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Lu YH, Mahajan L, Rudy H, Pettitt B, Pothula A, Ricci JA. Patterns of Marijuana Use and Nicotine Exposure in Patients Seeking Elective Aesthetic Procedures. Plast Reconstr Surg 2024; 154:478e-485e. [PMID: 39196865 DOI: 10.1097/prs.0000000000011145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Abstract
BACKGROUND With the increasing legalization and popularity of marijuana, it is frequently and sometimes unintentionally combined with nicotine-containing products. As a consequence, patients may fail to accurately report usage during preoperative examinations or remain unaware of the inclusion of nicotine. This poses a challenge for clinicians in identifying preoperative nicotine exposure. This study aimed to establish normative data on the use of marijuana and nicotine in plastic surgery patients and correlate it with urine nicotine and cotinine levels. METHODS All consecutive patients presenting to the authors' clinic seeking elective procedures were identified. Patients were surveyed on marijuana and nicotine use, and provided a urine sample for analysis. The survey responses, urine results, surgical treatments, and clinical outcomes were followed up prospectively. RESULTS A total of 135 patients completed the survey and were categorized as nonusers (50%), active nicotine users (19%), active marijuana users (7%), active users of both (13%), or past users (11%). Marijuana users who denied nicotine use showed significantly elevated nicotine and cotinine levels compared with nonusers (average nicotine level, 23.1 ± 13.5 ng/mL [P = 0.00007]; average cotinine level, 221.2 ± 141.8 ng/mL [P = 0.0002]). Fewer than a third of active marijuana or nicotine users reported active use of these products during clinical encounters. There was no difference in urine levels, reported use, or other patient characteristics in patients with and without postoperative complications. CONCLUSION This is the first descriptive study to document elevated urine nicotine levels in self-reported marijuana users in an urban, diverse patient population seeking elective plastic surgery procedures.
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Affiliation(s)
- Yi-Hsueh Lu
- From the Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine
| | - Lakshmi Mahajan
- From the Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine
| | - Hayeem Rudy
- From the Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine
| | - Brian Pettitt
- From the Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine
| | - Aravind Pothula
- From the Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine
| | - Joseph A Ricci
- Department of Plastic Surgery, Northwell Health, Hofstra School of Medicine
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2
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Mims MM, Parikh AC, Sandhu Z, DeMoss N, Mhawej R, Queimado L. Surgery-Related Considerations in Treating People Who Use Cannabis: A Review. JAMA Otolaryngol Head Neck Surg 2024:2822893. [PMID: 39172477 DOI: 10.1001/jamaoto.2024.2545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Importance Cannabis use has experienced substantial growth. Many patients treated by otolaryngologists are using cannabis in various forms, often without the knowledge of the treating surgeon. These cannabinoid substances have various systemic effects, and it is critical for otolaryngologists to recognize how cannabis use may contribute to a patient's care. Observations Cannabis use has effects that contribute to every phase of a surgeon's care. Preoperative counseling for tapering use may prevent increased rates of adverse effects. Care with anesthesia must be observed due to increased rates of myocardial ischemia, higher tolerance to standard doses, and prolonged sedation. Although results of studies are mixed, there may be an association with cannabis use and postoperative pain, nausea, and vomiting. Postoperative wound healing may be improved through the use of topical cannabinoids. Significant drug-drug interactions exist with cannabis, most notably with several common anticoagulant medications. Care should be exercised when managing medications for people who use cannabis. While many people who use cannabis consume it infrequently, a substantial population has developed cannabis use disorder, which is associated with increased morbidity and mortality postoperatively. Screening for cannabis use disorder is important and can be done through short screening tools. Conclusions and Relevance Patients who use cannabis may require special attention regarding preoperative counseling and workup, intraoperative anesthesia, postoperative pain management, nausea, wound healing, and drug-drug interactions. As patient use continues to increase, otolaryngologists will find an increasing need to remain up to date on how cannabis use contributes to patient care.
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Affiliation(s)
- Mark M Mims
- Department of Otolaryngology-Head and Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Aniruddha C Parikh
- Department of Otolaryngology-Head and Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Zainab Sandhu
- University of Oklahoma Medical School, Oklahoma City
| | - Noah DeMoss
- University of Oklahoma Medical School, Oklahoma City
| | - Rachad Mhawej
- Department of Otolaryngology-Head and Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Lurdes Queimado
- Department of Otolaryngology-Head and Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City
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3
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Sreenivasan S, Kaoutzani L, Ugiliweneza B, Boakye M, Schulder M, Sharma M. Cannabis and Craniotomy for Glioblastoma: Impact on Complications and Health Care Utilization. World Neurosurg 2024:S1878-8750(24)01351-2. [PMID: 39111656 DOI: 10.1016/j.wneu.2024.07.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 09/01/2024]
Abstract
OBJECTIVE Despite advances in treatment of glioblastomas (GBMs), the median survival remains 14-16 months. In the United States, 52.5 million people ≥12 years of age used cannabis in 2021. We aim to elucidate differences in complications after craniotomy for resection of GBM between users and nonusers of cannabis. METHODS Merative MarketScan Research Data (2008-2019) (includes >265 million patients) were used to extract adults (≥18 years of age) with GBM diagnosis (International Classification of Diseases-9 code 191.x and International Classification of Diseases-10 code C71.x) who had a craniotomy (Current Procedure Terminology code 61510) from inpatient admission data. The inverse probability treatment weighted analysis balanced the groups of cannabis abuse disorder (CAD) and no CAD in terms of age, gender, insurance coverage, comorbidities, and prior 12-month opioid dependence. RESULTS Individuals with CAD were younger (median, 37 vs. 51 years; P < 0.0001). There was a lower percentage of women (19% vs. 45%; P < 0.0001). In the CAD group, opioid abuse pattern for ≥12 months was higher (16% vs. 5%; P = 0.001) and the rate of complications was higher (32% vs. 15%; P = 0.001) during index hospital stay. At 6 months postdischarge, neurologic complications were higher among the CAD group (27% vs. 8%; P < 0.001). At 1 year postdischarge, patients with CAD sought fewer outpatient services (P = 0.012). More neurologic complications were seen in the CAD group (31% vs. 12%; P < 0.001). CONCLUSIONS This retrospective population-based study sounds a higher rate of neurologic complications among patients using cannabis who also had a newly diagnosed GBM. This suggests the lack of a protective effect from use of cannabis in patients with primary malignant brain tumors.
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Affiliation(s)
- Sanjeev Sreenivasan
- Department of Neurosurgery, NorthShore University Hospital & Long Island Jewish Medical Centre, Northwell Health, New York, New York, USA
| | - Lydia Kaoutzani
- Department of Neurosurgery, Augusta University, Augusta, Georgia, USA
| | | | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Michael Schulder
- Department of Neurosurgery, NorthShore University Hospital & Long Island Jewish Medical Centre, Northwell Health, New York, New York, USA
| | - Mayur Sharma
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.
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4
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Al-Saghir T, Hall J, Diffley M, Tang A, Teitelbaum A, Tepper DG, Darian V, Evangelista M, Atisha D. Marijuana's Impact On Implant-based Breast Reconstruction: A Retrospective Cohort Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6082. [PMID: 39171243 PMCID: PMC11338254 DOI: 10.1097/gox.0000000000006082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/17/2024] [Indexed: 08/23/2024]
Abstract
Background Studies have shown that chronic marijuana use is associated with increased vascular inflammation, endothelial damage, myocardial infarctions, strokes, arteritis, and cardiomyopathies; however, cannabis's effect on wound healing in immediate direct-to-implant (DTI) breast reconstruction is unknown. With the increasing prevalence of marijuana use, it is imperative to understand its effects on surgical outcomes. Methods We performed a retrospective cohort study of consecutive patients in a quaternary-care breast cancer center undergoing immediate DTI reconstruction. Patient demographics, operative details, and surgical complications were extracted through chart review. Active cannabis use was defined as use within 12 weeks of operation. Univariate and multivariable analyses were performed. Results In total, 243 consecutive patients underwent immediate DTI reconstruction, and 12 reported active cannabis use. There were no significant differences in patient demographics, cancer treatment, or operative details. Active marijuana users demonstrated higher rates of cellulitis treated with IV antibiotics (P = 0.004), explantation for infection (P = 0.004), emergency department visits (P = 0.028), readmission (P = 0.037), takeback to the operating room in 90 days (P < 0.001), and overall major complications (P < 0.001). Multivariable analysis demonstrated that active marijuana users were more likely to experience cellulitis treated with IV antibiotics [odds ratio (OR) = 3.55, P = 0.024], takeback to the OR within 90 days of operation (OR = 4.75, P = 0.001), and major complications (OR = 2.26, P = 0.048). Conclusions The consumption of cannabis in the perioperative setting is associated with increased rates of complications in patients undergoing immediate DTI reconstruction; however, an analysis with a larger patient population is needed to conclude that abstinence from its use should be highly encouraged.
