{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T08:36:24Z","timestamp":1790757384305,"version":"4.1.0"},"reference-count":12,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T00:00:00Z","timestamp":1614816000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Endoscopy under propofol sedation has become a routine procedure. Given the number of Canadians undergoing an endoscopy annually, as well as the pervasive use of cannabis by many patients, understanding the effect of cannabis use on the propofol dose at endoscopy is highly relevant. We aimed to evaluate the association between cannabis exposure and the propofol dose needed to achieve adequate sedation at endoscopy.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A case-control study of individuals undergoing endoscopy was conducted at a single outpatient endoscopy clinic in London, Ontario between 2014 and 2017. Cases included all individuals with any self-reported cannabis exposure, while controls included all individuals without any self-reported history of cannabis use. Dose of propofol administered by a single anesthetist was collected on each subject as well as additional demographic and procedure-related covariates.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Three hundred and eighteen participants were included (cases, n = 151; controls, n = 167). Cannabis exposure was associated with an increase in propofol dose (cases 0.33 mg\/kg\/minute \u00b10.24; controls, 0.18 mg\/kg\/minute \u00b10.11; p&lt;0.0001). Cannabis exposure remained an independent predictor of propofol dose on multivariate linear regression accounting for other important covariates (p&lt;0.0001). Daily cannabis users required a higher propofol dose than weekly or monthly users. Three procedural sedation-related complications occurred in the cannabis-exposed group, while none occurred in the unexposed group.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Our data suggest that cannabis use is significantly associated with the quantity of propofol needed for sedation at endoscopy. Further study is needed to better understand the molecular basis for this possible drug-drug interaction.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0248062","type":"journal-article","created":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T18:31:28Z","timestamp":1614882688000},"page":"e0248062","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":39,"title":["High quantities: Evaluating the association between cannabis use and propofol anesthesia during endoscopy"],"prefix":"10.1371","volume":"16","author":[{"given":"Ngozi","family":"Imasogie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhiannon V.","family":"Rose","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6568-1714","authenticated-orcid":true,"given":"Aze","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,3,4]]},"reference":[{"key":"pone.0248062.ref001","volume-title":"World Drug Report","author":"UNODC","year":"2015"},{"issue":"1","key":"pone.0248062.ref002","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/ADM.0b013e31820c23fa","article-title":"An evidence based review of acute and long-term effects of cannabis use on executive cognitive functions","volume":"5","author":"RD Crean","year":"2011","journal-title":"J Addict Med"},{"issue":"7","key":"pone.0248062.ref003","doi-asserted-by":"crossref","first-page":"436","DOI":"10.5348\/ijcri-201573-CR-10534","article-title":"Cannabis consumption before surgery may be associated with increased tolerance of anesthetic drugs: A case report","volume":"6","author":"R Georg","year":"2015","journal-title":"International Journal of Case Reports and Images (IJCRI)"},{"issue":"3","key":"pone.0248062.ref004","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1097\/EJA.0b013e328319be59","article-title":"Induction dose of propofol in patients using cannabis","volume":"26","author":"P Flisberg","year":"2009","journal-title":"European Journal of Anaesthesiology (EJA)"},{"issue":"2","key":"pone.0248062.ref005","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.cgh.2009.07.008","article-title":"Incidence of sedation-related complications with propofol use during advanced endoscopic procedures","volume":"8","author":"GA Cot\u00e9","year":"2010","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"11","key":"pone.0248062.ref006","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1046\/j.1365-2044.2002.288312.x","article-title":"Cannabis smoking and anaesthesia","volume":"57","author":"IE Symons","year":"2002","journal-title":"Anaesthesia"},{"key":"pone.0248062.ref007","article-title":"Effects of Cannabis Use on Sedation Requirements for Endoscopic Procedures","author":"MA Twardowski","year":"2019","journal-title":"J Am Osteopath Assoc"},{"issue":"suppl_2","key":"pone.0248062.ref008","doi-asserted-by":"crossref","first-page":"ii37","DOI":"10.1093\/bja\/aeu378","article-title":"Monitoring and delivery of sedation","volume":"113","author":"CG Sheahan","year":"2014","journal-title":"BJA: British Journal of Anaesthesia"},{"issue":"6","key":"pone.0248062.ref009","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1097\/ALN.0b013e31821c120e","article-title":"Propofol enhances memory formation via an interaction with the endocannabinoid system","volume":"114","author":"D Hauer","year":"2011","journal-title":"Anesthesiology"},{"key":"pone.0248062.ref010","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1097\/00003643-200706001-00435","article-title":"Cannabinoid 1 receptor antagonist reduces THC\/propofol interaction: 9AP4-9","volume":"24","author":"P Brand","year":"2007","journal-title":"European Journal of Anaesthesiology (EJA)"},{"issue":"5","key":"pone.0248062.ref011","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1038\/sj.bjp.0705334","article-title":"The general anesthetic propofol increases brain N-arachidonylethanolamine (anandamide) content and inhibits fatty acid amide hydrolase","volume":"139","author":"S Patel","year":"2003","journal-title":"Br J Pharmacol"},{"key":"pone.0248062.ref012","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/978-3-319-45541-9_4","article-title":"Molecular Targets of the Phytocannabinoids: A Complex Picture","volume":"103","author":"P Morales","year":"2017","journal-title":"Progress in the chemistry of organic natural products"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0248062","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T18:31:38Z","timestamp":1614882698000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0248062"}},"subtitle":[],"editor":[{"given":"Lucy 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