What they don't tell you about cannabis before surgery- Dr. Kaveh LIVE

going to give a couple quick shout outs I see Stacy is the first one in here and it's very different than LSD and psilocybin we'll talk about those in a separate video but let's get started I'm Dr Anthony cave a Stanford and Harvard Trent anesthesiologist an integrative Medicine specialist here in the San Francisco Bay area and I had a patient recently right before surgery they said wait DOC come back come back I was about to walk them to the operating room but they asked everyone else to leave their bed and they asked me to come back and I said what's wrong sir and he closed the curtain around me and he said doc I smoked weed this morning and I told everyone I didn't but I thought you should know am I going to be okay for surgery this happens to me about two or three times a week I practice in the San Francisco Bay area and there was a lot of weed use and that patient really needed to know what I'm going to share with you right now because there's a lot that nobody tells patients about weed marijuana CBD THC whatever before surgery and it makes a big difference so this is really important and this is live and unscripted because I want you to know what it's like when patients ask me I didn't give him all this information I'm going to give you but if you're having surgery or if a loved one is having surgery do please um share this with others because it's quite important especially because weed is used by about one in ten people in the United States if there was a condition that one in 10 people had that affects surgery so heavily I would hope that doctors would tell their patients about it before they come into this operating room before they get on the bed before they get connected to the ventilator but because of various social stigmas especially around Mental Health for which marijuana can be used for some benefits I'm not anti-marijuana at all but I am anti-corporations taking advantage of vulnerable patients and not sharing the risks that are very real especially in vulnerable patients before surgery so you have to know first that marijuana is incredibly diverse it refers to a plant that has so many different chemicals we just focus on THC and CBD because those are the most well studied and there are some relatively pure formulations of each and you should also know that there is absolutely a potential addictive quality to marijuana before I go any further you need to know that one of the most denial heavy substances that I encounter in patients from my perspective and I encourage you to ask any doctor out there is marijuana because when I was you know I went to college at Berkeley University of California Berkeley a lot of weed use and they taught us that we cannot be addictive and I'm going to be honest with you that my experience clinically has not been that because I treat so many patients for addiction in my ketamine infusion clinic and I will tell you right now because this is so important for anyone before surgery the definition of addiction is any substance that produces short-term benefits if the expense of long-term harm with an inability to hit the abort button short-term benefit long-term harm can't exit can't I can't abort that behavioral pattern Loop so many patients come to me before surgery saying doc the wheat is great I am so relaxed with it and if I stop taking it I am just an anxious mess or I can't stop taking my weed because it helps my nausea if I stop I will vomit I Non-Stop and these are conditions that we'll talk about in other videos that really make me concerned if you can't stop the marijuana sometimes it's contributing to other side effects that patients are unwilling to acknowledge once again I'm not anti-marijuana absolutely not it can be a sacred planet in many parts of the world it is but when it's used unscrupulously for the reasons I'm going to share you need to recognize that it can be addictive and anytime you have an addiction before surgery all of the medications here can and likely will interact with the addictive chemicals in your brain especially if they've built up because of fat soluble or lipophilic chemicals like weed more lipophilic than most other substances remember lipophilic means it's fat soluble means if you dissolve it in olive oil it'll mix in really well because your brain is made out of fat pretty much it means that it absorbs all those fatty chemicals that THC in particular gets absorbed very well and it stays around for a long time it affects all those medications I just showed you so quick review why cannabis is so so important for good and bad is that it affects the brain and the spinal cord why does this matter hey if I get poked in the finger that painful stimulus goes from my finger through the nerves in my arm to my spinal cord my brain stem then my brain that's how you feel things CB receptors cannabinoid receptors exist all throughout the spinal cord at the brain similar to opioid receptors in fact I have fentanyl in my pocket right now because this is another light relatively lipophilic medication it attaches to opioid receptors in the spinal cord and the Brain cannabinoids which are components of marijuana CBD and THC are the two most popular ones also affect all of these receptors and just remember that a receptor is nothing more than a hand so for example opioids imagine that they go to the receptor which is my hand and I do something in response to the opioid attaching to my receptor maybe I'll say thank you to you or something right but at the cellular level you had to sell with a bunch of hands on it when the right molecule attaches to the receptor the cell does something in response that's the definition that's how all this what we call pharmacokinetics work based on how cells respond to how chemicals bind to the hands on them The receptors for THC or I should say the CB1 and CB2 receptors respond with certainly as you know anti-anxiety and some anti-pain properties when used at moderate Doses and how to explain moderate later on but they can have medicinal qualities there's no question for cancer related pain or cancer related nausea certain forms of mental health conditions cannabinoids can be powerful but and this is also where the interactions with anesthesia come in you need to recognize that the doses used today are so different than the doses used before and like Joe Van is saying Edibles versus inhalation are vastly different so the C the THC attaches mostly to cv1 it causes the hallucinogenic or the psychogenic psychotropic effects CBD however actually has the opposite