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Study: Pot users may need more anesthesia, painkillers during, after surgery

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Marijuana users appear to need more anesthesia than nonusers, and also more opioids to relieve their pain after surgery, a new, preliminary study reports.

Users of cannabis products who had surgery for a broken leg required higher doses of sevoflurane, an inhaled anesthetic that keeps you asleep during a procedure. These folks also required nearly 60% more opioid painkillers per day while recuperating in the hospital, the researchers found.

The results jibe with earlier studies indicating that marijuana users might need more anesthesia initially to put them under, said lead author Dr. Ian Holmen, a resident anesthesiologist with the University of Colorado Anschutz Medical Campus in Aurora.

“It’s similar to flying a plane. You have a takeoff section, and then you have your cruising section and then your landing. These in anesthesia are induction, maintenance and emergence,” Holmen said. “We found that it’s not just in the induction phase of anesthesia that you need more anesthesia, but even during that cruising phase you need more inhaled anesthetic.”

The findings were reported Monday at an online meeting of the American Society of Anesthesiologists. Research presented at meetings is typically considered preliminary.

The implications for most marijuana users are not dire, according to Holmen and Dr. David Dickerson, vice chair of the ASA’s Committee on Pain Medicine.

Pot users should simply be honest with their doctors about their marijuana consumption, so they can dial in their anesthetic dose more accurately, said Dickerson.

“We want to know there might be a need for more anesthesia,” he said. “The last thing we want to do is to be under-dosing if someone is going to have an increased requirement. The more information we have, the more we can react and monitor to keep a patient safe during a procedure.”

But marijuana users who have heart or lung health issues might face some danger in the operating room, depending on how much additional anesthetic they need during surgery, Holmen added.

“Sevoflurane has a very clear dose-dependent effect on blood pressure,” he said. “The more sevoflurane you receive in the OR, the more a patient’s blood pressure drops. If you have heart problems or lung problems coming into the OR, it could be dangerous.”

For this study, Holmen and his colleagues reviewed the records of 118 patients who had surgery at the University of Colorado hospital for a broken shin bone.

Of those, 30 patients reported using cannabis. Holmen said that the amount and frequency of use were not recorded, nor was the type of cannabis product used — CBD, THC, edibles or smoked pot.

During surgery, marijuana users not only needed more inhaled sevoflurane anesthetic, but also higher doses of hydromorphone painkillers, the researchers found.

They also reported higher post-surgery levels of pain that needed larger doses of opioid painkillers to quell.

There are a few potential explanations. It could be that marijuana use alters the way that anesthetic and pain medications are processed by the body, Dickerson said.

“Cannabis is metabolized in the liver. Medications like anesthetics and our pain medicines are also metabolized in the liver,” he said. “Is there a change in the way the liver’s metabolic function is occurring after being exposed to cannabis?”

It’s also possible that marijuana changes the way a person’s nervous system responds to pain and to painkillers, Dickerson said.

“Is there a change in our neurophysiology or our nervous system that causes us to be in a more excited state, that then causes worsened pain after an injury or during surgical healing, or that actually increases the amount of anesthesia that takes us to sleep or deeper than sleep?” Dickerson said.

Holmen noted that alcohol use has been shown to alter the amount of anesthetic a person needs.

“Chronic alcohol users, oftentimes if they have not used prior to coming to the operating room, they also require higher anesthetic,” Holmen pointed out. “However, if they use it in short-term period right before anesthesia, they oftentimes require less.”

Dickerson said there might be some other unknown variable regarding people who choose to use cannabis that requires them to need more anesthesia, and what’s been found here is simply a link with no direct cause-and-effect relationship.

In any case, Holmen and Dickerson agree more research needs to be done on how marijuana affects anesthesia.
“The first step is asking: Is there a pattern worth studying? And it’s looking more and more like that is the case,” Dickerson said.

More information

The Cleveland Clinic has more about anesthesia.

Copyright 2020 HealthDay. All rights reserved.



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‘Green prescriptions’ could cancel mental health benefits for some

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So-called “green prescriptions” may end up being counterproductive for people with mental health conditions, researchers say.

Spending time in nature is believed to benefit mental health, so some doctors are beginning to “prescribe” outdoor time for their patients.

That led researchers to investigate whether being in nature helps actually does help people with issues such as anxiety and depression. They collected data from more than 18,000 people in 18 countries.

The takeaway: Time in nature does provide several benefits for people with mental health conditions, but only if they choose on their own to visit green spaces.

While being advised to spend time outdoors can encourage such activity, it can also undermine the potential emotional benefits, according to the authors of the study published this month in the journal Scientific Reports.

The researchers said they were surprised to find that people with depression were spending time in nature as often as folks with no mental health issues, and that people with anxiety were doing so much more often.

While in nature, those with depression and anxiety tended to feel happy and reported low anxiety. But those benefits appeared to be undermined when the visits were done at others’ urging, the investigators found.

The more external pressure people with depression and anxiety felt to visit nature, the less motivated they were to do so and the more anxious they felt.

“These findings are consistent with wider research that suggests that urban natural environments provide spaces for people to relax and recover from stress,” said study leader Michelle Tester-Jones, a postdoctoral research associate at the University of Exeter in the United Kingdom.

But the findings also show that health care practitioners and loved ones should be sensitive about recommending time in nature for people who have mental health issues.

