A Reason to Rethink Fasting Guidelines? Marijuana-Induced Gastroparesis and the Implications for Aspiration Risk in the Nil Per Os (NPO) Patient: A Case Report

Patient: Male, 24-year-old Final Diagnosis: Gastroparesis • tetrahydrocannabinol Symptoms: Vomiting Medication: — Clinical Procedure: — Specialty: Anesthesiology OBJECTIVE: Unusual clinical course BACKGROUND: Tetrahydrocannabinol has been implicated in gastroparesis development, a disorder characterized by delayed gastric emptying in the absence of mechanical obstruction. While most patients with gastroparesis present with upper gastrointestinal symptoms, patients with significantly delayed emptying can be asymptomatic, creating a dangerous aspiration risk. CASE REPORT: A 24-year-old man with a body mass index of 22 presented for right lower extremity open reduction and internal fixation. He endorsed daily marijuana use. His last meal was at 10 PM the prior night. After induction of general anesthesia and laryngeal mask airway (LMA) placement, 150 cc of gastric contents filled the LMA. The LMA was immediately removed and 25 to 50 cc of gastric contents was suctioned from the oropharynx. The airway was immediately secured with an endotracheal tube, after which 500 cc of clear gastric contents was suctioned from the stomach. Bronchoscopy revealed no obvious gastric contents in the tracheobronchial tree. The patient maintained adequate ventilation and oxygenation. He was safely extubated and brought to the post-anesthesia care unit, where recovery was uneventful. CONCLUSIONS: Our case raises important questions and considerations for management of THC- dependent patients with potential for impacting NPO guidelines. It is unclear whether the quantity and chronicity of THC use effects gastroparesis development. The patient endorsed no signs of hyperemesis syndrome or gastric fullness; therefore, we cannot reliably deem patients risk-free based on their lack of symptomology alone. Until the true incidence of THC-induced gastroparesis is elicited in further studies, it is prudent to take aspiration precautions in all patients who endorse THC use.