Ahrens Elena, Wachtendorf Luca J, Hill Kevin P, Schaefer Maximilian S
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Drugs Aging. 2024 Dec;41(12):933-943. doi: 10.1007/s40266-024-01161-6. Epub 2024 Dec 1.
Over the past decade, legislative changes occurred in the USA and the western world that were followed by a substantial increase in reported use of cannabis among the general population. Among patients undergoing anesthesia for surgery or interventional procedures, older patients-often defined as adults over 65 years-are one of the fastest-growing populations. Within this group, the prevalence of cannabis use almost tripled over the past decade. In addition to habitual cannabis use, recommendations for treatment of chronic pain with cannabinoids have become increasingly more common. The clinical relevance of cannabis use in older adults is supported by recent studies linking it to increased anesthetic requirements as well as respiratory, cardiovascular, and psychiatric complications following surgery. Still, evidence remains equivocal, as these associations may largely depend on the type, frequency, and route of cannabis administration, and current research is mostly limited to retrospective cohort studies. Multisystemic effects of cannabis can become especially relevant in patients of advanced age undergoing anesthesia, characterized by physiological and pharmacodynamic alterations as well as a higher risks of drug-to-drug interactions. Best-practice guidelines emphasize the need for detailed, systematic preoperative screening for habits of cannabis use, including the history, type, and frequency, to guide perioperative management in these patients. This review discusses considerations for anesthesia in older patients with habitual cannabis use while highlighting strategies and recommendations to ensure safe and effective anesthesia care.
在过去十年中，美国和西方世界发生了立法变化，随后普通人群中报告的大麻使用量大幅增加。在接受手术或介入手术麻醉的患者中，老年患者（通常定义为65岁以上的成年人）是增长最快的人群之一。在这一群体中，大麻使用的患病率在过去十年中几乎增加了两倍。除了习惯性使用大麻外，用大麻素治疗慢性疼痛的建议也越来越普遍。最近的研究将老年人使用大麻与麻醉需求增加以及术后呼吸、心血管和精神并发症联系起来，这支持了大麻使用在老年人中的临床相关性。然而，证据仍然不明确，因为这些关联可能很大程度上取决于大麻的使用类型、频率和途径，而且目前的研究大多限于回顾性队列研究。大麻的多系统效应在接受麻醉的老年患者中可能变得尤为重要，这些患者的特点是生理和药效学改变以及药物相互作用的风险更高。最佳实践指南强调需要对大麻使用习惯进行详细、系统的术前筛查，包括使用历史、类型和频率，以指导这些患者的围手术期管理。这篇综述讨论了习惯性使用大麻的老年患者麻醉的注意事项，同时强调了确保安全有效麻醉护理的策略和建议。
