Posted on 02/28/2024 12:36:33 PM PST by nickcarraway
— If they don't, things could get complicated by
Anesthesiology resident Max Feinstein, MD, explores how marijuana use can complicate medical procedures and the perioperative period.
Following is a transcript:
Feinstein: If there is one person who you should definitely not lie to about any drug use, it's your anesthesiologist. My name is Max Feinstein and I'm an anesthesiologist filming here at Mount Sinai Hospital in New York City. In this video, I describe the anesthesiologists' considerations for patients who consume marijuana. If you find this video interesting or helpful, I'd really appreciate it if you liked it and subscribe to the channel. Let's dive in.
This video does not contain medical advice. It's just a YouTube video. But if you need medical advice, you should talk to your doctor. It's estimated that about 15% of the population in the United States uses marijuana. That's 25 million people.
News Anchor: It is about that time, 4:20 here on 4/20. We're going to head back to Hippie Hill in San Francisco's Golden Gate Park for the main event as we call it. Christien Kafton there right now and folks getting things fired up.
Feinstein: And so that means that an anesthesiologist is virtually guaranteed to encounter patients who use marijuana. Worldwide it's estimated that about 200 million people use marijuana, so the same concept applies for anesthesiologists across the globe. For marijuana, as with any other drug, anesthesiologists are concerned about the effect that the drug has on the patient's mind and also on their body in the perioperative period, meaning before, during, and after surgery. Many of the effects of marijuana are well-studied and the extent of those effects is really dependent on whether the marijuana use is acute or chronic. No pun intended, sorry.
As far as the brain or central nervous system is concerned, marijuana is known to have cross-tolerance with opioid receptors, meaning that patients may have an increased opioid requirement. It's also been shown that patients who are regular marijuana users have a higher requirement for midazolam, which is a short-acting benzodiazepine in cases with sedation. Midazolam is also frequently given to help patients feel relaxed before surgery. This is the medication that makes up the anesthesia cocktail that people sometimes reference.
There are also documented effects that marijuana has on the heart, namely both acute and chronic use can lead to a higher baseline heart rate. There are also a number of arrhythmias that have been associated with marijuana use that include atrial fibrillation, ventricular tachycardia, ventricular fibrillation, and AV block to name a few.
The presence of an arrhythmia might be a reason that an anesthesiologist would delay a surgery for further workup and treatment or proceed to surgery with special precautions like electrodes to deliver a shock if needed. It's also been documented the risk of a myocardial infarction is approximately eight times higher in patients who have used marijuana within the last 60 minutes. When marijuana is inhaled, it can also have effects on a patient's airway. Namely whether it's smoked or vaped, marijuana can lead to increased irritation throughout the airway. This can be associated with a number of complications, including airway edema, obstruction, bronchospasm, bronchitis, and emphysema.
There are also hematologic considerations or blood considerations for patients who use marijuana and also take the medication warfarin. Warfarin is a powerful blood thinner that is sometimes prescribed for people who have heart valve replacements, clotting disorders, or a heart rhythm called atrial fibrillation. It's also the main ingredient used in rat poison, but that's neither here nor there. Warfarin is a blood thinner that is metabolized through an enzyme made in the liver. That enzyme is called CYP3A4. Marijuana has the effect of inhibiting CYP3A4's activity, meaning that there is less metabolism of warfarin, meaning that more warfarin is present in a patient's blood, which means that a patient could be more prone to bleeding during surgery.
As I already alluded to, marijuana does alter some of the enzymes in a patient's liver that are responsible for metabolism of medications. There is actually a very long list of medications whose metabolism is altered by marijuana. That list includes warfarin, clopidogrel, NSAIDs (or non-steroidal anti-inflammatory drugs), immunosuppressants, fentanyl, oxycodone, codeine, and steroids.
In a kind of funny-titled study about the effect that marijuana has on patients and their post-operative pain, it was found that patients who regularly use marijuana have significantly higher post-operative pain scores as compared to the patients who don't use marijuana. This probably has to do with the fact that many of the medications that are given for pain control are actually metabolized by enzymes that are interfered with by marijuana. I can say from experience as an anesthesiologist that patients who I have taken care of who are regular users of marijuana do indeed tend to have higher requirements for pain control in the post-operative period.
In order to best take care of patients who do use marijuana regularly, there are some recommendations that have been published in the literature in anesthesiology. As for the amount of time to stop marijuana use prior to surgery, there is a recommendation for at least 72 hours to have elapsed. For patients who are acutely intoxicated with marijuana, there is also a recommendation to consider postponing surgery if it's an elective surgery and not something that's urgent or emergent.
Anesthesiologist: Hi, Surgery.
Surgeon: Yes, Anesthesia. What is it?
Anesthesiologist: We're going to have to cancel the case.
Feinstein: There is also a recommendation to consider increasing the dose of medication that is provided for patients who are regular users of marijuana for the reasons that we've already talked about. Given the propensity for marijuana that's smoked or vaped to irritate a patient's airway, anesthesiologists should have everything ready to take care of a hyperreactive airway.
