The Ohio State University Wexner Medical Center, Department of Anesthesiology, Doan Hall 520, 410 W 10th Ave, Columbus 43210, OH, USA.
The Ohio State University Wexner Medical Center, Department of Anesthesiology, Doan Hall 520, 410 W 10th Ave, Columbus 43210, OH, USA; The Ohio State University Wexner Medical Center, Department of Neurological Surgery, 410 W 10th Ave, Columbus 43210, OH, USA.
J Clin Anesth. 2019 Nov;57:41-49. doi: 10.1016/j.jclinane.2019.03.011. Epub 2019 Mar 7.
According to the 2015 National Survey on Drug Use and Health, marijuana continues to be the most common illicit recreational drug used in the US. Cannabis is associated with systemic reactions that potentially affect perioperative outcomes. We have reviewed the most important pharmacological aspects and pathophysiological effects that should be considered during the perioperative management of chronic cannabis/cannabinoids users. The synthetic analogues provide higher potency with increased risk for complications. High cannabinoid liposolubility favors rapid accumulation in fatty tissue which prolongs its elimination up to several days after exposure. The multi-systemic effects of cannabinoids and their pharmacological interactions with anesthetic agents may lead to serious consequences. Low doses of cannabinoids have been associated with increased sympathetic response (tachycardia, hypertension and increased contractility) with high levels of norepinephrine detected 30 min after use. High doses enhance parasympathetic tone leading to dose-dependent bradycardia and hypotension. Severe vascular complications associated with cannabis exposure may include malignant arrhythmias, coronary spasm, sudden death, cerebral hypoperfusion and stroke. Bronchial hyperreactivity and upper airway obstruction are commonly reported in cannabis users. Postoperative hypothermia, shivering and increased platelet aggregation have been also documented.
根据 2015 年全国药物使用和健康调查，大麻仍然是美国最常见的非法消遣性药物。大麻与可能影响围手术期结果的全身反应有关。我们已经回顾了在慢性大麻/大麻素使用者的围手术期管理中应考虑的最重要的药理学方面和病理生理效应。合成类似物具有更高的效力，增加了并发症的风险。高大麻素脂溶性有利于在脂肪组织中快速积累，从而使其在暴露后长达数天内消除。大麻素的多系统效应及其与麻醉剂的药理相互作用可能导致严重后果。低剂量的大麻素与交感神经反应增加（心动过速、高血压和收缩力增加）有关，使用后 30 分钟即可检测到高水平的去甲肾上腺素。高剂量增强副交感神经张力，导致剂量依赖性心动过缓和低血压。与大麻暴露相关的严重血管并发症可能包括恶性心律失常、冠状动脉痉挛、猝死、脑灌注不足和中风。大麻使用者常报告支气管高反应性和上呼吸道阻塞。术后体温过低、寒战和血小板聚集增加也有记录。
