What is your MAC score? – Why cannabis users need stronger sedation drugs for colonoscopy and endoscopy

Endoscopies are a type of non-surgical medical procedure in which an endoscope is inserted down the throat and down the esophagus.

The tool called an endoscope is used to examine the digestive system with a built-in camera. Gastroenterologists or other specialists will use this procedure to determine if there are any diseases affecting the stomach, esophagus, or upper digestive system. In some cases, patients need to be sedated with anesthesia to perform endoscopy, especially if the case is high-risk or if the patient is pregnant, since the insertion of the endoscope can irritate the upper part of the gastrointestinal tract. This can cause a gag reflex and great discomfort in some people.

Now, a new study has found that cannabis users may need more anesthesia than usual when undergoing an endoscopy.

The study, presented during Digestive Disease Week 2022, involved researchers who analyzed 419 adult patients scheduled to undergo endoscopy at Canadian medical centers. Endoscopy should be performed under conscious sedation, with the patient relaxed but partially conscious. All patients were also asked to complete two surveys, one before the endoscopy regarding their cannabis use and the other after, to ask them questions about how aware and comfortable they felt during the procedure.

Researchers found that marijuana use was associated with the likelihood of requiring more anesthetics, such as B. more than 5 mg midazolam, more diphenhydramine or more than 100 micrograms fentanyl.

“Patients did not experience increased awareness or discomfort during the procedures, but they required more medication,” explains the study’s lead author, Dr. Yasmin Nasser, during a press release from the American Gastroenterological Association.

Same results as previous studies

There are several other studies showing that cannabis users require more anesthesia during surgical procedures, which is a warning to consumers.

A 2019 report published in the Journal of the American Osteopathic Association found that cannabis users may need twice the normal dose. The Colorado researchers analyzed the medical records of 250 patients who underwent endoscopic procedures after 2012, when recreational marijuana was legalized in the state. They found that daily or weekly marijuana users needed 220% more propofol, 20% more midazolam, and 14% more fentanyl to achieve the ideal sedating state for procedures, including colonoscopies.

“Some of the sedatives have dose-related side effects, meaning the higher the dose, the greater the likelihood of problems,” said lead researcher Mark Twardowski, DO. “This becomes particularly dangerous when suppressed respiratory function is a known side effect,” he added. Twardowski also acknowledged that marijuana has drug interactions. “Cannabis has some metabolic effects that we don’t understand, and patients need to know that their cannabis use may make other medications less effective. We see some problematic trends anecdotally, and there is virtually no formal data to give a sense of magnitude or suggest evidence-based protocols,” he says.

The researchers also suggest that patient forms asking about their cannabis use are critical for healthcare professionals to get the information they need to identify the right patient care protocols. “Determining cannabis use prior to procedural sedation can be an important tool for planning patient care and assessing both medication needs and potential risks associated with increased dosing requirements during endoscopic procedures,” they wrote.

Another preliminary study from 2020 found that cannabis users who had to undergo surgery for a broken leg required nearly 60% more opioid painkillers each day while recovering in hospital.

“It’s like flying an airplane. You have a take-off segment, and then you have your travel segment, and then you have your landing. In anesthesia these are induction, maintenance and emergence,” explains Dr. Ian Holmen, resident anesthesiologist at Colorado Anschutz Medical Campus and lead author of the study. “We’ve found that not only do you need more anesthesia during the induction phase of anesthesia, you also need more inhalation anesthetic during this travel phase.”

Holmen and his team analyzed the medical records of 118 operated patients who came to the clinic with a broken tibia. Thirty of them admitted to using cannabis, although frequency and amount were unknown. These patients reported more pain after surgery and required more opioid pain relievers.

They also found that cannabis users who have pre-existing lung or heart problems may be at serious risk during surgery based on the amount of anesthetic they need for the surgery. “Sevoflurane has a very clear dose-dependent effect on blood pressure,” says Dr. David Dickerson, Vice Chair of the American Society of Anesthesiologists (ASA). “The more sevoflurane you get in the OR, the more a patient’s blood pressure drops. If you have heart problems or lung problems when you come into the operating room, it could be dangerous.”

Conclusion

It can be understandable that you may feel concerned or uncomfortable about sharing your marijuana use habits with your doctor. However, as more states legalize the plant, more and more doctors are becoming aware of its uses and benefits.

Disclosing your cannabis habit to your doctor is extremely important if you are taking prescription medication or if you are going to have an endoscopy or any type of surgery. Even if your health questionnaire doesn’t ask for it, it can make a crucial difference in the outcome of your surgery, as more sedative use can lead to complications. Last but not least, it is in your best interest to share your medical history, including cannabis use.

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