A daily cannabis user had a dangerous aspiration risk during surgery from delayed stomach emptying he did not know about | Research

The takeaway

A 24-year-old daily cannabis user who fasted appropriately before surgery still had 500 mL of gastric contents, raising concerns that THC-induced gastroparesis may create hidden aspiration risks.

Anesthesiologists, surgeons, daily cannabis users planning surgery, perioperative medicine professionals

500 mL of gastric contents found despite proper pre-surgical fasting

What the researchers found

Despite standard fasting (last meal at 10 PM the prior night), a daily cannabis user had 150 cc of gastric contents fill the airway device upon anesthesia induction, with 500 cc total suctioned from the stomach. The patient was asymptomatic for gastroparesis beforehand.

Why it matters

Standard pre-surgical fasting guidelines assume normal gastric emptying. If chronic cannabis use causes asymptomatic gastroparesis, current fasting protocols may be insufficient for daily users.

The numbers in context

Age 24; BMI 22; daily marijuana use; last meal at 10 PM; 150 cc filled the airway device; 500 cc clear gastric contents suctioned from stomach; no aspiration into lungs; uneventful recovery

How the study worked

Case report of a 24-year-old male daily cannabis user who presented for elective orthopedic surgery and experienced near-aspiration during anesthesia induction.

What this study cannot tell us

Single case report cannot establish incidence. No gastric emptying study was performed. The relationship between cannabis dose, chronicity, and gastroparesis risk is unknown. Other causes of delayed emptying were not fully ruled out.

How to read the evidence

Single case report raising a safety concern without established incidence data

When this study was published

Published in 2021. The incidence of THC-induced gastroparesis in surgical patients has not been studied.

The bigger picture

This case raises a systemic question: should anesthesiologists modify their approach for the millions of daily cannabis users undergoing surgery, given the potential for unrecognized gastroparesis?

Questions still open

Should pre-operative screening ask about cannabis use? What percentage of daily cannabis users have subclinical gastroparesis? Should fasting guidelines be extended for chronic cannabis users?

Common questions

Can cannabis affect surgery safety?

This case shows chronic cannabis use may cause asymptomatic delayed stomach emptying, creating aspiration risks during anesthesia even when standard fasting guidelines are followed.

Should cannabis users tell their anesthesiologist?

Yes. This case suggests daily cannabis users may need modified fasting protocols or additional aspiration precautions during anesthesia, even if they have no digestive symptoms.

Read the original research

A Reason to Rethink Fasting Guidelines? Marijuana-Induced Gastroparesis and the Implications for Aspiration Risk in the Nil Per Os (NPO) Patient: A Case Report.

The American journal of case reports, 22, e934187

View on PubMed ↗Publisher’s paper ↗

Citation

Cammarano, Caitlin A; Villaluz, Joseph Evan. (2021). A Reason to Rethink Fasting Guidelines? Marijuana-Induced Gastroparesis and the Implications for Aspiration Risk in the Nil Per Os (NPO) Patient: A Case Report.. The American journal of case reports, 22, e934187. https://doi.org/10.12659/AJCR.934187