Baker Maxwell B, Binda Dhanesh D, Nozari Ala, Kennedy Joseph M, Dienes Erin, Baker William E
Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA.
Larner College of Medicine, University of Vermont, Burlington, VT 054052, USA.
J Clin Med. 2025 Jan 28;14(3):858. doi: 10.3390/jcm14030858.
: Rising cannabis use poses significant challenges in the administration of general anesthetics, particularly propofol, due to potential alterations in pharmacodynamics caused by tetrahydrocannabinol and its interactions with central nervous system receptors. This systematic review and meta-analysis aims to consolidate the existing literature to quantify propofol requirements in cannabis users, highlighting the complex relationship between cannabis use and anesthetic management. : A systematic search of English-language literature was conducted to identify studies with data on propofol dosing in adult cannabis users. Propofol requirements were defined as the total intraoperative dose needed to achieve and maintain adequate sedation or anesthesia, assessed using parameters like monitoring and procedural tolerance. A random-effects model was used with DerSimonian-Laird estimations for pooled effect sizes and 95% confidence intervals. Heterogeneity was assessed using I and Cochran's Q statistics, and sensitivity analysis was conducted by grouping publications by design, size, and quality. : Eight qualified studies were identified with 2268 patients included. Patients who used cannabis were typically younger and more likely to smoke tobacco than non-users. Propofol requirements were significantly higher in cannabis users, who required an average additional dose of 47.33 mg compared to non-users. Subgroup analyses revealed that cannabis users undergoing general anesthesia needed an additional 30.57 mg intraoperatively, while those undergoing sedation for endoscopic procedures required an additional 53.02 mg. : These results underscore the need for personalized anesthetic plans to accommodate physiological variations in cannabis users. However, the lack of standardized definitions for propofol requirements and the heterogeneity across studies necessitate caution in interpretation. The observed increase in propofol requirements suggests altered central nervous system sensitivities and receptor changes in cannabis users, emphasizing the need for further research to establish clear definitions, elucidate underlying mechanisms, and refine clinical guidelines for anesthetic management in this population.
大麻使用的增加给全身麻醉的管理带来了重大挑战，尤其是丙泊酚，因为四氢大麻酚会导致药效动力学的潜在改变及其与中枢神经系统受体的相互作用。本系统评价和荟萃分析旨在整合现有文献，以量化大麻使用者对丙泊酚的需求量，突出大麻使用与麻醉管理之间的复杂关系。对英文文献进行了系统检索，以确定有关成年大麻使用者丙泊酚给药数据的研究。丙泊酚需求量定义为实现和维持充分镇静或麻醉所需的术中总剂量，使用监测和手术耐受性等参数进行评估。采用随机效应模型和DerSimonian-Laird估计法计算合并效应量和95%置信区间。使用I统计量和Cochran's Q统计量评估异质性，并通过按设计、规模和质量对出版物进行分组来进行敏感性分析。确定了8项合格研究，纳入2268例患者。与非使用者相比，使用大麻的患者通常更年轻，吸烟的可能性更大。大麻使用者的丙泊酚需求量显著更高，与非使用者相比，平均额外需要47.33毫克剂量。亚组分析显示，接受全身麻醉的大麻使用者术中额外需要30.57毫克，而接受内镜手术镇静的使用者额外需要53.02毫克。这些结果强调了需要制定个性化麻醉计划以适应大麻使用者的生理差异。然而，丙泊酚需求量缺乏标准化定义以及研究之间的异质性使得在解释时需要谨慎。观察到的丙泊酚需求量增加表明大麻使用者中枢神经系统敏感性改变和受体变化，强调需要进一步研究以建立明确的定义、阐明潜在机制并完善该人群麻醉管理的临床指南。
