Research reveals recreational marijuana users undergoing oral and maxillofacial surgery – such as tooth extractions or biopsies in an ambulatory surgical center – may require higher doses of anesthetic drugs during intravenous (IV) sedation.
The study published in the Journal of Oral and Maxillofacial Surgery (JOMS) – the official journal of the American Association of Oral and Maxillofacial Surgeons (AAOMS) – provides insights into the impact of patients using marijuana before oral and maxillofacial surgery procedures involving sedation. Despite the increasing prevalence of recreational marijuana use due to its availability, legal status and cultural acceptance, the study’s authors said research is limited on the effects of tetrahydrocannabinol (THC) – the psychoactive component of marijuana – on patients receiving IV sedation in an outpatient setting.
The research study, which recently earned the 2024 OMS Foundation’s Daniel M. Laskin Award for the most outstanding article published in JOMS, sought to measure differences in the amount of anesthetic medication needed by marijuana users compared to non-users and determine if marijuana use prior to a procedure influences a patient’s vital signs – such as heart rate, blood pressure and respiratory rate – during IV sedation.
Researchers analyzed data from 53 patients who underwent outpatient oral and maxillofacial surgery with IV sedation at an ambulatory surgical center at the University of Rochester Medical Center in New York, between 2018 and 2022. The procedures ranged from third molar (“wisdom tooth”), single-tooth and full-mouth extractions to biopsies. The study indicated marijuana users required higher doses of two commonly used anesthetic medications: fentanyl and propofol. No statistically significant differences were reported by the study in vital signs between marijuana users and non-users.
The retrospective cohort study divided patients into two groups based on their marijuana use before surgery. As confirmed through toxicology screenings, patients who tested positive for THC were compared with those who tested negative.
According to the study, patients who tested positive for THC needed, on average, 29 percent more fentanyl and 55 percent more propofol than non-users. “The physiologic effects of recreational THC use may alter the response to sedation medications (midazolam, fentanyl, propofol, ketamine) and thus affect the level of sedation achievable,” the researchers wrote.
The authors of “Is Recreational Marijuana Use Associated With Changes in the Vital Signs or Anesthetic Requirements During Intravenous Sedation?” are Pooja Gangwani, DDS, HPH, from Temple University in Philadelphia, Pa.; Antonia Kolokythas, DDS, MSc, MSed, from the Dental College of Georgia in Augusta; David Lillian, DDS, from American Fork, Utah; and Joshua Dobbins, DMD; Changyong Feng, PhD; and John Vorrasi, DDS, from the University of Rochester.
The full article can be accessed at JOMS.org/article/S0278-2391(23)00090-3/fulltext.
The Journal of Oral and Maxillofacial Surgery is published by the American Association of Oral and Maxillofacial Surgeons to present to the dental and medical communities comprehensive coverage of new techniques, important developments and innovative ideas in oral and maxillofacial surgery. Practice-applicable articles help develop the methods used to handle dentoalveolar surgery, facial injuries and deformities, TMJ disorders, oral and head and neck cancer, jaw reconstruction, anesthesia and analgesia. The journal also includes specifics on new instruments and diagnostic equipment, and modern therapeutic drugs and devices.
