1
|
Saad D, Ghazala Z, Jesus A, Atteri M, Arundathi R, Ararat E. Preoperative vaping screening in pediatric patients. Pediatr Pulmonol 2024; 59:1832-1835. [PMID: 38506400 DOI: 10.1002/ppul.26981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/21/2024]
Affiliation(s)
- Dima Saad
- Department of Pediatrics, Pediatric Pulmonary Division, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Zena Ghazala
- Department of Pediatrics, Pediatric Pulmonary Division, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Apuya Jesus
- Department of Anesthesiology, Division of Pediatric Anesthesia and Pain Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Meenakshi Atteri
- Department of Anesthesiology, Division of Pediatric Anesthesia and Pain Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Reddy Arundathi
- Department of Anesthesiology, Division of Pediatric Anesthesia and Pain Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Erhan Ararat
- Department of Pediatrics, Pediatric Pulmonary Division, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| |
Collapse
|
2
|
Ekrami E, Sari S, Kopac O, Wang D, Mascha EJ, Stamper S, Esa WAS, Nair H, Ruetzler K, Turan A. Association Between Cannabis Use and Opioid Consumption, Pain, and Respiratory Complications After Surgery: A Retrospective Cohort Analysis. Anesth Analg 2024:00000539-990000000-00699. [PMID: 38190341 DOI: 10.1213/ane.0000000000006785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND Cannabis is a widely used illicit drug with effects on different pain pathways. However, interactions between cannabis and postoperative pain are unclear. Cannabis smoking also affects the lungs, but the impact of cannabis use on postoperative pulmonary complications is unknown. We hypothesized that preoperative cannabis use in adults having elective surgery is associated with higher postoperative opioid consumption. Secondarily, we tested the hypothesis that cannabis use is associated with higher pain scores, hypoxemia (oxygen saturation [Spo2]/fraction of inspired oxygen [Fio2] ratio), and higher postoperative pulmonary complications compared to nonuse of cannabis. METHODS In this retrospective study, we included adult patients who had elective surgeries at Cleveland Clinic Main Campus between January 2010 and December 2020. The exposure was use of cannabis within 30 days before surgery, and the control group never used cannabis. Patients who had regional anesthesia or chronic pain diagnosis were excluded. The primary outcome was postoperative opioid consumption; 3 secondary outcomes were time-weighted average (TWA) postoperative pain score, TWA Spo2/Fio2 ratio, and composite of pulmonary complications after surgery. We assessed the association between cannabis use and opioid consumption during the first 24 postoperative hours using linear regression on log-transformed opioid consumption with a propensity score-based method (inverse probability of treatment weighting [IPTW]) adjusting for confounders. We further adjusted for imbalanced confounding variables after IPTW was applied. RESULTS In total, 1683 of 34,521 patients were identified as cannabis users. Cannabis use was associated with increased opioid consumption, with an adjusted ratio of geometric means (95% confidence interval [CI]) of 1.30 (1.22-1.38; P < .0001) for cannabis users versus nonusers. Secondarily, (1) cannabis use was associated with increased TWA pain score, with a difference in means of 0.57 (95% CI, 0.46-0.67; P < .0001); (2) cannabis use was not associated with TWA Spo2/Fio2, with an adjusted difference in means of 0.5 (95% CI, -3.1 to 4.2; P = .76); and (3) cannabis use was not associated with a collapsed composite of pulmonary complications, with estimated odds ratio of 0.90 (95% CI, 0.71-1.13; P = .34). CONCLUSIONS Adult cannabis users undergoing surgeries were found to have significantly higher postoperative opioid consumption and pain scores than nonusers. Cannabis use did not have a clinically meaningful association with hypoxia or composite pulmonary complications.