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Affiliation(s)
- Tala Al-Saghir
- From the Division of Otolaryngology, Henry Ford Health System, Detroit, Mich
| | - Jamie Hall
- Division of Plastic Surgery, Henry Ford Health System, Detroit, Mich
| | - Michael Diffley
- Division of General Surgery, Henry Ford Hospital, Detroit, Mich
| | - Amy Tang
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Mich
| | | | - Donna G. Tepper
- Division of Plastic Surgery, Henry Ford Health System, Detroit, Mich
| | - Vigen Darian
- Division of Plastic Surgery, Henry Ford Health System, Detroit, Mich
| | | | - Dunya Atisha
- Division of Plastic Surgery, Henry Ford Health System, Detroit, Mich
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5
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Sladkey N, King DD, Reede LJ. Enhancing the Preanesthesia Evaluation: Consensus Development of the Cannabis Use and Behaviors Assessment Tool (CUBAT). J Perianesth Nurs 2024:S1089-9472(24)00109-6. [PMID: 38935007 DOI: 10.1016/j.jopan.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/24/2024] [Accepted: 03/17/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE This project aimed to develop an evidence-based preanesthesia cannabis use assessment tool to acquire complete and accurate patient history and develop a best-informed, individualized anesthesia and analgesia care plan. DESIGN Modified Delphi. METHODS Using an evidence synthesis and multistage, modified Delphi process, eight experts from across the United States developed a consensus-based tool to aid in developing a best-informed, individualized plan for anesthesia and analgesia care. FINDINGS Two survey rounds integrated informed evidence-based tool revisions. The final tool included instructions for use, a glossary of terms, and seven key assessment items aimed at gathering the most influential information regarding cannabis use. CONCLUSIONS The Cannabis Use and Behaviors Assessment Tool is a first-of-its-kind tool providing an essential framework for preanesthesia cannabis use assessment.
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Affiliation(s)
- Nadia Sladkey
- Northeastern University, Bouvé College of Health Sciences, School of Nursing, Boston, MA
| | - Daniel D King
- Rosalind Franklin University of Medicine and Science, College of Nursing, North Chicago, IL.
| | - Lynn J Reede
- Northeastern University, Bouvé College of Health Sciences, School of Nursing, Boston, MA
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Echeverria-Villalobos M, Guevara Y, Mitchell J, Ryskamp D, Conner J, Bush M, Periel L, Uribe A, Weaver TE. Potential perioperative cardiovascular outcomes in cannabis/cannabinoid users. A call for caution. Front Cardiovasc Med 2024; 11:1343549. [PMID: 38978789 PMCID: PMC11228818 DOI: 10.3389/fcvm.2024.1343549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/15/2024] [Indexed: 07/10/2024] Open
Abstract
Background Cannabis is one of the most widely used psychoactive substances. Its components act through several pathways, producing a myriad of side effects, of which cardiovascular events are the most life-threatening. However, only a limited number of studies address cannabis's perioperative impact on patients during noncardiac surgery. Methods Studies were identified by searching the PubMed, Medline, EMBASE, and Google Scholar databases using relevant keyword combinations pertinent to the topic. Results Current evidence shows that cannabis use may cause several cardiovascular events, including abnormalities in cardiac rhythm, myocardial infarction, heart failure, and cerebrovascular events. Additionally, cannabis interacts with anticoagulants and antiplatelet agents, decreasing their efficacy. Finally, the interplay of cannabis with inhalational and intravenous anesthetic agents may lead to adverse perioperative cardiovascular outcomes. Conclusions The use of cannabis can trigger cardiovascular events that may depend on factors such as the duration of consumption, the route of administration of the drug, and the dose consumed, which places these patients at risk of drug-drug interactions with anesthetic agents. However, large prospective randomized clinical trials are needed to further elucidate gaps in the body of knowledge regarding which patient population has a greater risk of perioperative complications after cannabis consumption.
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Affiliation(s)
| | - Yosira Guevara
- Department of Anesthesiology, St Elizabeth’s Medical Center, Brighton, MA, United States
| | - Justin Mitchell
- Department of Anesthesiology & Perioperative Medicine, UCLA Medical Center, Los Angeles, CA, United States
| | - David Ryskamp
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Joshua Conner
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Margo Bush
- University of Toledo, College of Medicine and Life Sciences, Toledo, OH, United States
| | - Luis Periel
- Touro College of Osteopathic Medicine, New York, NW, United States
| | - Alberto Uribe
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Tristan E. Weaver
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Maskal S, Foreman JM, Ellis RC, Phillips S, Messer N, Melland-Smith M, Beffa LRA, Petro CC, Prabhu AS, Rosen MJ, Miller BT. Cannabis smoking and abdominal wall reconstruction outcomes: a propensity score-matched analysis. Hernia 2024; 28:847-855. [PMID: 38386125 PMCID: PMC11249614 DOI: 10.1007/s10029-024-02976-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/25/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Despite increasing use of cannabis, literature on perioperative effects is lagging. We compared active cannabis-smokers versus non-smokers and postoperative wound morbidity and reoperations following open abdominal wall reconstruction (AWR). METHODS Patients who underwent open, clean, AWR with transversus abdominis release and retromuscular synthetic mesh placement at our institution between January 2014 and May 2022 were identified using the Abdominal Core Health Quality Collaborative database. Active cannabis-smokers were 1:3 propensity matched to non-smokers based on demographics and comorbidities. Wound complications, 30 day morbidity, pain (PROMIS 3a-Pain Intensity), and hernia-specific quality of life (HerQles) were compared. RESULTS Seventy-two cannabis-smokers were matched to 216 non-smokers. SSO (18% vs 17% p = 0.86), SSI (11.1% vs 9.3%, p = 0.65), SSOPI (12% vs 12%, p = 0.92), and all postoperative complications (46% vs 43%, p = 0.63) were similar between cannabis-smokers and non-smokers. Reoperations were more common in the cannabis-smoker group (8.3% vs 2.8%, p = 0.041), driven by major wound complications (6.9% vs 3.2%, p = 0.004). No mesh excisions occurred. HerQles scores were similar at baseline (22 [11, 41] vs 35 [14, 55], p = 0.06), and were worse for cannabis-smokers compared to non-smokers at 30 days (30 [12, 50] vs 38 [20, 67], p = 0.032), but not significantly different at 1 year postoperatively (72 [53, 90] vs 78 [57, 92], p = 0.39). Pain scores were worse for cannabis-smokers compared to non-smokers at 30 days postoperatively (52 [46, 58] vs 49 [44, 54], p = 0.01), but there were no differences at 6 months or 1 year postoperatively (p > 0.05 for all). CONCLUSION Cannabis smokers will likely experience similar complication rates after clean, open AWR, but should be counseled that despite similar wound complication rates, the severity of their wound complications may be greater than non-smokers.
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Affiliation(s)
- S Maskal
- General Surgery, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA.
| | - J M Foreman
- General Surgery, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA
| | - R C Ellis
- General Surgery, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA
| | - S Phillips
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - N Messer
- General Surgery, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA
| | - M Melland-Smith
- General Surgery, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA
| | - L R A Beffa
- General Surgery, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA
| | - C C Petro
- General Surgery, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA
| | - A S Prabhu
- General Surgery, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA
| | - M J Rosen
- General Surgery, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA
| | - B T Miller
- General Surgery, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA
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Mehta SR, Stolfi A, Johnson MR, Rajagopal U, Anderson SR. Peri-Operative Impact of Cannabis Use in Conjunction With Elective Primary Breast Augmentation in a Private Practice. Cureus 2024; 16:e57196. [PMID: 38681441 PMCID: PMC11056190 DOI: 10.7759/cureus.57196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Background The consumption of recreational and medicinal cannabis in the United States continues to increase. Understanding the effects of cannabis in patients undergoing elective primary breast augmentation (EPBA) is of paramount importance with the expanding rates of reported cannabis consumption. Objectives This study aims to analyze the peri-operative impact of cannabis use in conjunction with EPBA in a single-surgeon practice in San Francisco, California. Methods A retrospective chart review was performed of 134 adult female patients undergoing EPBA from August 2018 to January 2022 within a single-surgeon practice plastic surgery office. Cannabis use was self-reported as current use or former use. Cohorts were grouped as cannabis users and cannabis non-users. Results Of the 134 patient charts identified for analysis, 58 (43.3%) reported cannabis use. Cannabis users were significantly younger than cannabis non-users (26.8 years versus 31.5 years, P<0.001). No significant differences were found between groups among intra-operative blood loss, post-operative complication rates, post-operative narcotic use, or intra-operative anesthetic requirements. The incidence of adverse events, including wound breakdown, skin necrosis, and capsular contracture requiring reoperation, did not differ significantly between cannabis users and cannabis non-user groups. Ninety-six percent of patients had their implants placed subpectorally, and all procedures were done using a Keller funnel. Eighty-three percent of patients had Sientra implants, and 96% of all implants were silicone gel implants. All procedures were done under general anesthesia. Patients were followed for up to two years. Discussion This review found no significant differences in peri-operative and post-operative outcomes between cannabis users and cannabis non-users.