effect that CB1 and CV2 receptors nonetheless and by the way none of this matters because when you're under anesthesia everything is disrupted based on the medications I showed you in the drawer based on the gases that come out of the ventilator here inhalational or IV doesn't matter all of those theoretical receptor things are out the door so I'm going to share with you practically what happens to patients sorry that introduction took so long but you had to understand it to see why it's such a big deal Alexis I'm giving you a wave that's right so number one is that when you have cannabinoids in your system if they are anti-pain or anti-nausea at Baseline that's all well and good but when you have anesthetics on board this one's midaza Lam or versed a powerful cousin of Xanax this one's Fentanyl and I've shown you so many others they interact with THC and CBD in ways that are going to have different receptor profiles and receptor actions then if you take them on their own right so maybe for example if I have fentanyl floating around my brain and spinal cord and I also have CBD or really THC it appears also floating around though they're realistically they're always together and you need to know that it's very very rare to find a pure CBD product or a pure THC product it appears at at least 20 percent of pure CBD products are contaminated with THC for many reasons that we'll have to talk about politically different at a different time when you have fentanyl floating around and THC CBD floating around it's different than this THC CBD when you have the white stuff and I'll explain to you why the white stuff propofol it's just one of the many medications once again that we have here when this is floating around when you have cannabinoid or I should say cannabinoids in your body they increase the concentrations of propofol because they turn off some of the metabolism of propofol it appears it's liver metabolized so when you're using up the metabolism properties of the liver for your weed other things that get metabolized by the liver like Propofol um or other drugs like some opioids are going to accumulate and therefore the side effects of them are going to accumulate also we spend so much time naively very naively and ignorantly focusing on CB1 and CB2 no one talks about the serotonergic or the serotonin effects of especially THC so look at this medication here it's called Zofran or ondansetron used very commonly in nausea especially for chemo related nausea and post-surgical nausea well when THC also modulates serotonin activity what do you think might happen when we're giving serotonergic agents what is happening to the nausea effects when we're mixing different chemicals together now I human beings aren't meat bags we have so much more sanctity than that but we got to recognize that when we're putting a mixing pot of loads of chemicals it's like a chemistry set and I can't predict to you exactly what's going to happen but I will tell you that when we mix them together it appears that patients have more nausea after surgery more pain after surgery they whether this is from withdrawing from the cannabinoids that they're not using because they've been under anesthesia because of those interactions that change the concentrations of other anesthetics therefore their side effects hey Dave thank you for that uh thank you there and actually by the way Dave reminds me if you appreciate me uh coming on here after a long day in the operating room I really appreciate it if you leave a like and share what you've learned with others so that you can of course learn more is our broken Health Care System 18th ain't telling you this very important information and also you share with others so that you help Empower them remember this is a broken Health Care system and you I want you to be educated so you can advocate for yourself I don't want to do ads for anyone else I want you to get this knowledge to advocate for yourself so I really appreciate your support but back to the important Point why do these side effects get worse because patients come to me saying but I need my weed so I'm not nauseous but that's not what happens when you're mixing other chemicals with the CBD or the THC pain relieving properties are dose dependent for THC and CBD and those doses that you ordinarily take lead to a level in the brain and spinal cord that is completely disrupted when you mix other medications with it when you get IV fluid through your IV for surgery you're gonna have different concentrations and we know that wheat is not just like you take a pill and it get the same effect no because wheat is a plant it has varying concentrations of THC and CBD based on when it was cultivated what part of the world maybe it has pesticides or carcinogens or heavy metals in it no it's a natural plant that needs to be respected as a whole plant not as a pure medication even though people try to sell it that way I got to go back and give a shout out to Bitter pill to swallow has an upcoming hysterectomy and smokes daily best advice well first of all I hope everyone here sends you positive vibes for your hysterectomy I certainly am wishing you the best for that and smoking marijuana daily uh is we're actually going to talk about that right now because when you take marijuana orally it gets metabolized by your liver heavily it goes through your mouth into your stomach into your body and your liver transforms it so about 10 or so of the weed makes it to your brain and the rest of your body but it lasts for hours so if you eat marijuana please do not use anything ideally for four weeks before surgery stop as soon as you can and tell your doctors if you have been using it vaporizing or inhaling marijuana is very similar to Anesthesia when you inhale anesthesia what happens right depending on how you're breathing and I do this differently with patients when they're on the table I may ask them to breath hold when they're connected to the ventilator when they breath hold they're going to absorb more of the sibo fluorine gas here when you breath hold of marijuana you're going to also absorb more of that inhaled or that vaporized marijuana it's going to reach your brain differently it is fast on relatively fast off and it's important to recognize that please stop using vaporized marijuana also four weeks in advance if you can't tell your anesthesiologist ahead of time and if you it's too late it's on the morning of don't use it the morning of but recognize that we can give medications to counteract the nausea and the pain however it might be more challenging to counteract that