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Marijuana Use

 

 

Background

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  • Common names: marijuana, hashish, ganja, bud, hemp, weed, cannabis

  • Psychoactive compounds:

    • THC (delta-9-tetrahydrocannabinol)

    • CBD (Cannibidiol)

  • Cannot predict degree of intoxication from lab studies

    • Tissue half-life up to 30 days

  • Act on:

    • CB1 receptors: present throughout the central and peripheral nervous system

    • CB2 receptors: peripheral lymphoid and hematopoetic cells

  • Acute effects:

    • CNS: Euphoria vs anxiety, sedation, relaxation, altered spatial/temporal perception

    • CVS: tachycardia, vasodilation

    • Resp: bronchodilation, hyperreactivity, airway edema

    • GI: anti-nausea, increased appetite, abdominal pain

  • Chronic effects:

    • Atheromatous disease, chronic bronchitis/emphysema, tolerance, hyperemesis

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Withdrawal

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  • Signs & symptoms: irritability, anger, insomnia, altered dreams, anorexia, headache, tremors, fevers/chills

  • Onset: <1d

  • Duration: several weeks

  • Treatment:  symptom mgmt, synthetic THC

 

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Considerations 

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  • Ascertain careful history of use (frequency, route & amount)

    • Tox screen is not of value

    • Assess for the use of other drugs

  • R/o acute intoxication

    • may have more violent emergence

    • hypertension, fever, tachycardia may be confused with other more serious syndromes (i.e MH, serotonin syndrome)

  • Increased risk of MI in CAD patients 1hr after use

    • delay elective surgery for 1hr after acute use

  • Increased risk of airway hyperreactivity

  • Potential for:

    • elevated intra-op BIS (or unreliable BIS)

    • larger induction dose requirements

    • larger volatile requirements

    • more post-op pain, consider regional anesthesia

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References

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  • Alexander JC, Joshi GP. A review of the anesthetic implications of marijuana use. Proc (Bayl Univ Med Cent). 2019;32(3):364-371. Published 2019 May 21. doi:10.1080/08998280.2019.1603034

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