Collapse
Affiliation(s)
- Elyad Ekrami
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sinem Sari
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
- Department of General Anesthesiology, Adnan Menderes University, Aydin, Turkey
| | - Orkun Kopac
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dong Wang
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; and
| | - Edward J Mascha
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; and
| | - Samantha Stamper
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Wael Ali Sakr Esa
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Harsha Nair
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kurt Ruetzler
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alparslan Turan
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
3
|
Jain S, Cloud GW, Gordon AM, Lam AW, Vakharia RM, Saleh A, Razi AE. Cannabis Use Disorder Is Associated With Longer In-Hospital Lengths of Stay, Higher Rates of Medical Complications, and Costs of Care Following Primary 1- to 2-Level Lumbar Fusion. Global Spine J 2024; 14:67-73. [PMID: 35395920 PMCID: PMC10676152 DOI: 10.1177/21925682221093965] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVES The purpose of this study is to assess whether cannabis use disorder (CUD) patients undergoing primary 1- to 2-level lumbar fusion (1-2LF) for the treatment of degenerative lumbar spine disorders have higher rates of: (1) in-hospital lengths of stay (LOS), (2) medical complications, and (3) healthcare expenditures. MATERIALS AND METHODS A retrospective case-control study of the MSpine dataset of the PearlDiver claims from January 2007 to March 2018 was performed. Patients with CUD undergoing 1-2LF were queried and matched to a comparison group in a 1:5 ratio by age, sex, and various medical comorbidities yielding 22, 815 patients within the study (CUD = 3805; control = 19 010). Outcomes analyzed included LOS, 90-day medical complications, and costs. A P-value less than .004 was considered significant. RESULTS This study found CUD patients undergoing primary 1-2LF experience longer in-hospital LOS (4- vs. 3-days, P < .0001). Additionally, CUD patients were found to have significantly higher frequency and odds-ratios (OR) (31.88 vs. 18.01% OR: 1.41, P < .0001) of adverse events within ninety days following their procedure. CUD patients also had significantly higher day of surgery ($18,946.79 vs. $15,691.02, P < .0001) and 90 days healthcare expenditures ($21,469.01 vs. $19,556.71, P < .0001). CONCLUSION Patients with CUD can prepare for increased LOS, complications, and costs following primary 1-2LF. The study can be used to educate these patients of the potential outcomes following their procedure.
Collapse
Affiliation(s)
- Shreya Jain
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
- College of Medicine, State University of New York Downstate, Brooklyn, NY, USA
| | - Geoffrey W. Cloud
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
- College of Medicine, State University of New York Downstate, Brooklyn, NY, USA
| | - Adam M. Gordon
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Aaron W. Lam
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Rushabh M. Vakharia
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Ahmed Saleh
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Afshin E. Razi
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| |
Collapse
|
4
|
Lee BH, Sideris A, Ladha KS, Johnson RL, Wu CL. Cannabis and Cannabinoids in the Perioperative Period. Anesth Analg 2024; 138:16-30. [PMID: 35551150 DOI: 10.1213/ane.0000000000006070] [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: 11/05/2022]
Abstract
Cannabis use is increasingly common, and with a growing number of jurisdictions implementing legalization frameworks, it is likely that providers will encounter more patients who use cannabis. Therefore, it is important for providers to understand the implications of cannabis use and practical considerations for the perioperative period. Cannabis affects multiple organ systems and may influence intraoperative anesthesia, as well as postoperative pain management. The effects of cannabis and key anesthetic considerations are reviewed here.