“It could be helpful to encourage them to spend more time in places that people already enjoy visiting, so they feel comfortable and can make the most of the experience,” Tester-Jones said in a university news release.

More information

For more on the benefits of green spaces, go to the National Recreation and Park Association.

Copyright 2020 HealthDay. All rights reserved.



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Study: Nearly half of ‘essential workers’ in U.S. at risk for severe COVID-19

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Nov. 9 (UPI) — Nearly half of those classified as “essential workers” in the United States are at increased risk for severe COVID-19, according to an analysis published Monday by JAMA Internal Medicine.

This means that more than 74 million workers and those with whom they live could be at risk for serious illness, based on disease risk guidelines developed by the U.S. Centers for Disease Control and Prevention, the researchers said.

“Many parts of the country face high and rising infection rates, [and] we should not think about work exposure and health risks in isolation, given that workers and persons at increased risk often live in the same households,” study co-author Thomas M. Selden told UPI.

“Insofar as we can reduce the prevalence of COVID-19 in our communities, we can reduce the extent to which policymakers have to choose between the economy and keeping the population safe,” said Selden, an economist with the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality.

Since the COVID-19 pandemic spread to the United States in March, states and cities across the country have instituted lockdown measures designed to limit the spread of the disease.

Many of these measures entailed closing schools and non-essential businesses, with only banks, grocery stores, pharmacies and other businesses deemed to provide vital services allowed to stay open.

For this study, Selden and his colleagues analyzed data on the U.S. workforce to examine how many people were in essential jobs, how often they were able to work at home, their risk for severe COVID-19 and the potential health risks for their household members.

Of the more than 157 million workers across the country, 72% are in jobs deemed essential — based on U.S. Department of Homeland Security criteria — and more than three-fourths of all essential workers are unable to work at home, Selden said.

Essential workers include those in the medical and healthcare, telecommunications, information technology systems, defense, food and agriculture, transportation and logistics and energy, water and wastewater industries, as well as those in law enforcement and public works, the DHS criteria stipulates.

The study notes that up to 60% of these workers have underlying health issues, placing them at increased risk for severe COVID-19 if they get infected, as defined by U.S. Centers for Disease Control and Prevention guidelines.

Those with diabetes, heart disease, high blood pressure and chronic respiratory conditions like asthma are considered to be at high risk for serious illness, the CDC says.

Based on these findings, between roughly 57 million and 74 million adults working in on-site essential jobs — and their families — are at increased risk for serious illness, Selden and his colleagues estimated.

“Policymakers face important decisions about how to balance the economic benefits of keeping workers employed and the public health benefits of protecting those with increased risk of severe COVID-19,” Selden said.

“These issues arise in the context of decisions to close segments of the economy and decisions about how to distribute vaccines, which will initially be available only with limited supply, [and] become all the more difficult when the prevalence of infection rises in parts of the country,” he said.



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Study: Hydroxychloroquine no better than placebo for hospitalized COVID-19 patients

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Nov. 9 (UPI) — COVID-19 patients treated with hydroxychloroquine showed no signs of significant improvement in “clinical status” compared with those given a placebo, a study published Monday by JAMA found.

Patients given a five-day course of the drug were scored as “category six” based on the World Health Organization’s seven-category COVID Ordinal Outcomes Scale, the same as those given a placebo, the researchers said.

Also, 28 days after they started treatment, 10.4% of those treated with hydroxychloroquine died, just slightly lower than the 10.6% fatality rate in the placebo group.

“The results show that hydroxychloroquine did not help patients recover from COVID-19,” study co-author Dr. Wesley H. Self told UPI.

“In the study, patients treated with hydroxychloroquine and those treated with a placebo had nearly identical outcomes, [so] I do not foresee any role for hydroxychloroquine in acutely ill patients hospitalized with COVID-19,” said Self, an infectious disease specialist at Vanderbilt University Medical Center.

Hydroxychloroquine is an immunosuppressive and anti-parasitic drug that is used to treat malaria.

Early in the COVID-19 pandemic, it was touted by President Donald Trump and others as a potential treatment for the virus, despite the lack of any scientific data supporting its use.

Given its effectiveness helping those sickened with malaria — a mosquito-borne infection — to recover, “there was a strong rationale for why hydroxychloroquine may have been beneficial for patients with COVID-19,” according to Self.

However, in July, the U.S. Food and Drug Administration warned against the drug’s use in the treatment of those infected with the new coronavirus, due to potentially serious heart-related side effects.

For this study, Self and his colleagues treated 433 COVID-19 patients at 34 hospitals across the United States with either the drug or a placebo for a period of five days.

Patients assigned to the hydroxychloroquine group received 400 milligrams of the drug in pill form twice a day for the first two doses and then 200 mg. in pill form twice a day for the next eight doses, for a total of 10 doses over the five days.

All of the patients were then assessed based on the WHO’s COVID Ordinal Outcomes Scale, which categorizes those infected according to disease severity.

Most of the patients in both the hydroxycholorquine group and the placebo group were in “category six,” meaning they were hospitalized and receiving extracorporeal membrane oxygenation or invasive mechanical ventilation to maintain their breathing, the researchers said.

“Our results, especially when combined from other studies conducted in the United Kingdom and Brazil, are good evidence that hydroxychloroquine does not provide benefit for patients hospitalized with COVID-19,” Self said.



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