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Affiliation(s)
- Shayna R Mehta
- Plastic and Reconstructive Surgery, Wright State Boonshoft School of Medicine, Dayton, USA
| | - Adrienne Stolfi
- Pediatrics, Wright State Boonshoft School of Medicine, Dayton, USA
| | - Michael R Johnson
- Plastic and Reconstructive Surgery, Wright State Boonshoft School of Medicine, Dayton, USA
| | - Usha Rajagopal
- Plastic Surgery, San Francisco Plastic Surgery and Laser Center, San Francisco, USA
| | - Spencer R Anderson
- Plastic and Reconstructive Surgery, Wright State Boonshoft School of Medicine, Dayton, USA
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Dietz N, Alkin V, Agarwal N, Sharma M, Oxford BG, Wang D, Ugiliweneza B, Mettille J, Boakye M, Drazin D. Cannabis Use Disorder Trends and Health Care Utilization After Cervical and Lumbar Spine Fusions. Spine (Phila Pa 1976) 2024; 49:E28-E45. [PMID: 37962203 DOI: 10.1097/brs.0000000000004874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE To identify differences in complication rates after cervical and lumbar fusion over the first postoperative year between those with and without cannabis use disorder (CUD) and to assess how CUD affects opioid prescription patterns. SUMMARY OF BACKGROUND DATA Cannabis is legal for medical purposes in 36 states and for recreational use in 18 states. Cannabis has multisystem effects and may contribute to transient vasoconstrictive, prothrombotic, and inflammatory effects. METHODS The IBM MarketScan Database (2009-2019) was used to identify patients who underwent cervical or lumbar fusions, with or without CUD. Exact match hospitalization and postdischarge outcomes were analyzed at index, six, and 12 months. RESULTS Of 72,024 cervical fusion (2.0% with CUD) and 105,612 lumbar fusion patients (1.5% with CUD), individuals with CUD were more likely to be young males with higher Elixhauser index. The cervical CUD group had increased neurological complications (3% vs. 2%) and sepsis (1% vs. 0%) during the index hospitalization and neurological (7% vs. 5%) and wound complications (5% vs. 3%) at 12 months. The lumbar CUD group had increased wound (8% vs. 5%) and myocardial infarction (MI) (2% vs. 1%) complications at six months and at 12 months. For those with cervical myelopathy, increased risk of pulmonary complications was observed with CUD at index hospitalization and 12-month follow-up. For those with lumbar stenosis, cardiac complications and MI were associated with CUD at index hospitalization and 12 months. CUD was associated with opiate use disorder, decreasing postoperatively. CONCLUSIONS No differences in reoperation rates were observed for CUD groups undergoing cervical or lumbar fusion. CUD was associated with an increased risk of stroke for the cervical fusion cohort and cardiac (including MI) and pulmonary complications for lumbar fusion at index hospitalization and six and 12 months postoperatively. Opiate use disorder and decreased opiate dependence after surgery also correlated with CUD.
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Affiliation(s)
- Nicholas Dietz
- Department of Neurosurgery, University of Louisville, Louisville, KY
| | | | - Nitin Agarwal
- Washington University, Barnes Jewish Hospital Plaza, St. Louis, MO
| | - Mayur Sharma
- Department of Neurosurgery, University of Louisville, Louisville, KY
| | | | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, Louisville, KY
| | - Beatrice Ugiliweneza
- Department of Neurosurgery, University of Louisville, Louisville, KY
- Department of Health Management and Systems Science, School of Public Health and Information Science, University of Louisville, Louisville, KY
| | | | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, KY
| | - Doniel Drazin
- Providence Regional Medical Center Everett, Everett, WA
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10
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Nasser Y, Biala S, Chau M, Partridge ACR, Yang JY, Lethebe BC, Stinton LM, Cooray M, Cole MJ, Ma C, Chen YI, Andrews CN, Forbes N. Baseline Cannabinoid Use Is Associated with Increased Sedation Requirements for Outpatient Endoscopy. Cannabis Cannabinoid Res 2024; 9:310-319. [PMID: 36269560 DOI: 10.1089/can.2022.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background and Aims: Given the underlying properties of cannabinoids, we aimed to assess associations between cannabinoid use and sedation requirements for esophagogastroduodenoscopy (EGD) and colonoscopy. Methods: A prospective cohort study was conducted at three endoscopy units. Adult outpatients undergoing EGD or colonoscopy with endoscopist-directed conscious sedation (EDCS) were given questionnaires on cannabinoid use and relevant parameters. Outcomes included intraprocedural midazolam, fentanyl, and diphenhydramine use, procedural tolerability, and adverse events. Multivariable logistic regression was performed to yield adjusted odds ratios (AORs) of outcomes. Results: A total of 419 patients were included. Baseline cannabinoid use was associated with high midazolam use, defined as ≥5 mg, during EGD (AOR 2.89, 95% confidence interval, CI: 1.19-7.50), but not during colonoscopy (AOR 0.89, 95% CI 0.41-1.91). Baseline cannabinoid use was associated with the administration of any diphenhydramine during EGD (AOR 3.04, 95% CI: 1.29-7.30) with a similar nonsignificant trend for colonoscopy (AOR 2.36, 95% CI: 0.81-7.04). Baseline cannabinoid use was associated with increased odds of requiring high total sedation, defined as any of midazolam ≥5 mg, fentanyl ≥100 mcg, or any diphenhydramine during EGD (AOR 3.72, 95% CI: 1.35-11.68). Cannabinoid use was not independently associated with fentanyl use, intraprocedural awareness, discomfort, or adverse events. Conclusions: Baseline cannabinoid use was associated with higher sedation use during endoscopy with EDCS, particularly with midazolam and diphenhydramine. Given increasingly widespread cannabinoid use, endoscopists should be equipped with optimal sedation strategies for this population. As part of the informed consent process, cannabis users should be counseled that they may require higher sedation doses to achieve the same effect.
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Affiliation(s)
- Yasmin Nasser
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - Soliman Biala
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Millie Chau
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Jeong Yun Yang
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - B Cord Lethebe
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Laura M Stinton
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mohan Cooray
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Martin J Cole
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Ma
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Yen-I Chen
- Department of Medicine, McGill University, Montreal, QC, Canada
| | | | - Nauzer Forbes
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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11
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Moon AS, LeRoy TE, Yacoubian V, Gedman M, Aidlen JP, Rogerson A. Cannabis Use Is Associated With Increased Use of Prescription Opioids Following Posterior Lumbar Spinal Fusion Surgery. Global Spine J 2024; 14:204-210. [PMID: 35536563 PMCID: PMC10676165 DOI: 10.1177/21925682221099857] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective review. OBJECTIVES Cannabis is an antinociceptive which has been evaluated as a possible adjunct or substitute for opioid use in the treatment of acute pain. The aim of this study was to evaluate the association between preoperative cannabis usage and consumption of opioids for postoperative analgesia. METHODS Patients who underwent one- or two-level posterior lumbar fusion surgery were categorized as cannabis users or non-cannabis users based on preoperative diagnoses of cannabis use. Total morphine equivalent dose was calculated for both in-house opioid consumption and postoperative prescription opioid usage. Age, ASA, BMI, depression, tobacco use, estimated blood loss, OR time, LOS, disposition to rehab, 30-day readmission, in-house opioid consumption and postoperative prescription opioid usage were compared between groups using t-tests. RESULTS Of the 220 opioid naïve patients, 29 (13%) patients were identified as cannabis users while 191 (87%) were non-cannabis users. There were no significant associations between opioid naïve cannabis usage and ASA, BMI, tobacco use, EBL, OR time, LOS, disposition to rehab, or readmission. Opioid naïve cannabis users had greater association with depression (31.3% vs 13.7%, P=.017) and younger age (56.37 years vs 65.37 years, P<.001). Interestingly, cannabis use was associated with a lower Charlson Comorbidity Index (CCI), with 1.38 vs 2.49 (P=.002). Cannabis users were found to have increased postoperative prescription opioid usage (2545.41 POST-MED vs 1379.72 POST-MED, P=.019). CONCLUSIONS Cannabis usage is associated with increased usage of opioids postoperatively, both while in-patient and post-discharge, after posterior lumbar spinal fusion surgery.
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Affiliation(s)
- Andrew S. Moon
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
| | - Taryn E. LeRoy
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
| | | | | | - Jessica P. Aidlen
- Department of Orthopaedic Surgery, Newton Wellesley Hospital, Newton, MA, USA
| | - Ashley Rogerson
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
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12
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Nahabedian MY. Commentary on: Analysis of Complications in Patients With a History of Cannabis Use and Tobacco Use Undergoing Implant-Based Breast Reconstruction. Aesthet Surg J 2023; 44:NP49-NP50. [PMID: 37766471 DOI: 10.1093/asj/sjad317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
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13
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Cheng TH, Mendelsohn M, Patel R, Worah S, Butts SC. Perioperative Management of Patients with Craniomaxillofacial Trauma. Otolaryngol Clin North Am 2023; 56:1069-1078. [PMID: 37414655 DOI: 10.1016/j.otc.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Successful surgical management of patients with facial fractures requires a detailed preoperative evaluation and postoperative management that differs from elective surgical patients. This review presents evidence-based recommendations from the surgical and anesthesiology literature that address many of the clinical questions that arise during the perioperative management of this group of patients. Surgeons and anesthesiologists must work together at numerous points and make joint decisions, especially where airway and pain management challenges may arise. The multidisciplinary nature of the decision-making process is emphasized.
