A review found emerging evidence that cannabis users may require more propofol for sedation and more opioids for pain after surgery, with e-cigarette/THC vaping adding respiratory risks.
Anesthesiologists, surgeons, perioperative care teams, and cannabis users planning surgery.
Cannabis may reduce efficacy of propofol and postoperative opioid pain management
What the researchers found
Cannabis use may reduce the efficacy of propofol and postoperative opioid pain management, potentially requiring higher doses. E-cigarette use, particularly with THC vaping products, has been linked to severe acute lung injury (EVALI). Cannabis affects cardiovascular, respiratory, and neurological function, placing users at increased perioperative risk.
Why it matters
With cannabis use increasing, anesthesiologists need to understand how it interacts with surgical care. Under-dosing sedation or pain medication because of unrecognized cannabis tolerance could compromise patient safety.
The numbers in context
Cannabis users may be tolerant to propofol and opioid effects; EVALI has been linked to THC vaping products.
How the study worked
Narrative review of recent literature on cannabis and e-cigarette effects relevant to anesthesia practice, including clinical reports and pharmacological evidence.
What this study cannot tell us
Narrative review; limited controlled data specifically on cannabis-anesthesia interactions; most evidence for tolerance effects comes from case reports and small series; rapidly evolving landscape of cannabis products.
How to read the evidence
Moderate: synthesizes emerging clinical evidence but limited controlled data on specific anesthesia interactions.
When this study was published
Published 2020.
The bigger picture
The intersection of increasing cannabis use and surgical medicine is understudied. Preoperative screening for cannabis use may need to become standard to adjust anesthesia plans accordingly.
Questions still open
- How much additional propofol or opioid do cannabis users typically need? Should cannabis abstinence be recommended before elective surgery?
Common questions
Should I tell my anesthesiologist about cannabis use?
Does vaping THC add surgical risks?
Read the original research
Cannabis, e-cigarettes and anesthesia.
Current opinion in anaesthesiology, 33(3), 318-326
Citation
Lynn, Rachael S Rzasa; Galinkin, Jeffrey L. (2020). Cannabis, e-cigarettes and anesthesia.. Current opinion in anaesthesiology, 33(3), 318-326. https://doi.org/10.1097/ACO.0000000000000872
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