Collapse
Affiliation(s)
- Bradley H Lee
- From the Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Alexandra Sideris
- From the Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Karim S Ladha
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Christopher L Wu
- From the Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| |
Collapse
|
5
|
Padoan F, Colombrino C, Sciorio F, Piacentini G, Gaudino R, Pietrobelli A, Pecoraro L. Concerns Related to the Consequences of Pediatric Cannabis Use: A 360-Degree View. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1721. [PMID: 38002812 PMCID: PMC10670833 DOI: 10.3390/children10111721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 11/26/2023]
Abstract
Cannabis, a plant known for its recreational use, has gained global attention due to its widespread use and addiction potential. Derived from the Cannabis sativa plant, it contains a rich array of phytochemicals concentrated in resin-rich trichomes. The main cannabinoids, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), interact with CB1 and CB2 receptors, influencing various physiological processes. Particularly concerning is its prevalence among adolescents, often driven by the need for social connection and anxiety alleviation. This paper provides a comprehensive overview of cannabis use, its effects, and potential health risks, especially in adolescent consumption. It covers short-term and long-term effects on different body systems and mental health and highlights the need for informed decision making and public health initiatives, particularly regarding adolescent cannabis use.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
Gilmore BA, Gilmore CM, Reveles KR, Koeller JM, Spoor JH, Flores BE, Frei CR. A Survey of Vaping Use, Perceptions, and Access in Adolescents from South-Central Texas Schools. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6766. [PMID: 37754625 PMCID: PMC10530846 DOI: 10.3390/ijerph20186766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023]
Abstract
Despite efforts to dissuade major manufacturers and retailers from marketing and selling vape products to adolescents, the practice of vaping continues to increase in this population. Few studies have assessed adolescent perceptions of vaping, access to vaping, and use of vaping, and most rely, at least in part, on inferential conclusions drawn from data on smoking traditional combustible cigarettes. A novel electronic survey was created to assess the use of vapes, perceptions of vaping, and access to vaping among a convenience sample of adolescents (ages 12-20 years) in eleven schools in South-Central Texas from May to August 2021. The students' perceived threat of negative health outcomes due to vaping was calculated based on questions soliciting perceptions of severity (perceived danger) and susceptibility (perceived likelihood of illness). Trends were identified using descriptive and bivariate statistical tests. A total of 267 respondents were included; 26% had tried vaping. A majority (63%) did not believe vaping and smoking were synonymous. Most (70%) thought it was easy to obtain supplies and (76%) vape before and after (88%) or even during (64%) school. Respondents who vaped had a 34% lower perceived threat when compared to respondents who did not vape. In this sample of adolescents from South-Central Texas, one in four reported that they had tried vaping. Easy access to vapes and misperceptions regarding the safety of vaping might create a false sense of security with respect to vaping as an alternative to smoking, particularly among those who reported vaping, and is likely contributing to the increased use of vapes.
Collapse
Affiliation(s)
- Bretton A. Gilmore
- College of Pharmacy, The University of Texas at Austin, San Antonio, TX 78229, USA; (C.M.G.); (K.R.R.); (J.M.K.)
- Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA;
- Graduate School of Biomedical Sciences, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Corbyn M. Gilmore
- College of Pharmacy, The University of Texas at Austin, San Antonio, TX 78229, USA; (C.M.G.); (K.R.R.); (J.M.K.)
- Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA;
- Graduate School of Biomedical Sciences, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Kelly R. Reveles
- College of Pharmacy, The University of Texas at Austin, San Antonio, TX 78229, USA; (C.M.G.); (K.R.R.); (J.M.K.)
- Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA;
- Graduate School of Biomedical Sciences, University of Texas Health San Antonio, San Antonio, TX 78229, USA
- Audie L. Murphy Veterans Hospital, South Texas Veterans Health Care System, San Antonio, TX 78229, USA
- University Hospital, San Antonio, TX 78229, USA
| | - Jim M. Koeller
- College of Pharmacy, The University of Texas at Austin, San Antonio, TX 78229, USA; (C.M.G.); (K.R.R.); (J.M.K.)
- Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA;
- Graduate School of Biomedical Sciences, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Jodi H. Spoor
- Southside Independent School District, San Antonio, TX 78221, USA;
| | - Bertha E. Flores
- Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA;
- Graduate School of Biomedical Sciences, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Christopher R. Frei
- College of Pharmacy, The University of Texas at Austin, San Antonio, TX 78229, USA; (C.M.G.); (K.R.R.); (J.M.K.)
- Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA;
- Graduate School of Biomedical Sciences, University of Texas Health San Antonio, San Antonio, TX 78229, USA
- Audie L. Murphy Veterans Hospital, South Texas Veterans Health Care System, San Antonio, TX 78229, USA
- University Hospital, San Antonio, TX 78229, USA
- School of Public Health, University of Texas Health Houston, San Antonio, TX 78229, USA
| |
Collapse
|
8
|
Ahrens E, Wachtendorf LJ, Chiarella LS, Ashrafian S, Suleiman A, Tartler TM, Azizi BA, Chen G, Berger AA, Shay D, Teja B, Banner-Goodspeed V, Ma H, Eikermann M, Hill KP, Schaefer MS. Prevalence and association of non-medical cannabis use with post-procedural healthcare utilisation in patients undergoing surgery or interventional procedures: a retrospective cohort study. EClinicalMedicine 2023; 57:101831. [PMID: 36798752 PMCID: PMC9926083 DOI: 10.1016/j.eclinm.2023.101831] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is paucity of data regarding prevalence and key harms of non-medical cannabis use in surgical patients. We investigated whether cannabis use in patients undergoing surgery or interventional procedures patients was associated with a higher degree of post-procedural healthcare utilisation. METHODS 210,639 adults undergoing non-cardiac surgery between January 2008 and June 2020 at an academic healthcare network in Massachusetts, USA, were included. The primary exposure was use of cannabis, differentiated by reported ongoing non-medical use, self-identified during structured, preoperative nursing/physician interviews, or diagnosis of cannabis use disorder based on International Classification of Diseases, 9th/10th Revision, diagnostic codes. The main outcome measure was the requirement of advanced post-procedural healthcare utilisation (unplanned intensive care unit admission, hospital re-admission or non-home discharge). FINDINGS 16,211 patients (7.7%) were identified as cannabis users. The prevalence of cannabis use increased from 4.9% in 2008 to 14.3% by 2020 (p < 0.001). Patients who consumed cannabis had higher rates of psychiatric comorbidities (25.3 versus 16.8%; p < 0.001) and concomitant non-tobacco substance abuse (30.2 versus 7.0%; p < 0.001). Compared to non-users, patients with a diagnosis of cannabis use disorder had higher odds of requiring advanced post-procedural healthcare utilisation after adjusting for patient characteristics, concomitant substance use and socioeconomic factors (aOR [adjusted odds ratio] 1.16; 95% CI 1.02-1.32). By contrast, patients with ongoing non-medical cannabis use had lower odds of advanced post-procedural healthcare utilisation (aOR 0.87; 95% CI 0.81-0.92, compared to non-users). INTERPRETATION One in seven patients undergoing surgery or interventional procedures in 2020 reported cannabis consumption. Differential effects on post-procedural healthcare utilisation were observed between patients with non-medical cannabis use and cannabis use disorder. FUNDING This work was supported by an unrestricted philantropic grant from Jeff and Judy Buzen to Maximilian S. Schaefer.
Collapse
Affiliation(s)
- Elena Ahrens
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Luca J. Wachtendorf
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Laetitia S. Chiarella
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sarah Ashrafian
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Aiman Suleiman
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Anesthesia, Intensive Care and Pain Medicine, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Tim M. Tartler
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Basit A. Azizi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Guanqing Chen
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Amnon A. Berger
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Denys Shay
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Bijan Teja
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Valerie Banner-Goodspeed
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Haobo Ma
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Matthias Eikermann
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Essen, Germany
| | - Kevin P. Hill
- Division of Addiction Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Maximilian S. Schaefer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Klinik für Anästhesiologie, Universitätskliniken Düsseldorf, Düsseldorf, Germany
- Corresponding author. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, 02215, MA, USA.
| |
Collapse
|
9
|
Heath DM, Koslosky EJ, Bartush KC, Hogue GD. Marijuana in Orthopaedics: Effects on Bone Health, Wound-Healing, Surgical Complications, and Pain Management. JBJS Rev 2022; 10:01874474-202202000-00011. [PMID: 35180183 DOI: 10.2106/jbjs.rvw.21.00184] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
» Marijuana use is on the rise in the United States, and there is a paucity of information on the effects of cannabis and its chemical constituents on bone health, wound-healing, surgical complications, and pain management. » Current evidence suggests that cannabidiol (CBD) may enhance bone health and metabolism, while Δ9-tetrahydrocannabinol (Δ9-THC), the major psychoactive component in marijuana, has an inhibitory effect. » Marijuana users are at higher risk for delayed bone-healing, demonstrate lower bone mineral density, are at increased risk for fracture, and may experience postoperative complications such as increased opioid use and hyperemesis.
