Is cocaine a sympathetic stimulant during general anesthesia?

Area of Science:

• Anesthesiology
• Cardiovascular Pharmacology
• Surgical Patient Care

Background:

• Cocaine is sometimes used topically for nasal procedures.
• Its sympathomimetic effects may be a concern during general anesthesia, especially in patients with coronary artery disease.

Purpose of the Study:

• To investigate the sympathomimetic effects of clinically used topical cocaine doses.
• To assess cardiovascular function in patients with coronary artery disease undergoing surgery under general anesthesia.

Main Methods:

• Eighteen patients undergoing coronary artery surgery were divided into two groups.
• One group received topical cocaine hydrochloride (1.5 mg/kg) on the nasal mucosa before intubation; the control group did not.
• Cardiovascular parameters including blood pressure, pulse rate, and cardiac index were monitored.

Main Results:

• Plasma cocaine concentrations peaked at 331 ng/mL and 320 ng/mL at 30 and 45 minutes, respectively.
• No significant differences in cardiovascular function were observed between the cocaine and control groups.
• Topical cocaine administration showed no apparent relationship to changes in cardiovascular function.

Conclusions:

• Topical cocaine, at the dose studied, does not produce clinically significant sympathomimetic effects in anesthetized patients with coronary artery disease.
• The drug appears well tolerated in this specific clinical context.