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The cocaine-using patient: perioperative concerns
1Department of Anesthesia and Intensive Care, College of Medicine and Medical Sciences, Arabian Gulf University, Kingdom of Bahrain. jskerm@agu.edu.bh
Middle East Journal of Anaesthesiology
|April 16, 2005
Summary
Anesthetic management for patients with cocaine intoxication requires careful preoperative assessment of organ systems. Caution is advised with certain anesthetic agents due to cocaine
Area of Science:
- Anesthesiology
- Cardiology
- Toxicology
Background:
- Cocaine is a potent stimulant that inhibits catecholamine reuptake, leading to sympathetic nervous system activation.
- Increasingly, patients present for surgery with acute cocaine intoxication or chronic abuse impacting organ systems.
- Anesthetic management must account for cocaine's physiological effects on multiple organ systems.
Purpose of the Study:
- To review the anesthetic considerations for patients presenting with acute cocaine intoxication.
- To highlight the impact of chronic cocaine abuse on anesthetic management.
- To discuss controversies and recommendations for managing cocaine-associated cardiovascular emergencies.
Main Methods:
- Review of physiological effects of cocaine on organ systems.
- Analysis of anesthetic management strategies for cocaine-intoxicated patients.
- Discussion of pharmacologic interventions for cocaine-associated complications.
Main Results:
- Preoperative assessment of major organ systems is crucial.
- Nitroglycerin may manage cocaine-induced hypertension and coronary vasoconstriction.
- Management of ventricular dysrhythmias and asystole, particularly the use of epinephrine, remains controversial due to catecholamine excess.
Conclusions:
- Anesthetic management requires a thorough preoperative evaluation.
- General anesthesia agents like inhalational agents should be used cautiously due to myocardial depressant effects.
- Regional anesthesia can be considered if coagulopathies and hypovolemia are corrected.