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Affiliation(s)
- Tzu-Hsuan Cheng
- Department of Anesthesiology, State University of New York-Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Matthew Mendelsohn
- Department of Otolaryngology, State University of New York-Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Radhika Patel
- State University of New York-Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Samrat Worah
- Department of Anesthesiology, State University of New York-Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Sydney C Butts
- Department of Otolaryngology, State University of New York-Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA; Division of Facial Plastic Surgery, Department of Otolaryngology, Kings County Hospital Center, Brooklyn, NY, USA.
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14
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Oleru OO, Seyidova N, Mai D, Taub PJ. Cannabis use and flap reconstruction: A propensity score matched analysis. Microsurgery 2023; 43:865-867. [PMID: 37965693 PMCID: PMC10961227 DOI: 10.1002/micr.31038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/01/2023] [Accepted: 03/03/2023] [Indexed: 11/16/2023]
Affiliation(s)
- Olachi O. Oleru
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nargiz Seyidova
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Davis Mai
- Department of Orthopedic Surgery and Rehabilitation Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Peter J. Taub
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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15
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Yoon Y, Lee N, Lee AD, Gehring MB, Constantine R, Mathes DW, Yu JW, Khechoyan D, Iorio ML, Kaoutzanis C. Analysis of postoperative complications related to cannabis and tobacco usage in patients undergoing mandible facial fracture surgeries. J Plast Reconstr Aesthet Surg 2023; 85:127-133. [PMID: 37482026 DOI: 10.1016/j.bjps.2023.06.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/16/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Cannabis is the third most used controlled substance in the world. Despite its widespread use, minimal research investigates cannabis usage in patients undergoing facial fracture surgeries. This study aimed to evaluate patterns of postoperative complications related to cannabis and tobacco usage after mandible fracture surgeries. MATERIALS AND METHODS PearlDiver™, a commercially available healthcare database, was used to identify patients endorsing the use of cannabis, tobacco, or both who underwent mandible fracture surgeries for cross-sectional analysis. The study population was categorized into groups using the Classification of Diseases, 9th revision (ICD-9), ICD-10, and Current Procedural Terminology (CPT) codes. A chi-square analysis was performed to assess the influence of cannabis and tobacco use on postoperative complications. RESULTS A total of 8288 patients met the inclusion criteria, with 72 patients with cannabis-only usage, 914 patients with cannabis and tobacco usage, 3236 patients with tobacco-only usage, and 4066 in the control group. For patients using only cannabis, there was not an increased risk of developing postoperative complications compared with the control population. Patients with concurrent cannabis and tobacco usage and those with tobacco-only usage had an increased risk of surgical site infection, facial nonunion, facial abscess, debridement, and malocclusion after surgical repair of mandibular facial fracture. CONCLUSION Patients with tobacco-only as well as cannabis and tobacco usage had an increased risk of all postoperative complications, except malocclusion, compared with cannabis-only. Based on the results of this study, it is recommended that healthcare providers consider a patient's history of tobacco use when planning and performing surgical treatment for traumatic mandible fractures.
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Affiliation(s)
- YooJin Yoon
- University of Colorado School of Medicine, United States
| | - Nayun Lee
- University of Colorado School of Medicine, United States
| | - Anna D Lee
- University of Colorado School of Medicine, United States
| | - Michael B Gehring
- University of Colorado School of Medicine Division of Plastic & Reconstructive Surgery, United States
| | - Ryan Constantine
- University of Colorado School of Medicine Division of Plastic & Reconstructive Surgery, United States
| | - David W Mathes
- University of Colorado School of Medicine Division of Plastic & Reconstructive Surgery, United States
| | - Jason W Yu
- University of Colorado School of Medicine Division of Plastic & Reconstructive Surgery, United States
| | - David Khechoyan
- University of Colorado School of Medicine Division of Plastic & Reconstructive Surgery, United States
| | - Matthew L Iorio
- University of Colorado School of Medicine Division of Plastic & Reconstructive Surgery, United States
| | - Christodoulos Kaoutzanis
- University of Colorado School of Medicine Division of Plastic & Reconstructive Surgery, United States.
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16
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Pombeiro Stein ICA, Fricke TC, Leffler A. [Does medicinal cannabis or cannabis consumption have an influence on the perioperative anesthesiological management?]. DIE ANAESTHESIOLOGIE 2023; 72:621-626. [PMID: 37439805 DOI: 10.1007/s00101-023-01314-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/14/2023]
Abstract
The greatly increasing use of medicinal cannabis products as well as the upcoming legalization of cannabis not only require a general re-evaluation of how these substances might be classified as illegal drugs, but also enforce a critical view on the possible consequences that cannabis consumption might have on the anesthesiological strategies applied for surgical procedures. Although high-quality clinical studies are still lacking, several clinical studies meanwhile indicate that an active preoperative cannabis consumption seems to be associated with relevant pathophysiological aspects. Patients who regularly consume high doses of cannabis show an increased risk of cardiovascular and respiratory complications as well as the postoperative nausea and vomitting (PONV) associated with anesthesia. This also applies to relatively young patients. Moreover, the requirements for general anesthetics and analgesics seem to be increased in the context of cannabis consumption, e.g., these patients may require additional efforts when it comes to monitoring the depth of anesthesia and providing a personalized multimodal postoperative pain therapy. It therefore appears to be meaningful to carefully assess and document the extent and duration of the preoperative cannabis consumption during the preoperative assessment. Furthermore, the possibility to perform a preoperative dose reduction of cannabis products in cases with high doses should at least be considered. As the consumption of cannabis is not only increasing in Germany but also worldwide, important future insights will offer a guide towards a safe handling of cannabis in perioperative medicine in the coming years.
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Affiliation(s)
| | - Tabea Caroline Fricke
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Andreas Leffler
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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Shah S, Schwenk ES, Sondekoppam RV, Clarke H, Zakowski M, Rzasa-Lynn RS, Yeung B, Nicholson K, Schwartz G, Hooten WM, Wallace M, Viscusi ER, Narouze S. ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids. Reg Anesth Pain Med 2023; 48:97-117. [PMID: 36596580 DOI: 10.1136/rapm-2022-104013] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/08/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The past two decades have seen an increase in cannabis use due to both regulatory changes and an interest in potential therapeutic effects of the substance, yet many aspects of the substance and their health implications remain controversial or unclear. METHODS In November 2020, the American Society of Regional Anesthesia and Pain Medicine charged the Cannabis Working Group to develop guidelines for the perioperative use of cannabis. The Perioperative Use of Cannabis and Cannabinoids Guidelines Committee was charged with drafting responses to the nine key questions using a modified Delphi method with the overall goal of producing a document focused on the safe management of surgical patients using cannabinoids. A consensus recommendation required ≥75% agreement. RESULTS Nine questions were selected, with 100% consensus achieved on third-round voting. Topics addressed included perioperative screening, postponement of elective surgery, concomitant use of opioid and cannabis perioperatively, implications for parturients, adjustment in anesthetic and analgesics intraoperatively, postoperative monitoring, cannabis use disorder, and postoperative concerns. Surgical patients using cannabinoids are at potential increased risk for negative perioperative outcomes. CONCLUSIONS Specific clinical recommendations for perioperative management of cannabis and cannabinoids were successfully created.
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Affiliation(s)
- Shalini Shah
- Dept of Anesthesiology & Perioperative Care, UC Irvine Health, Orange, California, USA
| | - Eric S Schwenk
- Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Hance Clarke
- Anesthesiology and Pain Medicine, Univ Toronto, Toronto, Ontario, Canada
| | - Mark Zakowski
- Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Brent Yeung
- Anesthesiology and Perioperative Care, University of California Irvine, Irvine, California, USA
| | | | - Gary Schwartz
- AABP Integrative Pain Care, Melville, New York, USA.,Anesthesiology, Maimonides Medical Center, Brooklyn, New York, USA
| | | | - Mark Wallace
- Anesthesiology, Division of Pain Medicine, University of California San Diego, La Jolla, California, USA
| | - Eugene R Viscusi
- Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Samer Narouze
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
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Madsen HJ, Carmichael H, Reinicke T, Gleisner AL, Del Chiaro M, Schulick RD, Stewart CL. Cannabis use and post-operative complications in patients undergoing pancreatic resection. HPB (Oxford) 2023; 25:431-438. [PMID: 36740564 DOI: 10.1016/j.hpb.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 11/20/2022] [Accepted: 01/16/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Many states have legalized medical cannabis with various reported therapeutic benefits. However, there is little data assessing the effects of cannabis on surgical outcomes. We sought to compare post-operative pancreatic resection complications between cannabis users and non-users. METHODS This is a single-center, retrospective review of patients who underwent Whipple or distal pancreatectomy from 1/2017-12/2020. The primary outcome was any in-hospital complication, using Clavien-Dindo. Multivariable regression analysis was performed. RESULTS There were 486 patients who underwent Whipple (n=346, 71.2%) or distal pancreatectomy (n=140, 28.8%). Overall, 21.4% (n=104) reported cannabis use, of whom 80.8% were current users. Cannabis users were younger (60 vs. 66 years, p < 0.001), and more likely to have smoked tobacco (p=0.04), but otherwise had similar demographics as non-users. There were 288 (59.3%) patients who developed an in-hospital complication (grade 1-2, 75.3%; grade 3-5, 24.7%). A trend towards increased complications was observed with tobacco smoking (OR 1.33, 95% CI 0.91-1.94, p=0.14), but no association of cannabis use with complications was observed (OR 0.93, 95% CI 0.58-1.47, p=0.74). DISCUSSION A significant proportion of patients undergoing pancreatic resection report cannabis use. These results suggest that there was no association between cannabis use and post-operative complications, future prospective evaluation is warranted.
