Abstract
BackgroundEndoscopy under propofol sedation has become a routine procedure. Given the number of Canadians undergoing an endoscopy annually, as well as the pervasive use of cannabis by many patients, understanding the effect of cannabis use on the propofol dose at endoscopy is highly relevant. We aimed to evaluate the association between cannabis exposure and the propofol dose needed to achieve adequate sedation at endoscopy.MethodsA case-control study of individuals undergoing endoscopy was conducted at a single outpatient endoscopy clinic in London, Ontario between 2014 and 2017. Cases included all individuals with any self-reported cannabis exposure, while controls included all individuals without any self-reported history of cannabis use. Dose of propofol administered by a single anesthetist was collected on each subject as well as additional demographic and procedure-related covariates.ResultsThree hundred and eighteen participants were included (cases, n = 151; controls, n = 167). Cannabis exposure was associated with an increase in propofol dose (cases 0.33 mg/kg/minute ±0.24; controls, 0.18 mg/kg/minute ±0.11; p<0.0001). Cannabis exposure remained an independent predictor of propofol dose on multivariate linear regression accounting for other important covariates (p<0.0001). Daily cannabis users required a higher propofol dose than weekly or monthly users. Three procedural sedation-related complications occurred in the cannabis-exposed group, while none occurred in the unexposed group.ConclusionOur data suggest that cannabis use is significantly associated with the quantity of propofol needed for sedation at endoscopy. Further study is needed to better understand the molecular basis for this possible drug-drug interaction.
Highlights
Cannabis, commonly known as marijuana, is one of the most frequently used substances worldwide [1]
Cases included all individuals with any self-reported cannabis exposure, while controls included all individuals without any self-reported history of cannabis use
Cannabis exposure was associated with an increase in propofol dose
Summary
Commonly known as marijuana, is one of the most frequently used substances worldwide [1]. Acute use of cannabis is linked to impairments in cognitive skills and psychomotor function [2]. The long-term effects of cannabis use on patient outcomes are not well defined, though it has been linked to persistent deficits in executive functioning, memory, and concentration [2]. Its effect on anesthesia has not been well-documented beyond small prospective studies, case reports and anecdotal accounts [3,4,5,6,7]. Endoscopy under propofol sedation has become a routine procedure. Given the number of Canadians undergoing an endoscopy annually, as well as the pervasive use of cannabis by many patients, understanding the effect of cannabis use on the propofol dose at endoscopy is highly relevant. We aimed to evaluate the association between cannabis exposure and the propofol dose needed to achieve adequate sedation at endoscopy
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