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Considerations for the Intersection of Sedation and Marijuana

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Pediatric Sedation Outside of the Operating Room

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Abstract

The large and increasing prevalence of cannabis use obligates practitioners to be familiar with the pharmacology and clinical ramifications of cannabinoids. Childhood exposure to cannabis spans medical therapy to accidental ingestion and self-experimentation. Although tetrahydrocannabinol is the most well-characterized cannabinoid, use of cannabidiol has dramatically increased in recent years. A branded form of cannabidiol has received approval for use in certain refractory childhood seizure disorders. Cannabis-associated accidental intoxication, minor trauma, and medication side effects can result in the urgent medical evaluation of minors.

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References

  1. Johnston LD, Miech RA, O’Malley PM, Bachman JG, Schulenberg JE, Patrick ME. Monitoring the future national survey results on drug use 1975–2018: overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, University of Michigan; 2019.

    Google Scholar 

  2. Volkow ND, Han B, Compton WM, McCance-Katz EF. Self-reported medical and nonmedical Cannabis use among pregnant women in the United States. JAMA. 2019;322(2):167–9.

    PubMed  Google Scholar 

  3. Russo EB, Marcu J. Cannabis pharmacology: the usual suspects and a few promising leads. Adv Pharmacol. 2017;80:67–134.

    CAS  PubMed  Google Scholar 

  4. Izzo A, et al. Non-psychotropic plant cannabinoids: new therapeutic opportunities from an ancient herb. Trends Pharmacol Sci. 2009;30:515–27.

    CAS  PubMed  Google Scholar 

  5. Greger J, Bates V, Mechtler L, Gengo F. A review of cannabis and interactions with anticoagulant and antiplatelet agents. J Clin Pharmacol. 2019. https://doi.org/10.1002/jcph.1557.

  6. Geffrey AL, Pollack SF, Bruno PL, Thiele EA. Drug-drug interaction between clobazam and cannabidiol in children with refractory epilepsy. Epilepsia. 2015;56:1246–51.

    CAS  PubMed  Google Scholar 

  7. Gaston TE, Bebin EM, Cutter GR, Liu Y, Szaflarski JP, UAB CBD Program. Interactions between cannabidiol and commonly used antiepileptic drugs. Epilepsia. 2017;58:1586–92.

    CAS  PubMed  Google Scholar 

  8. Booth JK, Bohlmann J. Terpenes in Cannabis sativa- from plant genome to humans. Plant Sci. 2019;284:67–72.

    CAS  PubMed  Google Scholar 

  9. Schierenbeck T, Riemann D, Berger M, Hornyak M. Effect of illicit recreational drugs upon sleep: cocaine, ecstasy, and marijuana. Sleep Med Rev. 2008;12:381–9.

    PubMed  Google Scholar 

  10. Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA. 2015;313:2456–73.

    CAS  PubMed  Google Scholar 

  11. Aviram J, Samuelly-Leichtag G. Efficacy of cannabis-based medicines for pain management: a systematic review and meta-analysis of randomized controlled trials. Pain Physician. 2017;20(6):E755–96.

    CAS  PubMed  Google Scholar 

  12. National Academies of Sciences, Engineering, and Medicine. The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. Washington, DC: The National Academies Press; 2017. https://doi.org/10.17226/24625.

    Book  Google Scholar 

  13. Nugent SM, Morasco BJ, O’Neil ME, Freeman M, Low A, Kondo K, Elven C, Zakher B, Motu’apuaka M, Paynter R, Kansagara D. The effects of cannabis among adults with chronic pain and an overview of general harms: a systematic review. Ann Intern Med. 2017;167:319–31.

    PubMed  Google Scholar 

  14. Mücke M, Phillips T, Radbruch L, Petzke F, Häuser W. Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2018;3:CD012182.

    PubMed  Google Scholar 

  15. Stockings E, Campbell G, Hall WD, et al. Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies. Pain. 2018;159:1932–54.

    CAS  PubMed  Google Scholar 

  16. Stevens AJ, Higgins MD. A systematic review of the analgesic efficacy of cannabinoid medications in the management of acute pain. Acta Anaesthesiol Scand. 2017;61:268–80.

    CAS  PubMed  Google Scholar 

  17. GW Pharmaceuticals. Sativex. Available from: https://www.gwpharm.com/healthcare-professionals/sativex.

  18. Bonn-Miller MO, Loflin MJE, Thomas BF, Marcu JP, Hyke T, Vandrey R. Labeling accuracy of cannabidiol extracts sold online. JAMA. 2017;318:1708–9.

    PubMed  PubMed Central  Google Scholar 

  19. Richards JR, Smith NE, Moulin AK. Unintentional cannabis ingestion in children: a systematic review. J Pediatr. 2017;190:142–52.

    PubMed  Google Scholar 

  20. Wang GS, Le Lait MC, Deakyne SJ, Bronstein AC, Bajaj L, Roosevelt G. Unintentional pediatric exposures to marijuana in Colorado, 2009–2015. JAMA Pediatr. 2016;170:e160971.