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Affiliation(s)
- Helen J Madsen
- Department of Surgery, University of Colorado School of Medicine, 12631 E. 17th Avenue, MS C-310, Room 6602, Aurora, CO 80045, USA.
| | - Heather Carmichael
- Department of Surgery, University of Colorado School of Medicine, 12631 E. 17th Avenue, MS C-310, Room 6602, Aurora, CO 80045, USA
| | - Trenton Reinicke
- Department of Surgery, University of Colorado School of Medicine, 12631 E. 17th Avenue, MS C-310, Room 6602, Aurora, CO 80045, USA
| | - Ana L Gleisner
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, 12631 E. 17th Avenue, MS C-310, Room 6602, Aurora, CO 80045, USA; University of Colorado Cancer Center, Denver, CO, USA
| | - Marco Del Chiaro
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, 12631 E. 17th Avenue, MS C-310, Room 6602, Aurora, CO 80045, USA; University of Colorado Cancer Center, Denver, CO, USA
| | - Richard D Schulick
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, 12631 E. 17th Avenue, MS C-310, Room 6602, Aurora, CO 80045, USA; University of Colorado Cancer Center, Denver, CO, USA
| | - Camille L Stewart
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, 12631 E. 17th Avenue, MS C-310, Room 6602, Aurora, CO 80045, USA; University of Colorado Cancer Center, Denver, CO, USA
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Preoperative Preparation and Guidelines for Cannabis-Using Patients Undergoing Elective Surgery. J Perianesth Nurs 2023:S1089-9472(22)00544-5. [PMID: 36609136 DOI: 10.1016/j.jopan.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/20/2022] [Accepted: 10/06/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE Appropriate preoperative screening techniques are needed to safely provide anesthesia to increasing numbers of cannabis using surgical patients. DESIGN This was a quasi-experimental quality improvement project. METHODS Preoperative identification of cannabis users by registered nurses (RNs) and certified registered nurse anesthetists (CRNAs) was compared to baseline identification rates. CRNAs' compliance with evidenced base guidelines was recorded. Perioperative medication requirements were recorded and compared between cannabis-users and non-cannabis users. FINDINGS Identification of cannabis users by CRNAs conducting preanesthetic assessments increased from 4.08% to 14.36% while RN identification improved from 11.22% to 13.81%. Compliance with identification guidelines was 69.2% among CRNAs. There were no differences in anesthetic requirements, complications, or postanesthesia care unit (PACU) length of stay between cannabis users and non-users. CONCLUSION Preoperative identification of cannabis users allows for safer, more effective perioperative care by CRNAs, registered nurses, and surgical staff.
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Coca-Martinez M, Wu K. Modification of Behavioral Habits in Prehabilitation Programs. Semin Oncol Nurs 2022; 38:151331. [PMID: 36030142 DOI: 10.1016/j.soncn.2022.151331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVES To review the evidence supporting the modification of behavioral habits and substance use management during cancer treatment and how to implement them as part of a multimodal optimization intervention. DATA SOURCES A literature review of the association between cancer and behavioral habits, their impact on oncological treatment outcomes, and substance use management guidelines. CONCLUSION There is an association between harmful habits, such as smoking and alcohol consumption, and cancer. The continuation of poor behavioral habits throughout oncological treatments is associated with poor oncological outcomes and increased complications. Prehabilitation could be an ideal setting to screen, assess, and modify these harmful habits. Prehabilitation programs should be equipped with professionals and resources to help patients achieve harmful habit cessation. IMPLICATIONS FOR NURSING PRACTICE This review puts into manifest the importance of a multidisciplinary approach to substance use management. It can serve as a framework to develop a harmful habit cessation intervention in the context of multimodal prehabilitation to improve surgical and oncological outcomes in the cancer population.
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Affiliation(s)
- Miquel Coca-Martinez
- Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Anesthesia McGill University Health Centre, Montreal, Canada.
| | - Kelan Wu
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
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21
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Carreira DS, Garden S, Huffman A, Ueland T. Cannabinoids in the Orthopedic Setting: A Literature Review. Orthopedics 2022; 45:e183-e189. [PMID: 35245146 DOI: 10.3928/01477447-20220225-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Public interest in the analgesic potential of cannabinoids has grown, but there is no consensus regarding orthopedic applications. Available evidence was identified for cannabinoid use in arthritis, neuropathic pain, fibromyalgia, multiple sclerosis, and postoperative pain. Extracted information included the risks of preoperative use, associations with opioid dependence, and surgical complications. There is limited evidence for therapeutic benefit of cannabinoids in rheumatoid arthritis and fibromyalgia. Cannabinoids are not indicated for postoperative pain. Preoperative unregulated use has been linked with postoperative opioid dependence. Cannabinoids may be considered a second- or third-line treatment for analgesia for some orthopedic pathologies. [Orthopedics. 2022;45(4):e183-e189.].
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22
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Williams K. Guidelines in Practice: Moderate Sedation and Analgesia. AORN J 2022; 115:553-564. [PMID: 35616460 DOI: 10.1002/aorn.13690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/10/2022]
Abstract
Moderate sedation and analgesia (MSA) can help patients experience less anxiety and discomfort, tolerate procedures that do not require general anesthesia, and maintain the ability to respond to verbal commands. Nurses administer MSA in a variety of clinical areas, and facility leaders may have difficulty creating a single standard of care for this task. Completion of a presedation assessment that includes the patient in the decision-making process is an important aspect of care. When administering MSA, nurses should have immediate unrestricted patient access and no competing responsibilities that could distract them from monitoring and assessing the patient. Nurses should complete education and competency verification activities before administering MSA. AORN recently revised the "Guideline for care of the patient receiving moderate sedation/analgesia," and this article addresses the standard of care, the presedation assessment, patient monitoring, and competency; it also includes scenarios describing specific concerns in two patient care areas.
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Shah RM, Saklecha A, Patel AA, Divi SN. Analyzing the Impact of Cannabinoids on the Treatment of Spinal Disorders. Curr Rev Musculoskelet Med 2022; 15:133-142. [PMID: 35132567 PMCID: PMC9076773 DOI: 10.1007/s12178-022-09743-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Cannabis is among the most used illicit substances globally, with medical applications, increased legalization, and shifting social attitudes leading to increased use in recent years. Cannabinoids are a group of psychoactive substances found within the cannabis plant, with the most common being Δ9-tetrahydrocannabinol and cannabidiol. Due to the high prevalence of use, it is increasingly important to evaluate the effects of cannabis and cannabinoids on spine patients, in both operative and nonoperative settings. RECENT FINDINGS Cannabis and cannabinoids may be effective in treating patients with chronic conditions such as back pain and spinal cord injuries. Longitudinal effects and implications on surgical outcomes and complications are poorly understood. High-quality, outcomes-focused research can inform approaches for clinicians to approach cannabis and cannabinoid use. Studies to elucidate the standardization of cannabis regimens can help develop guidelines for potential therapeutic applications. Cannabis and cannabinoids may be useful alternatives or additions for many spine patients, but future research is needed for recommendations to be determined. Our manuscript reviews the available literature regarding cannabis use and various spinal conditions, organizing our findings into the following narrative themes: (1) the management of chronic lower back pain, (2) perioperative outcomes, (3) cannabis use in general orthopaedic procedures, and (4) spinal cord injuries.
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Affiliation(s)
| | | | - Alpesh A Patel
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Srikanth N Divi
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Gallagher JP, Twohig PA, Crnic A, Rochling FA. Illicit Drug Use and Endoscopy: When Do We Say No? Dig Dis Sci 2022; 67:5371-5381. [PMID: 35867192 PMCID: PMC9306238 DOI: 10.1007/s10620-022-07619-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 05/11/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Illicit drug use (IDU) is often encountered in patients undergoing elective ambulatory surgical procedures such as endoscopy. Given the variety of systemic effects of these drugs, sedation and anesthetics are believed to increase the risk of cardiopulmonary complications during procedures. Procedural cancelations are common, regardless of the drug type, recency of use, and total dosage consumed. There is a lack of institutional and society recommendations regarding the optimal approach to performing outpatient endoscopy on patients with IDU. AIM To review the literature for current recommendations regarding the optimal management of outpatient elective endoscopic procedures in patients with IDU. Secondary aim is to provide guidance for clinicians who encounter IDU in endoscopic practice. METHODS Systematic review of PubMed, CINAHL, Embase, and Google Scholar for articles presenting data on outcomes of elective procedures in patients using illicit drugs. RESULTS There are no clinically relevant differences in periprocedural complications or mortality in cannabis users compared to non-users. Endoscopy in patients with remote cocaine use was also found to have similar outcomes to recent use. CONCLUSIONS Canceling endoscopic procedures in patients with recent IDU without consideration of the type of drug, dosage, and chronicity may lead to unnecessary delays in care and increased patient morbidity. Healthcare systems would benefit from additional guidelines for evaluating the patient with recent illicit drug use for acute intoxication and consider proceeding with procedures in the non-toxic population.