Collapse
Affiliation(s)
- David M Heath
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas
| | | | | | - Grant D Hogue
- Department of Orthopaedics, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
10
|
Heller ZA, MS ECA, DMD JEP. Implications of Electronic Cigarettes on the Safe Administration of Sedation and General Anesthesia in the Outpatient Dental Setting. Anesth Prog 2022; 69:41-52. [PMID: 35849811 PMCID: PMC9301538 DOI: 10.2344/anpr-69-02-16] [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: 01/10/2022] [Accepted: 05/02/2022] [Indexed: 12/30/2022] Open
Abstract
Today the number of electronic cigarette users continues to rise as electronic cigarettes slowly, yet steadily overtake conventional cigarettes in popularity. This shift is often attributed to the misconception that electronic cigarettes are "safer" or "less dangerous" than conventional cigarettes. Recent studies have shown that electronic cigarettes are far from safe and that the inhaled agents and byproducts within vaping aerosols can have adverse effects on systemic and oral health like combustible tobacco products. The first electronic cigarettes were originally introduced as a tool for smoking cessation. However, newer iterations of electronic cigarette devices have been modified to allow the user to consume tetrahydrocannabinol (THC), the psychoactive component of cannabis, in addition to nicotine. As the popularity of these devices continues to rise, the number of patients seeking dental treatment who also consume electronic cigarettes will too. This article aims to shed light on the deleterious effects electronic cigarettes can have on systemic and oral health, as well as the special considerations for sedation and anesthesia providers treating patients who use electronic cigarettes.
Collapse
Affiliation(s)
- Zachary A. Heller
- Resident, Department of Oral and Maxillofacial Surgery, Broward Health Medical Center, Nova Southeastern University College of Dental Medicine, Fort Lauderdale, Florida
| | - Edward C. Adlesic MS
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania
| | - Jason E. Portnof DMD
- Adjunct Associate Professor, Department of Oral and Maxillofacial Surgery, Nova Southeastern University College of Dental Medicine, Davie, Florida; Private Practice Oral & Maxillofacial Surgery, Surgical Arts of Boca Raton, Boca Raton, Florida
| |
Collapse
|
11
|
Preoperative Considerations for Teenagers Undergoing Orthopaedic Surgery: VTE Prevention, Mental Health Assessment, Vaping, and Drug Addiction. J Pediatr Orthop 2021; 41:S64-S69. [PMID: 34096540 DOI: 10.1097/bpo.0000000000001764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Adolescents undergoing pediatric orthopaedic surgery typically experience an uncomplicated postoperative course. However, adolescence represents a unique transition period from pediatric to adult physiology. As a result, the astute pediatric orthopaedic surgeon will be aware of unique medical and social scenarios which are relevant to adolescents during the perioperative course including the risk of venous thromboembolism (VTE), prevalence of mental health conditions, and rising use of electronic cigarettes or "vaping" to consume nicotine and cannibas. DISCUSSION Adolescents are at a greater risk of VTE after pediatric orthopaedic surgery. In particular, adolescent females with a family history of blood clotting disorders and those with a change in mobility after surgery should be considered for prophylaxis. The prevalence of adolescent mental health conditions including anxiety, depression, and behavioral issues is increasing in the United States. Higher levels of preoperative anxiety and the presence of mental health pathology are associated with slower recovery, higher levels of postoperative pain, and the increased likelihood for chronic pain. Several quick screening instruments are available to assess adolescents for preoperative anxiety risk, including the Visual Analogue Scale for Anxiety or the Amsterdam Perioperative Anxiety Information Scale. Unfortunately, electronic cigarettes have become increasingly popular for the consumption of nicotine and cannabis among adolescents. Preoperative use of combustive cigarettes (nicotine/cannabis) represents perioperative risks for induction/anesthesia, postoperative pain, and analgesia requirements and issues with delayed wound and fracture healing. CONCLUSIONS VTE, underlying mental health conditions, and usage of nicotine and cannabis are clear detriments to the recovery and healing of adolescent patients following orthopaedic surgery. Therefore, standardized screening for adolescents before orthopaedic surgery is indicated to identify perioperative risk factors which have negative impacts on functional outcomes.
Collapse
|
12
|
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: 5] [Impact Index Per Article: 1.7] [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.
Collapse
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
| |
Collapse
|