    PubMed  Google Scholar 

  21. Noble MJ, Hedberg K, Hendrickson RG. Acute cannabis toxicity. Clin Toxicol (Phila). 2019;57:735–42.

    CAS  Google Scholar 

  22. Benowitz NL, Rosenberg J, Rogers W, Bachman J, Jones RT. Cardiovascular effects of intravenous delta-9-tetrahydrocannabinol: autonomic nervous mechanisms. Clin Pharmacol Ther. 1979;25:440–6.

    CAS  PubMed  Google Scholar 

  23. Beaconsfield P, Ginsburg J, Rainsbury R. Marihuana smoking: cardiovascular effects in man and possible mechanisms. N Engl J Med. 1972;287:209–12.

    CAS  PubMed  Google Scholar 

  24. Large M, Sharma S, Compton MT, Slade T, Nielssen O. Cannabis use and earlier onset of psychosis: a systematic meta-analysis. Arch Gen Psychiatry. 2011;68:555–61.

    PubMed  Google Scholar 

  25. Di Forti M, Quattrone D, Freeman TP, Tripoli G, Gayer-Anderson C, Quigley H, et al. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study. Lancet Psychiatry. 2019;6:427–36.

    PubMed  PubMed Central  Google Scholar 

  26. Gobbi G, Atkin T, Zytynski T, Wang S, Askari S, Boruff J, et al. Association of cannabis use in adolescence and risk of depression, anxiety, and suicidality in young adulthood: a systematic review and meta-analysis. JAMA Psychiat. 2019;76:426–34.

    Google Scholar 

  27. Vandrey R, Umbricht A, Strain EC. Increased blood pressure after abrupt cessation of daily cannabis use. J Addict Med. 2011;5:16–20.

    PubMed  PubMed Central  Google Scholar 

  28. Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana. Circulation. 2001;103:2805–9.

    CAS  PubMed  Google Scholar 

  29. Grigoriadis CE, Cork DP, Dembitsky W, Jaski BE. Recurrent cardiogenic shock associated with cannabis use: report of a case and review of the literature. J Emerg Med. 2019;56:319–22.

    PubMed  Google Scholar 

  30. Kaushik M, Alla VM, Madan R, Arouni AJ, Mohiuddin SM. Recurrent stress cardiomyopathy with variable regional involvement: insights into etiopathogenetic mechanisms. Circulation. 2011;124(22):e556–7.

    PubMed  Google Scholar 

  31. Goel A, McGuinness B, Jivraj N, Wijeysundera D, Mittleman M, Bateman B, et al. Cannabis use disorder and perioperative outcomes in major elective surgeries: a retrospective cohort analysis. Anesthesiology. 2019. https://doi.org/10.1097/ALN.0000000000003067.

  32. Tashkin DP, Shapiro BJ, Frank IM. Acute pulmonary physiologic effects of smoked marijuana and oral (delta)9-tetrahydrocannabinol in healthy young men. N Engl J Med. 1973;289:336–41.

    CAS  PubMed  Google Scholar 

  33. Winhusen T, Theobald J, Kaelber DC, Lewis D. Regular cannabis use, with and without tobacco co-use, is associated with respiratory disease. Drug Alcohol Depend. 2019;204:107557.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. NIDA. Vaping of marijuana on the rise among teens. 2019. Available from: https://www.drugabuse.gov/news-events/news-releases/2019/12/vaping-marijuana-rise-among-teens.

  35. Han YY, Rosser F, Forno E, Celedon JC. Electronic vapor products, marijuana use, smoking, and asthma in US adolescents. J Allergy Clin Immunol. 2019;S0091-6749(19)31630-6.

    Google Scholar 

  36. Bucchino L, Monzani A, Fracon S, Genoni G, Cena T, Bellone S. Cannabis-related diffuse alveolar hemorrhage in a 16-year-old patient: a case report. Front Pediatr. 2019;7:468.

    PubMed  PubMed Central  Google Scholar 

  37. Murray AW, Smith JD, Ibinson JW. Diffuse alveolar hemorrhage, anesthesia, and cannabis. Ann Am Thorac Soc. 2014;11:1338–9.

    PubMed  Google Scholar 

  38. Mallat A, Roberson J, Brock-Utne JG. Preoperative marijuana inhalation—an airway concern. Can J Anaesth. 1996;43:691–3.

    CAS  PubMed  Google Scholar 

  39. Kleine-Brueggeney M, Greif R, Brenneisen R, Urwyler N, Stueber F, Theiler LG. Intravenous delta-9-tetrahydrocannabinol to prevent postoperative nausea and vomiting: a randomized controlled trial. Anesth Analg. 2015;121:1157–64.