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Affiliation(s)
- John P. Gallagher
- Department of Internal Medicine, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE 68198 USA
| | - Patrick A. Twohig
- Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE 68198 USA
| | - Agnes Crnic
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON K1Y 4E9 Canada
| | - Fedja A. Rochling
- Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE 68198 USA
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Narayanan M, Alnahhal KI, Lingutla R, Irshad A, Iafrati M, Suarez L, Kumar S, Salehi P. Outcomes of Infrainguinal Bypass in Patients with Cannabis vs Opioid Use Disorder Outcomes of IIB in Patients with CUD vs OUD. Ann Vasc Surg 2021; 82:144-155. [PMID: 34902470 DOI: 10.1016/j.avsg.2021.10.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Marijuana and opioids are commonly used illicit drugs in the United States and their use continues to rise. Cannabis use disorder (CUD) and Opioid use disorder (OUD) are associated with adverse effects on public health and postoperative outcomes. However, their impact on vascular surgery, specifically infrainguinal bypass repair (IIB). is not well described in the literature. Therefore, our study aimed to assess perioperative outcomes in patients with CUD and OUD who underwent IIB. METHODS A retrospective analysis of the National Inpatient Sample database for the years 2005 to 2018 was performed. Using the International Classification of Diseases Clinical Modification, Ninth and Tenth revisions, patients who were diagnosed with peripheral artery disease and underwent IIB repair.were identified. Our primary outcome was the comparison of rates of in-hospital complications between the groups, and the secondary outcomes included analysis of total hospital charges and length of stay. A 1:1 propensity score matching (PSM) CUD and OUD patients to their control groups without the disease was conducted using the nearest-neighbor method. The matching was based on select patient demographics and comorbidities included in our analyses. RESULTS A total of 190,794 patients were identified: 972 patients with CUD and 682 patients with OUD. In the matched cohorts, patients with a diagnosis of CUD had a higher incidence of in-hospital cardiac complications (adjusted Odds Ratio [aOR], 1.76; 95% Confidence Interval [CI], 0.99 - 3.12) and acute kidney injury (AKI) (aOR, 1.51; CI, 1.09 - 2.08). Additionally, total hospital charges and mean length of stay were higher in the CUD group (P <.001). Those with OUD had a higher incidence of postoperative respiratory complications (aOR, 1.92; CI, 1.23 - 2.99), sepsis (aOR, 2.39; CI, 1.32 - 4.34), infection (aOR, 3.55; CI, 1.16 - 10.84), AKI (aOR, 2.11; CI,1.47-3.04), major amputations (aOR, 1.69; CI, 1.07 - 2.69), along with higher total charges and mean length of stay (P <.001). CONCLUSIONS Both CUD and OUD have increased incidence of postoperative complications following IIB. The OUD group had generally worse outcomes compared to patients with CUD. Both were associated with a substantial increase in total hospital charges and length of hospital stay. A further prospective study is warranted to provide better insight on the effects of substance use disorders on the procedure's short- and long-term outcomes.
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Affiliation(s)
- Meyyammai Narayanan
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA
| | - Khaled I Alnahhal
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA
| | | | - Ali Irshad
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA
| | - Mark Iafrati
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA
| | - Luis Suarez
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA
| | - Shivani Kumar
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA
| | - Payam Salehi
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA.
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Gotesman RD, Lalonde E, McKim DA, Bourque PR, Warman-Chardon J, Zwicker J, Breiner A. Laryngospasm in amyotrophic lateral sclerosis. Muscle Nerve 2021; 65:400-404. [PMID: 34817079 DOI: 10.1002/mus.27466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Laryngospasm is an involuntary, sustained closure of sphincter musculature that leads to an unpleasant subjective experience of dyspnea and choking. It is an underreported symptom in amyotrophic lateral sclerosis (ALS). In this study we aimed to better characterize the prevalence and clinical characteristics of laryngospasm in ALS patients. METHODS The medical records of 571 patients with ALS followed between 2008 and 2018 were searched for evidence of laryngospasm. A total of 23 patients with laryngospasm were identified and the data related to patient and laryngospasm characteristics were extracted. RESULTS Laryngospasm was reported in 4% of ALS patients. Females comprised 57% of patients and their mean age was 63.4 years. Laryngospasm frequently manifested in patients with moderate bulbar dysfunction and seemed independent of respiratory function. Among laryngospasm patients, 26% were cigarette smokers and 13% had a history of gastroesophageal reflux. The most common reported trigger was excessive saliva irritating the vocal cords (35%) followed by eating a meal (17%). There was significant variation in laryngospasm frequency (up to 5 per hour) and duration (seconds to minutes). Most patients could not identify an effective coping mechanism, although 13% reported that drinking water was effective. DISCUSSION Despite its low prevalence in ALS, laryngospasm should be included in the symptom inquiry. The present findings may improve patient care through increased recognition of the clinical features of laryngospasm in ALS patients, identifying a link between laryngospasm and moderate bulbar dysfunction, and highlighting trigger avoidance as a management strategy. Additional research is required to understand the pathophysiology and optimal treatment.
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Affiliation(s)
- Ryan D Gotesman
- Department of Medicine (Neurology), The Ottawa Hospital, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, Ontario, Canada
| | - Emilie Lalonde
- Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, Ontario, Canada
| | - Douglas A McKim
- Division of Respiratory Medicine, CANVent Respiratory Rehabilitation Services, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Pierre R Bourque
- Department of Medicine (Neurology), The Ottawa Hospital, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, Ontario, Canada
| | - Jodi Warman-Chardon
- Department of Medicine (Neurology), The Ottawa Hospital, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, Ontario, Canada
| | - Jocelyn Zwicker
- Department of Medicine (Neurology), The Ottawa Hospital, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, Ontario, Canada
| | - Ari Breiner
- Department of Medicine (Neurology), The Ottawa Hospital, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, Ontario, Canada
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Carter J, Chang J, Birriel TJ, Moustarah F, Sogg S, Goodpaster K, Benson-Davies S, Chapmon K, Eisenberg D. ASMBS position statement on preoperative patient optimization before metabolic and bariatric surgery. Surg Obes Relat Dis 2021; 17:1956-1976. [PMID: 34629296 DOI: 10.1016/j.soard.2021.08.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/11/2021] [Accepted: 08/27/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Jonathan Carter
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California.
| | - Julietta Chang
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - T Javier Birriel
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Fady Moustarah
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Stephanie Sogg
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Kasey Goodpaster
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Sue Benson-Davies
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Katie Chapmon
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Dan Eisenberg
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
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Times Are a Changin': Marijuana Use among Plastic Surgery Patients. Plast Reconstr Surg 2021; 148:702e-704e. [PMID: 34495898 DOI: 10.1097/prs.0000000000008380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wood A. Clinical Issues-September 2021. AORN J 2021; 114:262-269. [PMID: 34436773 DOI: 10.1002/aorn.13492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 04/29/2021] [Indexed: 11/08/2022]
Abstract
Interviewing the patient about cannabis use Key words: cannabis, marijuana, tetrahydrocannabinol (THC), cannabidiol (CBD), patient interview. AORN guidance for non-OR settings Key words: cardiac catheterization laboratory, endoscopy suite, interventional radiology suite, practice setting, invasive procedure. Using personal continuous positive airway pressure devices in the perioperative setting Key words: continuous positive airway pressure (CPAP), obstructive sleep apnea (OSA), home equipment, biomedical engineering, electrical devices. Screening for cognitive impairment in the older adult patient Key words: older adult patient, dementia, delirium, cognitive impairment screening tool, prehabilitation.
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Vakharia RM, Mannino A, Salem HS, Roche MW, Wong CHJ, Mont MA. The association between cannabis use disorder and the outcome following primary total hip arthroplasty : analysis of a nationwide administrative claims database. Bone Joint J 2021; 103-B:111-115. [PMID: 34192906 DOI: 10.1302/0301-620x.103b7.bjj-2020-2424.r1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Although there is increasing legalization of the use of cannabis in the USA, few well-powered studies have evaluated the association between cannabis use disorder and outcomes following primary total hip arthroplasty (THA). Thus, the aim of this study was to determine whether patients who use cannabis and undergo primary THA have higher rates of in-hospital length of stay (LOS), medical complications, implant-related complications, and costs. METHODS Using an administrative database, patients with cannabis use disorder undergoing primary THA were matched to a control group in a 1:5 ratio by age, sex, and various medical comorbidities. This yielded 23,030 patients (3,842 in the study group matched with 19,188 in the control group). The variables which were studied included LOS, 90-day medical complications, two-year implant-related complications, and 90-day costs of care. Mann-Whitney U tests were used to compare LOS and costs. Multivariate logistic regression analyses were used to calculate the odds ratios (ORs) of developing complications. RESULTS We found that patients in the study group had a significantly longer mean LOS compared with the controls (four days vs three days; p < 0.0001).The study group also had a significantly higher incidence and odds of developing medical (23.0 vs 9.8%, OR 1.6; p < 0.0001) and implant-related complications (16 vs 7.4%, OR 1.6; p < 0.0001) and incurred significantly higher mean 90-day costs ($16,938.00 vs $16,023.00; p < 0.0001). CONCLUSION With the increasing rates of cannabis use, these findings allow orthopaedic surgeons and other healthcare professionals to counsel patients with cannabis use disorder about the possible outcomes following their THA, with increased hospital stays, complications, and costs. Cite this article: Bone Joint J 2021;103-B(7 Supple B):111-115.
