Cannabis Use Raises Anesthesia Risks, Duke Review Finds

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September 11 2025

Key Issue

Cannabis use is increasingly common. A Duke University medical review warns it complicates anesthesia during surgeries.

Research Findings

Published in Current Opinions in Anesthesiology, the review shows cannabis users need 15-30% higher propofol doses for proper sedation. Propofol induces unconsciousness quickly but can affect heart function. Higher doses raise risks of under-sedation or cardiovascular issues.

Clinical Recommendations

“Cannabis use matters for anesthesia planning,” says lead author Ruba Sajdeya, MD, PhD, Duke Anesthesiology. Clinicians should:

• Ask patients about cannabis use.

• Adjust sedative doses carefully.

• Monitor for cardiovascular changes.

Challenges

Cannabis is legal in nearly 40 U.S. states, used by 1 in 5 Americans. Many patients don’t disclose use due to stigma or unawareness. No guidelines exist on safe cannabis use before surgery or its impact on anesthesia.

Why It Happens

Cannabis compounds like THC and CBD may alter anesthesia response. Studies show a consistent link, but the exact cause—pharmacological resistance or individual differences—is unclear.

Research Gaps

Federal restrictions limit cannabis studies. More data is needed for evidence-based practices. Sajdeya’s 2023 algorithm helps detect cannabis use in medical records, aiding safer planning.

Takeaway

Clinicians must take a cautious, individualized approach. As cannabis use grows, understanding its interaction with anesthesia is critical for patient safety.

Authors

• Ruba Sajdeya, MD, PhD, Duke University

• Miriam Treggiari, MD, PhD, MPH, Duke University

• Samer Narouze, MD, PhD, Western University, Ohio

Funding

National Institutes of Health T32 Integrated Training in Anesthesiology Program, Duke University.