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  • 1Monash Health, Melbourne, Australia.

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Topical cocaine in a modified Moffett's solution shows low systemic absorption during endoscopic sinus surgery (ESS). This study quantifies cocaine and benzoylecgonine levels, finding minimal absorption post-ESS.

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Area of Science:

  • Otolaryngology
  • Pharmacology
  • Surgical Anesthesia

Background:

  • Nasal mucosa preparation with vasoconstrictors is vital for safe and efficient endoscopic sinus surgery (ESS).
  • Cocaine has been a traditional choice, but concerns exist regarding systemic side effects from topical application.
  • Limited research addresses cocaine absorption during ESS.

Purpose of the Study:

  • To determine the systemic absorption amount and duration of cocaine.
  • To evaluate cocaine absorption following intranasal atomized administration of modified Moffett's solution before ESS.

Main Methods:

  • Twelve adult patients undergoing ESS were included.
  • Modified Moffett's solution (100 mg cocaine HCl, 1 mg adrenaline) was applied topically 5 minutes pre-surgery.
  • Serum cocaine and benzoylecgonine levels were measured up to 12 hours post-administration.

Main Results:

  • Peak plasma cocaine concentrations ranged from 13-31 µg/L, occurring 60-120 minutes post-administration.
  • Mean peak plasma cocaine concentration was 20.35 µg/L at 120 minutes.
  • Benzoylecgonine was detected in 11 subjects at 60 minutes and all subjects at 12 hours.

Conclusions:

  • Atomized modified Moffett's solution results in low systemic cocaine absorption prior to ESS.
  • This formulation may offer a safer alternative for nasal preparation in ESS.