Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida.
Center for Drug Evaluation and Safety, Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida.
Anesthesiology. 2024 Nov 1;141(5):870-880. doi: 10.1097/ALN.0000000000005146.
Cannabis use is associated with higher intravenous anesthetic administration. Similar data regarding inhalational anesthetics are limited. With rising cannabis use prevalence, understanding any potential relationship with inhalational anesthetic dosing is crucial. Average intraoperative isoflurane or sevoflurane minimum alveolar concentration equivalents between older adults with and without cannabis use were compared.
The electronic health records of 22,476 surgical patients 65 yr or older at the University of Florida Health System between 2018 and 2020 were reviewed. The primary exposure was cannabis use within 60 days of surgery, determined via (1) a previously published natural language processing algorithm applied to unstructured notes and (2) structured data, including International Classification of Diseases codes for cannabis use disorders and poisoning by cannabis, laboratory cannabinoids screening results, and RxNorm codes. The primary outcome was the intraoperative time-weighted average of isoflurane or sevoflurane minimum alveolar concentration equivalents at 1-min resolution. No a priori minimally clinically important difference was established. Patients demonstrating cannabis use were matched 4:1 to non-cannabis use controls using a propensity score.
Among 5,118 meeting inclusion criteria, 1,340 patients (268 cannabis users and 1,072 nonusers) remained after propensity score matching. The median and interquartile range age was 69 (67 to 73) yr; 872 (65.0%) were male, and 1,143 (85.3%) were non-Hispanic White. The median (interquartile range) anesthesia duration was 175 (118 to 268) min. After matching, all baseline characteristics were well-balanced by exposure. Cannabis users had statistically significantly higher average minimum alveolar concentrations than nonusers (mean ± SD, 0.58 ± 0.23 vs. 0.54 ± 0.22, respectively; mean difference, 0.04; 95% confidence limits, 0.01 to 0.06; P = 0.020).
Cannabis use was associated with administering statistically significantly higher inhalational anesthetic minimum alveolar concentration equivalents in older adults, but the clinical significance of this difference is unclear. These data do not support the hypothesis that cannabis users require clinically meaningfully higher inhalational anesthetics doses.
大麻的使用与更高剂量的静脉内麻醉剂的使用相关。关于吸入性麻醉剂的数据则较为有限。鉴于大麻的使用呈上升趋势，了解其与吸入性麻醉剂剂量之间的任何潜在关系至关重要。比较了在佛罗里达大学健康系统接受手术的年龄在 65 岁或以上的成年人中，有和无大麻使用史的患者在术中使用异氟醚或七氟醚的最低肺泡浓度等效物的平均值。
对 2018 年至 2020 年间佛罗里达大学健康系统 22476 名年龄在 65 岁或以上的手术患者的电子健康记录进行了回顾。主要暴露因素是手术前 60 天内的大麻使用情况，通过（1）应用于非结构化笔记的先前发表的自然语言处理算法，以及（2）包括大麻使用障碍和大麻中毒的国际疾病分类代码、实验室大麻素筛查结果以及 RxNorm 代码的结构化数据来确定。主要结局是 1 分钟分辨率下异氟醚或七氟醚最低肺泡浓度等效物的术中时间加权平均值。没有预先确定最小的临床重要差异。使用倾向评分对表现出大麻使用的患者与非大麻使用对照组进行了 4:1 匹配。
在符合纳入标准的 5118 名患者中，有 1340 名患者（268 名大麻使用者和 1072 名非使用者）在进行倾向评分匹配后仍符合条件。中位（四分位距）年龄为 69（67 至 73）岁；872 名（65.0%）为男性，1143 名（85.3%）为非西班牙裔白人。麻醉持续时间的中位数（四分位距）为 175（118 至 268）分钟。匹配后，所有基线特征均按暴露情况得到很好的平衡。与非使用者相比，大麻使用者的平均最低肺泡浓度明显更高（均值±标准差，分别为 0.58±0.23 与 0.54±0.22；平均差异，0.04；95%置信区间，0.01 至 0.06；P=0.020）。
大麻的使用与老年患者吸入性麻醉剂的最低肺泡浓度等效物的使用呈统计学上的显著相关，但这种差异的临床意义尚不清楚。这些数据不支持大麻使用者需要临床上意义重大的更高剂量吸入性麻醉剂的假设。