Everything that I mentioned in this video is evidence-based and all of the studies that I have cited are included in the description below. If you found this video interesting, you might want to check out this video where I go through all of the medications that are commonly used as part of a general anesthetic. Thanks very much for watching. I'll see you next time.
Max Feinstein, MD, is a PGY-4 anesthesiology resident at the Mount Sinai Hospital in New York City, where he is also chief resident of teaching. His YouTube channelopens in a new tab or window focuses on perioperative medicine, especially the role of the anesthesiologist.
Call into any doctor's office or hospital and you will be connected with a low level clerk who has complete and unfettered access to your medical records.
This is not even a new thing. It has been the case for decades. It is just easier now since there is a computerized data base.
And as to there not being a nationwide data base of medical records.... Ever hear of Epic?
Oh please just stop. You are wrong, wrong, wrong.
And yes, I’m quite familiar with Epic.
I’ve worked in hospital IT since 1997, and for Epic’s largest competitor for the last 14 years.
I can assure you that while Epic, and other EMRs, are used nationwide, none of them could remotely considered to be a “national database”.
Augie,
Don’t be so obtuse. Just be less obtuse.
BTW - anyone who completes an application for Life Insurance signs an authorization for the insurance company to have full access to the Medical Information Bureau.
See this article, for example: https://www.verywellhealth.com/how-to-access-the-medical-information-bureau-2615511
Note to FReepers - Augie is WRONG on this.
Last time I was put under my anesthesiologist said he had to give me the amount of fentanyl an elephant would take. I use marijuana daily. So this checks out.
If your statement was factual, then there would no longer be any federal impediments to recreational Marijuana use. The Deep State would have made sure those laws were done away with, but that hasn't happened.
Most of the users I'm aware of despise commies and jackasses such as Soros, but that means little as I tend not to associate with liberals.
Get better propaganda.
Sounds like if you want them to give you more pain and knockout meds, tell them you smoke weed.
“But does anyone really believe that any more?”
Figure that ANYTHING you say to a doctor will find its way to government and if you’re like most of us here (including myself), those are people you’d rather not be giving information to.
“But does anyone really believe that any more?”
AND...if they want conservative patients to be truthful, perhaps there should be LAWS preventing disclosure to the government, even if there’s a court order for it.
It is up to the DOCTORS to push for that - otherwise, they’ll simply have to take our word.
lol.
I told the anesthesiologist before my colonoscopy that he should be aware my tolerance is high.
He laughed it off and the procedure continued.
When I woke up they told me I tried to get up and walk away halfway through.
Then they believed me.
Big pharma makes money by inventing and selling drugs, equipment and procedures-
I’m not seeing any of that going on with weed.
It seems like competition to me.
Both sides are polarizing. I’d give the potheads an edge.
The case of two bong hits made me a psychotic murderer! Obv weed being legal is the proximate cause but hardly the sole problem with that judgment.
Read what you just wrote.
“applies for life insurance”
“signs an authorization”
Nothing about that equates to “full and unfettered access to your medical records”.
Note to FReepers - Honest Nigerian isn’t.
...users have a higher requirement for midazolam
I really hate this stuff, but it's a little odd that an anesthesiologist is implying that he uses it. Maybe that's still standard, but I was always under the impression that it was part of the "standard cocktail" that would be used for minor procedures that didn't require the attendance of a specialist anesthesiologist.
It's bad enough on its own, but combined with weed it sounds like a guaranteed bad trip.
Always smart when going under to tell the Docs everything, your life depends on it. Also, the Docs and Police nowadays don’t give a rats pattotie if you use weed, it’s a non issue if you use weed, it’s only an issue if your illness is possibly weed related, or if your driving while stoned. It’s now legal in Ohio and you can walk down any street and smoke a joint if ya want. I’ve not seen anyone do this yet, but the news says the yahoos in downtown Cincy are stinking up certain streets and parks around the bar areas.
Incorrect of course.
A database that is used nationwide is indeed a national data base.
And yes, the clerks all have access to it, because they have to, how do you think Mr Hospital IT Guy, that the data in the system is entered and retrieved?
All of your low level clerks have access to the health data files.
I am sorry reality offends you.
He said you had to sign a authorization for the LIFE INSURANCE COMPANY to have access.
The low level clerks at the hospital do indeed have free and unfettered access to the data base that you insist does not exist.
It is not at all attractive how you lie about people.
I highly recommend it for migraines and neuropathy. Works better than anything I have been prescribed.
Snoop Dogg?
“Big Pharma has latched onto marijuana in a big way.”
I doubt that - it’s not patentable.
Does Big Pharma own grows or dispensaries?
“If there is one person who you should definitely not lie to about any drug use, it’s your anesthesiologist.”
Well, duh. Like he said, ANY drug - legal or illegal, medicinal or recreational.
You are misinformed. Big Pharma is spending billions to come up with their own breeds of cannabis.
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