    CAS  PubMed  Google Scholar 

  40. Sorensen CJ, DeSanto K, Borgelt L, Phillips KT, Monte AA. Cannabinoid hyperemesis syndrome: diagnosis, pathophysiology, and treatment-a systematic review. J Med Toxicol. 2017;13:71–87.

    CAS  PubMed  Google Scholar 

  41. Pertwee RG. Cannabinoids and the gastrointestinal tract. Gut. 2001;48:859–67.

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Camilleri M. Cannabinoids and gastrointestinal motility: pharmacology, clinical effects, and potential therapeutics in humans. Neurogastroenterol Motil. 2018;30:e13370.

    CAS  PubMed  PubMed Central  Google Scholar 

  43. Devinsky O, Patel AD, Thiele EA, Wong MH, Appleton R, Harden CL, et al. Randomized, dose-ranging safety trial of cannabidiol in Dravet syndrome. Neurology. 2018;90:e1204–e11.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Devinsky O, Patel AD, Cross JH, Villanueva V, Wirrell EC, Privitera M, et al. Effect of cannabidiol on drop seizures in the Lennox-Gastaut syndrome. N Engl J Med. 2018;378:1888–97.

    CAS  PubMed  Google Scholar 

  45. Paton WD, Temple DM. Proceedings: effects of chronic and acute cannabis treatment upon thiopentone anaesthesia in rabbits. Br J Pharmacol. 1972;44:346–7.

    Google Scholar 

  46. Brand PA, Paris A, Bein B, Meybohm P, Scholz J, Ohnesorge H, et al. Propofol sedation is reduced by delta9-tetrahydrocannabinol in mice. Anesth Analg. 2008;107:102–6.

    CAS  PubMed  Google Scholar 

  47. Ibera C, Shalom B, Saifi F, Shruder J, Davidson E. Effects of cannabis extract premedication on anesthetic depth. Harefuah. 2018;157:162–6.

    PubMed  Google Scholar 

  48. Flisberg P, Paech MJ, Shah T, Ledowski T, Kurowski I, Parsons R. Induction dose of propofol in patients using cannabis. Eur J Anaesthesiol. 2009;26:192–5.

    CAS  PubMed  Google Scholar 

  49. Twardowski MA, Link MM, Twardowski NM. Effects of cannabis use on sedation requirements for endoscopic procedures. J Am Osteopath Assoc. 2019;119:307–11.

    Google Scholar 

  50. Patel S, Wohlfeil ER, Rademacher DJ, Carrier EJ, Perry LJ, Kundu A, et al. The general anesthetic propofol increases brain N-arachidonylethanolamine (anandamide) content and inhibits fatty acid amide hydrolase. Br J Pharmacol. 2003;139:1005–13.

    CAS  PubMed  PubMed Central  Google Scholar 

  51. Jefferson DA, Harding HE, Cawich SO, Jackson-Gibson A. Postoperative analgesia in the Jamaican cannabis user. J Psychoactive Drugs. 2013;45:227–32.

    PubMed  Google Scholar 

  52. Liu CW, Bhatia A, Buzon-Tan A, Walker S, Ilangomaran D, Kara J, et al. Weeding out the problem: the impact of preoperative cannabinoid use on pain in the perioperative period. Anesth Analg. 2019;129:874–81.

    PubMed  Google Scholar 

  53. Salottolo K, Peck L, Tanner Ii A, Carrick MM, Madayag R, McGuire E, et al. The grass is not always greener: a multi-institutional pilot study of marijuana use and acute pain management following traumatic injury. Patient Saf Surg. 2018;12:16.

    PubMed  PubMed Central  Google Scholar 

  54. Flannery KM, D’Souza G, Agarwal R. Perioperative management of the pediatric patient on medicinal marijuana: what anesthesiologists should know. Anesth Analg. 2019;129:1339–43.

    PubMed  Google Scholar 

  55. Wu PE. Cannabinoid hyperemesis syndrome: caution with urine drug screens for marijuana. BMJ. 2019;366:l5621.

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Headache Medicine, Department of Neurology, Brigham and Women’s Hospital, Brigham and Women’s Faulkner Hospital, JR Graham Headache Clinic, Boston, MA, USA

    Brian E. McGeeney

  2. Department of Anesthesiology, University of Colorado School of Medicine, University of Colorado Hospital Pain Management Clinic, Aurora, CO, USA

    Rachael Rzasa Lynn

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  1. Brian E. McGeeney
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Correspondence to Brian E. McGeeney .

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Editors and Affiliations

  1. Department of Anesthesiology, Harvard Medical School, Boston, MA, USA

    Keira P. Mason, MD

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McGeeney, B.E., Rzasa Lynn, R. (2021). Considerations for the Intersection of Sedation and Marijuana. In: Mason, MD, K.P. (eds) Pediatric Sedation Outside of the Operating Room. Springer, Cham. https://doi.org/10.1007/978-3-030-58406-1_44

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  • DOI: https://doi.org/10.1007/978-3-030-58406-1_44

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-030-58406-1

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