paranoia and anxiety that also come up in patients after surgery we call this emergence delirium so talk about this with your anesthesiologist especially if you're using the weed four anxiety depression traumas you know I didn't want to go into this but we have to recognize please recognize that when someone's coming on this table with me they are in a vulnerable vulnerable state and if they're using drugs first you got to share that and that's not easy to share and second of all recognize that they're using it for a reason yes some individuals use marijuana recreationally in my experience anything we're using recreationally is because there's something that we're trying to overcome maybe it's emotional pain or physical pain or anxiety it's hard to share that with someone but before surgery remember surgery is going to reveal this in many cases I don't want to say inevitably we'll reveal it but your pre-operative mindset will come up so if you're using marijuana for something let us know so that if that anxiety bubbles up as emergence delirium if that paranoia exacerbates how you wake up after anesthesia we know to help prepare you to wake up more smoothly Heidi thank you for that thank you by the way I really appreciate that as well and Teresa says every generation has a tendency for this you are correct you're absolutely correct that every generation has a tendency to reach after any type of intoxicant whether it be alcohol marijuana Etc but it it doesn't matter by the generation it matters about the underlying cause a whole different topic please don't try to derail me because this is such an important topic here um all right numbing oh SAR currents as numbing so marijuana being used for numbing is another way of reviewing this thank you for sharing that perspective I also agree with you unfortunately when you were using an external substance whether it's alcohol or marijuana to numb your anxiety before surgery once those medications go away if you don't have a withdrawal from that the anesthesia might well open it up in that emergence delirium so you're right the numbing is not helpful if it's no longer there uh psychedelic store Harwell fungus no stop that no we're not talking about psychedelics and that is illegal what you're doing so please stop putting that on this slide uh okay a couple of last things I'm going to share with you that um are important to know number one is that when you smoke marijuana it appears to have similar effects on the risk of heart attacks as smoking cigarettes that's because THC increases your sympathetic nervous system so if you're taking antidepressants in the tricyclic antidepressant class that's going to also have an additive effect with increasing the risk of a heart attack during surgery so you gotta you have to be very very careful for THC especially in patients who have coronary artery disease and then lung inflammation or bronchial spasm like asthma attacks we don't yet know for sure but it appears that if you're smoking especially if you're using a high temperature vaporizer that this might also cause inflammation that can be dangerous when you have a mask on or if you're trying to place a breathing tube in somebody before surgery these can cause complications after surgery on top of the pain nausea paranoia emergence delirium Etc no one wants to wake up from a heart attack after surgery I want to remind everyone that it's I'm not anti-marijuana I'm not anti-weed but it we need to have a respect for the whole plant and not take away one part of it and try to commercialize that slap a price tag and pretend like it's just a natural thing no THC concentrations in the weed where I live in San Francisco have gone from two three percent to 30 percent and if you buy butane hash oil that can be 80 these are unnatural highly concentrated effects on the brain totally not natural and when patients look at me in the eye before surgery and are terrified about what's going to happen or when I call them before surgery and I hear it in their voice they're like doctor am I going to be okay for surgery you're in such a vulnerable place and now this is an another fear to have it's not worth it at least speak with your doctor about it and recognize that just because someone's selling you something and telling you it's safe doesn't mean it's safe Therese was asking about tolerance there is certainly a tolerance of anesthesia and I'm going to just remind you that in individuals that use weed every day they need to do about two times the amount of Propofol if they don't get that 2x amount of purple Fallen theoretically there's a risk that they might be aware and they might remember things we know that remembering things can be a huge stressor can cause PTSD in the future but this is one of the realities that when individuals are using weed every day when they tell us their anesthesiologist we can give them the right medications here to help minimize the risks of awareness that is being aware when you're on the bed if you don't tell us though we might not be able to take care of the rest of those side effects that might lead to you waking up uncomfortable after surgery uh the molecular dance asks me if I would go to medical school again if I could do it over again and that's a hard question to answer in all honesty I will say that medical school did not prepare me for the real world as much as I love Stanford and I loved Harvard and they were grateful I'm so grateful to my teachers the real world has turned out to be a harder place for patients to get the care that they deserve that's why I'm sharing with you so that you hopefully are less likely to be fooled by people trying to sell you and push weed at you once again I'm not anti-psychedelic I'm not anti-weed but when it's pushed a certain way it can be harmful you know that I am a big advocate for ketamine I'm an advocate for certain psychedelics but they have to be used responsibly wheat is the same way so please take what you've learned share with others remember that if you want to hear about a topic answer my polls or leave a comment below with what you want to specifically hear about and I hope that all of you remember that you have more power over your health than you've probably ever been told until next time peace

Channel: Medical Secrets

Views: 1,318,706

Keywords: marijuana, cannabis, weed, THC, CBD, CB1, CB2, serotonin, anesthesia awareness, surgery complications, anesthesia complications, edible, anesthesia recall, medical marijuana, marijuana legalization

Id: 2AeTDIyKDUs

Length: 22min 14sec (1334 seconds)

Published: Thu Jun 15 2023