Department of Anesthesiology, University of Colorado School of Medicine, Aurora.
US Anesthesia Partners, Greenwood Village, Colorado, USA.
Curr Opin Anaesthesiol. 2020 Jun;33(3):318-326. doi: 10.1097/ACO.0000000000000872.
Both cannabis and e-cigarette use are increasing, particularly among adolescents. The use of cannabis products may impact patients' physiology under anesthesia. Understanding the effects of cannabis and vaping are critical to the provision of safe and effective anesthetic care.
E-cigarettes have recently been implicated in a severe presentation of acute lung injury, often in association with vaporization of the cannabinoid, THC. E-cigarette use appears to be associated with other less-acute pulmonary adverse effects that are yet to be fully understood. Cannabis affects many organ systems with alterations in cardiovascular, respiratory and neurological function. Specifically, there is emerging evidence that cannabis use may reduce the efficacy of sedative agents and postoperative pain management efforts.
There is a very wide variety of cannabis products currently available, with respect to both route of administration as well as cannabinoid content. Patients using cannabis products prior to anesthesia may present with altered physiology that place them at increased risk for cardiovascular and respiratory complications. They may also be tolerant to the effects of propofol and opioid for pain management, thus consideration should be given to use of a multimodal regimen.
大麻和电子烟的使用都在增加，尤其是在青少年中。大麻制品的使用可能会影响患者在麻醉下的生理机能。了解大麻和蒸气的影响对于提供安全有效的麻醉护理至关重要。
电子烟最近与大麻素 THC 的蒸发有关，与急性肺损伤的严重表现有关。电子烟的使用似乎与其他不太严重的肺部不良影响有关，这些影响仍有待充分了解。大麻影响许多器官系统，改变心血管、呼吸和神经系统功能。具体来说，有新的证据表明，大麻的使用可能会降低镇静剂和术后疼痛管理效果。
目前有各种各样的大麻产品，无论是给药途径还是大麻素含量。在接受麻醉前使用大麻制品的患者可能会出现改变的生理机能，使他们面临心血管和呼吸并发症的风险增加。他们也可能对丙泊酚和阿片类药物的止痛效果产生耐受，因此应考虑使用多模式治疗方案。