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Affiliation(s)
- Rushabh M Vakharia
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Angelo Mannino
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Hytham S Salem
- Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, New York, USA
| | - Martin W Roche
- Department of Orthopaedic Surgery, Hospital for Special Surgery, West Palm Beach, Florida, USA
| | - Che Hang J Wong
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Michael A Mont
- Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, New York, USA.,Department of Orthopaedic Surgery, Cleveland Clinic Hospital, Cleveland, Ohio, USA
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Talley-Bruns RC, Shatkin MS, Dhar Y, Zelicof SB. The Physiological Effects, Including Risks and Potential Benefits, of Cannabis for Patients Undergoing Elective Orthopedic Procedures. Orthopedics 2021; 44:e314-e319. [PMID: 33561869 DOI: 10.3928/01477447-20210201-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Given the evolving regulations regarding and availability of cannabis in the United States, physicians should understand the risks and benefits associated with its use. Patients are interested in learning about the use of cannabis for the management of orthopedic pain and any potential risks associated with it when undergoing elective surgery. Edible and topical cannabis products appear to have fewer side effects than inhaled cannabis products. A review of the literature was performed regarding different modes of administration and their related risks and potential benefits specifically regarding perioperative concerns for elective orthopedic procedures. Larger studies are necessary to further determine the efficacy, safety, and side effect profile of cannabis. [Orthopedics. 2021;44(3):e314-e319.].
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Sadighi T, Londahl-Ramsey V. Cannabis Use: Change in Screening for Primary Care Preoperative Clearance. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yu JS, Premkumar A, Liu S, Sculco P. Rates of self-directed perioperative cannabidiol use in patients undergoing total hip or knee arthroplasty. Pain Manag 2021; 11:655-660. [PMID: 34102871 DOI: 10.2217/pmt-2021-0018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aim: To evaluate the prevalence of self-directed cannabidiol (CBD) use in patients with end-stage degenerative hip and knee arthritis who underwent total hip arthroplasty and total knee arthroplasty. Materials & methods: Anonymous surveys for 109 patients were completed at 6 weeks follow-up after either total hip arthroplasty or total knee arthroplasty at a single tertiary care US orthopedic hospital. Results: Within the perioperative window encompassing both preoperative and postoperative periods, 22% (95% CI: 14-30%) of patients used CBD. Conclusion: There was no difference in pain satisfaction between patients who used CBD and patients who did not. Given high rates of self-directed perioperative CBD use and the mixed body of evidence, further research is needed to better understand whether CBD is safe and effective.
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Affiliation(s)
- Jonathan S Yu
- Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY 10065, USA
| | - Ajay Premkumar
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY 10021, USA
| | - Shangyi Liu
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY 10021, USA
| | - Peter Sculco
- Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY 10065, USA.,Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY 10021, USA
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Chiu RG, Patel S, Siddiqui N, Nunna RS, Mehta AI. Cannabis Abuse and Perioperative Complications Following Inpatient Spine Surgery in the United States. Spine (Phila Pa 1976) 2021; 46:734-743. [PMID: 33769411 DOI: 10.1097/brs.0000000000004035] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
MINI Due to its complicated legal status, the effects of cannabis on elective spine surgery patients have not been well studied. In this nationwide analysis, we find that cannabis abuse is associated with higher perioperative thromboembolism and neurologic complications, respiratory complications, sepsis, length of stay, hospital charges, and rates of unfavorable discharge disposition.
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Affiliation(s)
- Ryan G Chiu
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL
| | - Saavan Patel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL
| | - Neha Siddiqui
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL
- Carle Illinois College of Medicine, University of Illinois, Champaign, IL
| | - Ravi S Nunna
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL
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King DD, Stewart SA, Collins-Yoder A, Fleckner T, Price LL. Anesthesia for Patients Who Self-Report Cannabis (Marijuana) Use Before Esophagogastroduodenoscopy: A Retrospective Review. AANA JOURNAL 2021; 89:205-212. [PMID: 34042571 PMCID: PMC8764743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Increasing numbers of patients are using cannabis before procedures that require anesthesia. This study set out to examine the impact of cannabis use on anesthetic agent requirements, associated cardiac and respiratory morbidity, and overall satisfaction levels in patients undergoing esophagogastroduodenoscopy (EGD). This involved a retrospective review of patients undergoing EGD at a single center. Fortyseven, self-reported cannabis users were identified and 23 were successfully cross-matched with control participants for comparison purposes. The Wilcoxon signed rank test was used to evaluate differences in propofol administration between the 2 groups, and the McNemar test was used to test for differences in fentanyl and ketamine administration. No statistically significant differences were observed in propofol, fentanyl, or ketamine administration in the cannabis group compared with the control group. No adverse cardiac or respiratory events were reported within 30 days for either group. This study was specific to EGD procedures of short duration, and larger studies are needed to confirm results of no consequence in cannabis users undergoing anesthesia. Future studies should consider cannabis users who undergo anesthesia for diverse procedure types of various durations.
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Affiliation(s)
- Daniel D King
- is an assistant clinical professor at Northeastern University in Boston, Massachusetts, and a staff nurse anesthetist at Good Samaritan Medical Center in Brockton, Massachusetts.
| | - Scott A Stewart
- is the chair of the Department of Anesthesiology at Good Samaritan Medical Center in Brockton, Massachusetts
| | - Angela Collins-Yoder
- is a clinical professor in the Capstone College of Nursing at The University of Alabama. She is also a critical care nurse specialist at Sacred Heart in Pensacola, Florida
| | - Tara Fleckner
- is a project coordinator in the Tufts Clinical and Translational Science Institute at Tufts University in Boston, Massachusetts
| | - Lori Lyn Price
- is a senior statistician in the Tufts Clinical and Translational Science Institute at Tufts University
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Albelo FD, Baker M, Zhang T, Schneider MB, Jauregui JJ, Nadarajah V, Meredith SJ, Packer JD, Henn RF. Impact of pre-operative recreational marijuana use on outcomes two years after orthopaedic surgery. INTERNATIONAL ORTHOPAEDICS 2021; 45:2483-2490. [PMID: 34052856 DOI: 10.1007/s00264-021-05069-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/07/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to investigate the relationship between recreational marijuana use and patient-reported outcomes two years after orthopaedic surgery. We hypothesized that pre-operative recreational marijuana use would be associated with less pain, better function, and better mental health measures two years after orthopaedic surgery. METHODS Patients were retrospectively analyzed from a prospective orthopaedic registry at a single urban institution. A total of 1710 patients completed the pre-operative assessment and 1103 patients (64.5%) completed the two-year follow-up questionnaires. The cohort was then divided into two groups based on reported preoperative recreational marijuana usage, and statistical analysis was performed to determine if marijuana use was associated with two-year outcomes. Multivariable analysis was used to control for confounding variables. RESULTS Marijuana use was reported by 47 (4.3%) patients. Significantly worse scores for two-year PROMIS Anxiety (53.2 vs. 49.2, p = 0.005), PROMIS Depression (51.1 vs. 46.5, p = 0.001), Met Expectations (63.1 vs. 74.4, p = 0.024), Surgical Satisfaction Questionnaire-8 (71.7 vs. 80.4, p = 0.005), and Numeric Satisfaction Scale (75.6 vs. 83.1, p = 0.041) were associated with marijuana use. Marijuana users also had less improvement of Numeric Pain Scores at the operative site (- 1.8 vs. - 2.7, p = 0.037) and greater decrease in Marx activity scores for lower extremities (- 12.3 vs. - 3.9, p = 0.024). Marijuana use was not an independent predictor of any outcome measure in the multivariable analysis. CONCLUSION Marijuana use was associated with worse mental health scores, lower activity level, less pain relief, and worse satisfaction two years after orthopaedic surgery. However, after controlling for confounding variables, marijuana use was not predictive of any two-year outcome measure. STUDY DESIGN Cross-sectional study.
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Affiliation(s)
- Fernando D Albelo
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Mitchell Baker
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Tina Zhang
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Matheus B Schneider
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Julio J Jauregui
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Vidushan Nadarajah
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA.,Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA.
