Post written by Christopher Adam Bouvette, MD, and Mohammad Madhoun, MD, MS, FACP, from the University of Oklahoma College of Medicine and the Oklahoma City Veterans Health Administration Medical Center, Oklahoma City, Oklahoma, USA.

Our patients are more frequently using marijuana amid varying degrees of legality and medical indication. We set out to describe any potential effect of marijuana use on procedural sedation requirements for EGD and colonoscopy.

It is important to understand how patients will respond to procedural sedation to plan and individualize care for each patient. Sedation can be challenging, and knowing ahead of time which patient may be more difficult to sedate can be instrumental in providing a comfortable, safe, and successful procedure.

Several patient-level health and home medications often drive choice of sedation (ie, moderate vs monitored anesthesia care [MAC]). We aimed to determine the clinical significance of ongoing marijuana use across care delivery.

Overall, 976 patients were analyzed, and 21.5% of the patients endorsed marijuana usage. A total of 335 (34%) procedures were performed under MAC and 641 (66%) under moderate sedation. Marijuana use was associated with a higher requirement of sedation (fentanyl [P = .003], midazolam [P = .05], propofol [P = .02]) and higher use of adjunct sedation (diphenhydramine in moderate sedation [P = .0003]).

Upon multivariable analysis, marijuana use was found to independently predict relatively higher propofol (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.00-3.12) and midazolam requirement (OR, 1.57; 95% CI, 1.02-2.42). Although marijuana use was associated with increased fentanyl requirements, this failed to reach statistical significance upon multivariable modeling (OR, 1.54; 95% CI, 0.98-2.38).

To our knowledge, this represents the largest comprehensive, modern study encompassing EGD and colonoscopy under moderate sedation or MAC. We have demonstrated that ongoing marijuana use impacts procedural sedation and may suggest a more challenging subset of patients. A patient’s marijuana history should be considered during procedure planning and when determining the methods of sedation to be used for endoscopy.

Study sample selection flow chart.

Read the full article online.

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