This document provides a detailed elaboration of the potential adverse effects of cannabis smoking in the context of anesthetic care for anesthesiologists.
1. Pulmonary Effects:
  • Smoking synthetic tetrahydrocannabinol (THC) products or cannabis can lead to airway irritation and exacerbation of underlying respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD), and pneumonia.
  • Similar to conventional cigarette smoking, smoking cannabis increases the levels of carboxyhemoglobin in the blood, which reduces the blood’s capacity to carry oxygen.
2. Cardiovascular and Cerebrovascular Effects:
  • Cannabis use can result in sympathetic activation, leading to increased circulating levels of catecholamines. This can lead to an elevated heart rate and blood pressure, both with acute and chronic use.
  • Impaired vascular endothelial function is associated with cannabis use, which can have implications for blood vessel health and overall cardiovascular function.
  • There’s an increased risk of cardiovascular events, such as myocardial infarction (heart attack), ischemic stroke, or transient ischemic attack (mini-stroke), among cannabis users.
  • A retrospective study involving over 27,000 patients found that the incidence of postoperative myocardial infarction was higher in patients who reported active cannabis use compared to those without (adjusted odds ratio 1.88). This suggests a potential association between cannabis use and postoperative cardiovascular complications.
  • At high doses, cannabis use can lead to enhanced parasympathetic tone, resulting in dose-dependent bradycardia (slow heart rate) and hypotension (low blood pressure).
3. Neuropsychiatric Effects:
  • Smoking cannabis can lead to impaired cognitive performance, which can impact decision-making, concentration, and overall mental clarity.
  • Acute administration of cannabis or withdrawal in chronic users can lead to the development of anxiety and/or psychotic symptoms in some patients. This has implications for patient comfort and psychological well-being during the perioperative period.
4. Anesthetic Requirements and Pain Management:
  • Cannabis use may lead to increased requirements for anesthetic agents during surgery. Anesthesiologists may need to adjust their anesthesia plans based on the potential effects of cannabis on drug metabolism and patient response.
  • There’s evidence suggesting that cannabis users may experience increased postoperative pain and require higher doses of opioids for pain management after surgical procedures. However, patient responses to pain and opioid use may vary.
5. Gastrointestinal Effects:
  • Some cannabis users may experience gastrointestinal effects, such as delayed gastric emptying, recurrent nausea and vomiting, or abdominal pain. Anesthesiologists should be aware of these potential issues, as they can impact patient comfort and anesthesia management.
Overall, cannabis smoking has the potential to affect various physiological systems, including the respiratory, cardiovascular, neuropsychiatric, and gastrointestinal systems. Anesthesiologists should consider these potential effects when assessing patients who are cannabis users, as they can influence anesthesia planning, intraoperative management, and postoperative care. Effective communication with patients about their cannabis use and its potential implications for anesthesia and surgery is crucial for providing safe and tailored perioperative care.

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