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Zhang BH, Saud H, Sengupta N, Chen M, Bakshi D, Richardson L, Wang L, Shanthanna H. Effect of preoperative cannabis use on perioperative outcomes: a retrospective cohort study. Reg Anesth Pain Med 2021; 46:650-655. [PMID: 33990440 DOI: 10.1136/rapm-2021-102479] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/01/2021] [Accepted: 04/04/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The reported use of cannabis within surgical population is increasing. Cannabis use is potentially associated with increased harms and varied effects on pain control. These have important implications to perioperative care. METHODS We conducted a retrospective cohort study comparing surgical patients reporting cannabis use preoperatively to control patients with no cannabis exposure, in a 1:2 ratio. To control for confounding, we used a propensity score-matched analysis to assess the adjusted association between cannabis use and study outcomes. Our primary outcome was a composite of (1) respiratory arrest or cardiac arrest, (2) intensive care admission, (3) stroke, (4) myocardial infarction and (5) mortality during this hospital stay. Secondarily, we assessed the effects on pain control, opioid usage, induction agent dose and nausea-vomiting. RESULTS Between January 2018 and March 2019, we captured 1818 patients consisting of cannabis users (606) and controls (1212). For propensity score-matched analyses, 524 cannabis patients were compared with 1152 control patients. No difference in the incidence of composite outcome was observed (OR 1.06, 95% CI 0.23 to 3.98). Although a higher incidence of arrhythmias (2.7% vs 1.6%) and decreased incidence of nausea-vomiting needing treatment (9.6% vs 12.6%) was observed with cannabis users vs controls, results were not statistically significant. No significant differences were observed with other secondary outcomes. CONCLUSION Our results do not demonstrate a convincing association between self-reported cannabis use and major surgical outcomes or pain management. Perioperative decisions should be made based on considerations of dose, duration, and indication.
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Affiliation(s)
- Betty Huiyu Zhang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Haris Saud
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Neil Sengupta
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Max Chen
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Devyani Bakshi
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Liz Richardson
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Li Wang
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Harsha Shanthanna
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada .,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Research Institute of St Joes, Hamilton, Ontario, Canada.,Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada
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Everett L, Foley AJ, Scholl AT, Petrovic MA. Perioperative and anaesthetic considerations of marijuana use. J Perioper Pract 2021; 32:190-195. [PMID: 33779402 DOI: 10.1177/1750458921991117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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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Affiliation(s)
- Lauren Everett
- School of Medicine, University of Miami at Holy Cross Hospital, Fort Lauderdale, FL, USA
| | - Adam J Foley
- College of Medicine, University of Central Florida, Orlando, FL, USA
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Abstract
PURPOSE OF REVIEW Marijuana use presents a unique challenge to bariatric surgery programs. We review the recent evidence examining marijuana use on outcomes following bariatric surgery. RECENT FINDINGS Recent studies have not demonstrated an increased risk of short-term surgical complications or differences in up to 2-year weight loss following surgery among marijuana users. However, studies have demonstrated increased risks in two areas: pain management and problematic eating behaviors. Additionally, preoperative marijuana use has been linked to increased postoperative marijuana use which may undermine weight loss and increase risk for weight regain. There are still many unanswered questions regarding marijuana use and bariatric surgery, and the limited literature base has produced mixed results when considering marijuana as a contraindication for bariatric surgery. Programs must take into consideration the laws of their state, individual patterns of use, and route of administration when considering whether marijuana is a contraindication for surgery.
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Affiliation(s)
- Allyson Diggins
- Cleveland Clinic Bariatric & Metabolic Institute, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Leslie Heinberg
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Bariatric & Metabolic Institute, Cleveland, OH, USA
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Cannabis use and bariatric surgery psychology practice: survey and insights. Surg Obes Relat Dis 2020; 17:701-710. [PMID: 33551252 DOI: 10.1016/j.soard.2020.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/16/2020] [Accepted: 12/09/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cannabis is second only to alcohol as a substance of abuse and dependence in the United States. While there is extensive research examining alcohol use and bariatric surgery, there is currently little research and there are no published guidelines specific to cannabis use and bariatric surgery. OBJECTIVES To identify major themes and general guidelines applied by bariatric surgery psychology clinicians. SETTING This practice survey was disseminated to bariatric surgery psychologists at various U.S. academic medical centers, hospitals, and private practices. METHODS An electronic, 35-question survey was sent to 47 bariatric surgery psychologists to collect information on current clinical practice guidelines regarding cannabis use before and after bariatric surgery. RESULTS The survey questionnaire was completed by 34 (72.34%) bariatric surgery psychologists. The major identified themes included: (1) the lack of a standardized assessment of cannabis use; (2) a requirement for 3 months of abstinence from cannabis before bariatric surgery; (3) recommended lifetime abstinence from cannabis after bariatric surgery; and (4) discussion of cannabis use risks following bariatric surgery, including appetite stimulation, addiction potential, and possible negative impacts on judgment. CONCLUSION Cannabis use will likely further increase in the United States. This survey highlighted common bariatric surgery psychology practices in the absence of extensive research and published guidelines. These findings suggest a preliminary framework with which to address cannabis use in patients seeking bariatric surgery. It is recommended that professional organizations and societies build on these initial survey findings to develop guidelines for more consistent, evidence-based practice regarding cannabis use and bariatric surgery.
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Famiglietti A, Memoli JW, Khaitan PG. Therapeutic Application of Cannabis in Medicine and Its Relevance to Thoracic Surgery. Ann Thorac Surg 2020; 112:665-671. [PMID: 33248994 DOI: 10.1016/j.athoracsur.2020.08.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/12/2020] [Accepted: 08/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cannabis is the most commonly used illicit substance in the United States. As cannabis use rises in popularity and its legalization continues to expand, the scientific community must address the controversy between beneficial and adverse effects of cannabis consumption. METHODS We performed a comprehensive literature review to study the medicinal and pathologic effects of cannabis use, with emphasis on its association with cancer pathophysiology and thoracic surgery. RESULTS We found evidence that cannabis products often contain carcinogenic materials and that their use is associated with the development of certain head and neck cancers, but not lung cancer. Indeed, several in vitro and in vivo studies have demonstrated that cannabis may have a therapeutic role in cancer given the antiproliferative effects of its active compounds such as δ-9-tetrahydrocannabinol. Cannabis-derived products have also been shown to be effective treatments for chronic pain, neuropathy, spasticity, and as antiemetics. CONCLUSIONS We acknowledge that additional studies are required to elucidate the long-term effects of cannabis products and that many potential biases and limitations exist in the literature due to self-reporting and limited survey studies. Appropriate stewardship over cannabis use among our patient population will likely determine its full implications in both oncologic and perioperative outcomes.
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Affiliation(s)
- Amber Famiglietti
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Jessica Wang Memoli
- Division of Interventional Pulmonology, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Puja Gaur Khaitan
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC; Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC.
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Medicinal and Recreational Marijuana: Review of the Literature and Recommendations for the Plastic Surgeon. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2838. [PMID: 33133899 PMCID: PMC7572176 DOI: 10.1097/gox.0000000000002838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/19/2020] [Indexed: 11/27/2022]
Abstract
Supplemental Digital Content is available in the text. With the shift in public opinion and legalization of cannabis for therapeutic and recreational use, cannabis consumption has become more common. This trend will likely continue as decriminalization and legalization of marijuana and associated cannabinoids expand. Despite this increase in use, our familiarity with this drug and its associated effects remains incomplete. The aim of this review is to describe the physiologic effects of marijuana and its related compounds, review current literature related to therapeutic applications and consequences, discuss potential side effects of marijuana in surgical patients, and provide recommendations for the practicing plastic surgeon. Special attention is given to areas that directly impact plastic surgery patients, including postoperative pain, nausea and vomiting and wound healing. Although the literature demonstrates substantial support for marijuana in areas such as chronic pain and nausea and vomiting associated with chemotherapy, the data supporting its use for common perioperative problems are lacking. Its use for treating perioperative problems, such as pain and nausea, is poorly supported and requires further research.
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Effects of Perioperative Cannabis Use on Bariatric Surgical Outcomes: a Systematic Review. Obes Surg 2020; 31:299-306. [DOI: 10.1007/s11695-020-04962-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 12/31/2022]
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Woo M, Andrews CN. Implications of cannabis use on sedation for endoscopic procedures. Gastrointest Endosc 2019; 90:656-658. [PMID: 31540633 DOI: 10.1016/j.gie.2019.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/07/2019] [Indexed: 02/08/2023]
Affiliation(s)
- Matthew Woo
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher N Andrews
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Impact of recreational and medicinal marijuana on surgical patients: A review. Am J Surg 2019; 217:783-786. [DOI: 10.1016/j.amjsurg.2018.10.053] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/30/2018] [Accepted: 10/12/2018] [Indexed: 12/18/2022]
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No longer rare diseases and obstetric anesthesia. Curr Opin Anaesthesiol 2019; 32:271-277. [PMID: 30893118 DOI: 10.1097/aco.0000000000000726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW With new medical technologies and changing life styles, maternal demographics has changes and consequently older and sicker women are becoming pregnant.In this review, we present these different high-risk parturient populations, which were once considered rare for the practicing obstetric anesthesiologist. RECENT FINDINGS With lifestyle and medical advances, older and sicker women are getting pregnant. Older women are more prone to pregnancy complications. Cancer survivors are becoming pregnant and more pregnant women are being diagnosed with cancer. Previous neurological and cardiac conditions considered not compatible with pregnancy are now seen more frequently. As the rate of obesity increases so does the rate of obstructive sleep apnea, which is known to be associated with many adverse maternal and neonatal sequalae. Finally, increased use of both opioids and marijuana has led to increased number of pregnant women using these illicit substances. SUMMARY Future research and implementation of international guidelines for management of these high-risk parturient population is necessary in order to reduce maternal and neonatal morbidity.
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