Marijuana and endoscopy: the effects of marijuana on sedation.

BACKGROUND AND AIMS: Marijuana usage has increased significantly as it has become more readily available and legal, either recreationally or medicinally, in many states. It has been postulated that marijuana usage increases the amount of sedation required for procedures. However, there are minimal data defining this relationship. We aimed to establish the relationship between marijuana usage and the amount of sedation used during endoscopy. METHODS: This was a single-institution prospective study of patients undergoing outpatient endoscopy (both monitored anesthesia care [MAC] and moderate sedation) at the Oklahoma City Veterans Affairs Medical Center. Marijuana usage was assessed by a voluntary de-identified pre-endoscopy survey. Information regarding sedation used, endoscopy outcomes, demographics, comorbidities, medical history, and medications used was extracted from the medical record. A univariate and stratified analysis of alcohol usage was performed. A P value of <.05 was considered to be significant. RESULTS: A total of 976 patients were analyzed; 21.5% of them endorsed marijuana usage (210/976). Marijuana users were found to be younger (P = .0002), leaner (P < .0001), and less likely to have diabetes (P = .002), obstructive sleep apnea (P = .0002), and hypertension (P = .04). They were also more likely to smoke (P < .0001) and vape (P < .0001). Marijuana usage 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]). Further multivariate analyses were performed to control for possible confounders. Marijuana usage was still deemed to be an independent predictor for high propofol use among MAC cases (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.00-3.12). Likewise, marijuana usage was found to be an independent predictor for high midazolam use (OR, 1.57; 95% CI, 1.02-2.42) and high fentanyl use (OR, 1.54; 95% CI, 0.98-2.38), but failed to reach statistical significance in the fentanyl group. CONCLUSIONS: Marijuana use is associated with a significantly higher amount of sedation along with a significantly higher usage of other adjunct sedatives. A patient's marijuana history should be considered when determining the methods of sedation to be used for endoscopy.

High-risk smoking in the United States: Nicotine staining predicts increased colonic adenomas and advanced adenomas on colonoscopy.

BACKGROUND: Smoking is linked with numerous adverse health effects. Nicotine staining on fingers or teeth is thought to suggest active or heavy smoking. The significance of nicotine staining within gastroenterology remains unclear. AIM: We set out to establish the predictive value of nicotine staining for adenomas and advanced adenomas. METHODS: This was a cross-section study of patients who underwent colonoscopy at the Oklahoma City Veterans Affairs Medical Center from November 2019 to November 2020. Pre-procedure patient survey ascertained current smoking status. Endoscopist performed a nicotine staining survey upon completion of the respective colonoscopy. Chart review allowed determination of patient demographics, comorbidities, and colonoscopy findings. Patients without smoking history were assigned to a control cohort. We applied one-way analysis of variance when comparing the mean of continuous variables and the Chi-square test when comparing categorical variables. Lastly, we used stepwise logistic regression to estimate adjusted odds ratio. A p-value <0.05 was considered statistically significant. RESULTS: Compared to those without smoking history or evidence of nicotine staining, patients with positive nicotine staining were older (P = 0.03), leaner (P < 0.0001), and more likely to have chronic obstructive pulmonary disease (P < 0.0001) or history of alcohol abuse (P < 0.0001). Furthermore, presence of nicotine staining independently predicted increased likelihood of multiple adenomas (OR 1.5, 95% CI [1.2-1.9]) and advanced adenomas (OR 1.6, 95% CI [1.2-2.2]). CONCLUSION: This marks the first investigation of nicotine staining within gastroenterology. We have demonstrated that the presence of nicotine staining independently predicts numerous adenomas and advanced adenomas.

Intracranial subdural hematoma after epidural anesthesia: a case report and review of the literature.

BACKGROUND: Intracranial subdural hematoma occurring as a result of a procedure that causes a puncture of the spinal dura mater is extremely rare, with less than 100 cases reported. Often, this condition is initially misdiagnosed and treated as a post dural puncture headache. CASE PRESENTATION: A woman presented to our emergency department complaining of a headache 4 days after receiving epidural anesthesia during uncomplicated childbirth. The headache's characteristics were consistent with a post dural puncture headache, and the patient was initially treated as such. Computed tomography later revealed the presence of bilateral intracranial subdural hematomas. In light of the patient's clinical status, treatment involved cautious observation only. Repeat imaging revealed spontaneous resolution of the hematomas, and the patient had a benign clinical course. CONCLUSIONS: Headaches are common in the postpartum period, often after receiving epidural or spinal anesthesia. While exceptionally rare, intracranial subdural hematoma may occur as a complication of any procedure that results in spinal dural puncture. The possibility of this potentially life-threatening complication must be kept in mind when evaluating these patients.