both thought to impact substance use. 3 Substance use patterns in the wake of the COVID-19 pandemic are explored. Although current literature is mostly on adults, the evidence-based medical treatments for patients with SUD are reviewed, and recommendations for perioperative considerations are suggested. The emphasis of this review is on opioid use disorder, cannabis, and vaping particularly because these have disproportionately affected the younger population. The article provides recommendations and resources for recognizing and treating adolescents and young adults at risk for SUD in the perioperative period. It also provides suggestions to reduce new persistent postoperative opioid use.

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“…They quote a study that found that treatment with cannabis was ineffective in reducing pain and postoperative opioid consumption, while the administration of higher doses of cannabis decreased frequency of breakthrough pain while increasing sedation. However, they do not mention that there are recent studies that have reported analgesic and opioid-sparing effects of cannabis in acute pain setting with no increased adverse events …”

mentioning

confidence: 94%

“…The onset of withdrawal symptoms generally occurs within 1 to 2 days, and the symptoms typically peak within 1 week and dissipate within about 2 to 4 weeks. Therefore, recent publications mention practice of continuing cannabis until the day of surgery and providing cannabis to chronic cannabis consumers postoperatively …”

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confidence: 99%

Concerns About Recommendations for Perioperative Cannabis Use

Davidson¹,

Raz²,

Eyal³

2021

JAMA Surg

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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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Perioperative Management of the Pediatric Patient on Medicinal Marijuana: What Anesthesiologists Should Know

Cited by 11 publications

References 27 publications

Perioperative and anaesthetic considerations of marijuana use

Perioperative and anaesthetic considerations of marijuana use

Substance Use Disorders in Adolescents and Young Adults: History and Perioperative Considerations From the Society for Pediatric Pain Medicine

Concerns About Recommendations for Perioperative Cannabis Use

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