Department of Otolaryngology-Head and Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City.
University of Oklahoma Medical School, Oklahoma City.
JAMA Otolaryngol Head Neck Surg. 2024 Oct 1;150(10):918-924. doi: 10.1001/jamaoto.2024.2545.
Cannabis use has experienced substantial growth. Many patients treated by otolaryngologists are using cannabis in various forms, often without the knowledge of the treating surgeon. These cannabinoid substances have various systemic effects, and it is critical for otolaryngologists to recognize how cannabis use may contribute to a patient's care.
Cannabis use has effects that contribute to every phase of a surgeon's care. Preoperative counseling for tapering use may prevent increased rates of adverse effects. Care with anesthesia must be observed due to increased rates of myocardial ischemia, higher tolerance to standard doses, and prolonged sedation. Although results of studies are mixed, there may be an association with cannabis use and postoperative pain, nausea, and vomiting. Postoperative wound healing may be improved through the use of topical cannabinoids. Significant drug-drug interactions exist with cannabis, most notably with several common anticoagulant medications. Care should be exercised when managing medications for people who use cannabis. While many people who use cannabis consume it infrequently, a substantial population has developed cannabis use disorder, which is associated with increased morbidity and mortality postoperatively. Screening for cannabis use disorder is important and can be done through short screening tools.
Patients who use cannabis may require special attention regarding preoperative counseling and workup, intraoperative anesthesia, postoperative pain management, nausea, wound healing, and drug-drug interactions. As patient use continues to increase, otolaryngologists will find an increasing need to remain up to date on how cannabis use contributes to patient care.
大麻使用量大幅增长。耳鼻喉科医生治疗的许多患者正在以各种形式使用大麻，而医生往往并不了解这一情况。这些大麻素物质具有各种全身作用，耳鼻喉科医生必须认识到大麻的使用如何影响患者的治疗。
大麻的使用会影响到外科医生治疗的各个阶段。术前逐渐减少使用量的咨询可以预防不良反应发生率的增加。由于心肌缺血发生率增加、对标准剂量的耐受性增加和镇静作用延长，必须注意麻醉管理。尽管研究结果不一，但大麻的使用可能与术后疼痛、恶心和呕吐有关。局部使用大麻素可能会改善术后伤口愈合。大麻与许多药物存在显著的药物相互作用，尤其是与几种常见的抗凝药物。管理使用大麻的患者的药物时应谨慎。虽然许多使用大麻的人只是偶尔使用，但相当一部分人已经出现大麻使用障碍，这与术后发病率和死亡率增加有关。大麻使用障碍的筛查很重要，可以通过简短的筛查工具进行。
使用大麻的患者可能需要特别注意术前咨询和检查、术中麻醉、术后疼痛管理、恶心、伤口愈合和药物相互作用。随着患者使用量的持续增加，耳鼻喉科医生将发现越来越需要及时了解大麻的使用如何影响患者的治疗。
