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Description

Purpose: Cannabinoid hyperemesis syndrome (CHS) is characterized by cyclic nausea, vomiting, and abdominal pain in chronic cannabis users, often relieved by exposure to hot water. Propofol, a widely used GABAergic anesthetic with antiemetic properties, has paradoxically been implicated in exacerbating hyperemetic episodes in some cannabis users. With the growing legalization of marijuana and social acceptance to its recreational use it is believed that this phenomenon will be more ubiquitous to clinicians. This review aims to investigate the mechanistic and clinical evidence linking propofol administration to CHS and to summarize strategies for prevention, diagnosis, and management.

Methods: PubMed and EBSCO were searched for literature addressing: (1) CHS mechanisms, (2) propofol-induced nausea and emesis, and (3) clinical reports of propofol-indcued hyperemesis in cannabis users. Search parameters were iteratively refined to capture both mechanistic studies and clinical reports.

Results: Preliminary PubMed searches yielded 28 articles on CHS mechanisms, 1 article on propofol-induced nausea mechanisms, 1 article directly linking propofol and CHS, and 34 articles on propofol-related emesis mechanisms. Analysis of the literature suggests a potential correlation and indicates that propofol may trigger or amplify hyperemetic episodes in predisposed individuals.

Conclusions: Although limited, current evidence supports a possible mechanistic and clinical association between propofol and CHS exacerbation. Awareness of this potential risk is important for anesthesiologists and clinicians, particularly in settings of widespread recreational cannabis use, to inform prevention, diagnosis, and management strategies.

Disciplines

Anesthesiology | Biochemical Phenomena, Metabolism, and Nutrition | Medical Pharmacology | Medical Physiology

Keywords

Propofol; Chronic cannabis use; Cannabinoid hyperemesis syndrome (CHS); Endocannabinoid system; CB1 receptor; Anesthetic pharmacology; GABA-A receptor modulation; Dopaminergic pathways; TRPV1 receptor; Cyclic vomiting; Perioperative management; Anesthetic requirements; Substance use and anesthesia; Neuropharmacology; Mechanistic hypothesis.

Document Type

Poster

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Propofol in Chronic Cannabis Users: A Mechanistic Link to Cannabinoid hyperemesis?

Purpose: Cannabinoid hyperemesis syndrome (CHS) is characterized by cyclic nausea, vomiting, and abdominal pain in chronic cannabis users, often relieved by exposure to hot water. Propofol, a widely used GABAergic anesthetic with antiemetic properties, has paradoxically been implicated in exacerbating hyperemetic episodes in some cannabis users. With the growing legalization of marijuana and social acceptance to its recreational use it is believed that this phenomenon will be more ubiquitous to clinicians. This review aims to investigate the mechanistic and clinical evidence linking propofol administration to CHS and to summarize strategies for prevention, diagnosis, and management.

Methods: PubMed and EBSCO were searched for literature addressing: (1) CHS mechanisms, (2) propofol-induced nausea and emesis, and (3) clinical reports of propofol-indcued hyperemesis in cannabis users. Search parameters were iteratively refined to capture both mechanistic studies and clinical reports.

Results: Preliminary PubMed searches yielded 28 articles on CHS mechanisms, 1 article on propofol-induced nausea mechanisms, 1 article directly linking propofol and CHS, and 34 articles on propofol-related emesis mechanisms. Analysis of the literature suggests a potential correlation and indicates that propofol may trigger or amplify hyperemetic episodes in predisposed individuals.

Conclusions: Although limited, current evidence supports a possible mechanistic and clinical association between propofol and CHS exacerbation. Awareness of this potential risk is important for anesthesiologists and clinicians, particularly in settings of widespread recreational cannabis use, to inform prevention, diagnosis, and management strategies.