Echeverria-Villalobos Marco, Fabian Catherine A, Mitchell Justin G, Mazzotta Elvio, Fiorda Diaz Juan C, Noon Kristen, Weaver Tristan E
From the Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Department of Anesthesiology. University of Michigan Hospital, Ann Arbor, Michigan.
Anesth Analg. 2024 Nov 6;140(6):1401-13. doi: 10.1213/ANE.0000000000007313.
Cannabis has been used for recreation and medical purposes for more than a millennium across the world; however, its use's consequences remain poorly understood. Although a growing number of surgical patients are regular cannabis consumers, little is known regarding the pharmacological interactions between cannabis and general anesthetics; consequently, there is not a solid consensus among anesthesiologists on the perioperative management of these patients. The existing evidence about the molecular mechanisms underlying pharmacological interactions between cannabinoids and anesthetic agents, both in animal models and in humans, shows divergent results. While some animal studies have demonstrated that phytocannabinoids (tetrahydrocannabinol [THC], cannabidiol [CBD], and cannabinol [CBN]) potentiate the anesthetic effects of inhalation and intravenous anesthetics, while others have found effects comparable with what has been described in humans so far. Clinical studies and case reports have consistently shown increased requirements of GABAergic anesthetic drugs (isoflurane, sevoflurane, propofol, midazolam) to achieve adequate levels of clinical anesthesia. Several potential molecular mechanisms have been proposed to explain the effects of these interactions. However, it is interesting to mention that in humans, it has been observed that the ingestion of THC enhances the hypnotic effect of ketamine. Animal studies have reported that cannabinoids enhance the analgesic effect of opioids due to a synergistic interaction of the endogenous cannabinoid system (ECS) with the endogenous opioid system (EOS) at the spinal cord level and in the central nervous system. However, human data reveals that cannabis users show higher scores of postoperative pain intensity as well as increased requirements of opioid medication for analgesia. This review aims to improve understanding of the molecular mechanisms and pharmacological interactions between cannabis and anesthetic drugs and the clinical outcomes that occur when these substances are used together.
在全球范围内，大麻已被用于娱乐和医疗目的长达一千多年；然而，其使用后果仍知之甚少。尽管越来越多的外科手术患者经常吸食大麻，但对于大麻与全身麻醉剂之间的药理相互作用却知之甚少；因此，麻醉医生对于这些患者的围手术期管理尚未达成坚实的共识。关于大麻素与麻醉剂之间药理相互作用的分子机制，在动物模型和人类中的现有证据显示出不同的结果。虽然一些动物研究表明植物大麻素（四氢大麻酚[THC]、大麻二酚[CBD]和大麻酚[CBN]）可增强吸入和静脉麻醉剂的麻醉效果，但其他研究发现的效果与迄今为止人类研究中所描述的相当。临床研究和病例报告一致表明，需要增加使用γ-氨基丁酸能麻醉药物（异氟烷、七氟烷、丙泊酚、咪达唑仑）以达到足够的临床麻醉水平。已经提出了几种潜在的分子机制来解释这些相互作用的影响。然而，有趣的是，在人类中观察到，摄入THC可增强氯胺酮的催眠效果。动物研究报告称，由于内源性大麻素系统（ECS）与内源性阿片系统（EOS）在脊髓水平和中枢神经系统中的协同相互作用，大麻素可增强阿片类药物的镇痛效果。然而，人类数据显示，大麻使用者术后疼痛强度得分更高，并且镇痛所需的阿片类药物用量也增加。本综述旨在增进对大麻与麻醉药物之间的分子机制、药理相互作用以及这些物质联合使用时所产生的临床结果的理解。
