Cocaine and elective surgery

[GasEmDee]

We've all heard about how cocaine (and other stimulatnt) use causes catecholamine depletion and potentially catastrophic drops in blood pressure during induction.

From a practical standpoint, how do you manage this in your practice? If an otherwise healthy young patient tells you he's used cocaine the night prior to his knee arthroscopy, what do you do?

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[Planktonmd]

We've all heard about how cocaine (and other stimulatnt) use causes catecholamine depletion and potentially catastrophic drops in blood pressure during induction.

From a practical standpoint, how do you manage this in your practice? If an otherwise healthy young patient tells you he's used cocaine the night prior to his knee arthroscopy, what do you do?

Nothing different.

 

[BLADEMDA]

Nothing different.

Recent study (in the last 3-4 months) in one of our Journals shows cocaine use/abuse by patients does not lead to increased morbidity with Anesthesia.

Blade

 

[Noyac]

No big deal!


But if you find yourself treating someone with a cocaine overdose, do you know how its treated? This was one of my simulator sessions in residency.

 

[DrDre']

I NEVER do coke when I perform elective surgery or said anesthetic!

No big deal!


But if you find yourself treating someone with a cocaine overdose, do you know how its treated? This was one of my simulator sessions in residency.

 

[2ndyear]

No big deal!


But if you find yourself treating someone with a cocaine overdose, do you know how its treated? This was one of my simulator sessions in residency.

Think Pheo.

 

[Noyac]

Think Pheo.

That would probably work but there is another much easier way. I'm also not talking about cocaine overdose and surgery (I should have been more clear) but just a cocaine overdose, say in the ER.

 

[jetproppilot]

Recent study (in the last 3-4 months) in one of our Journals shows cocaine use/abuse by patients does not lead to increased morbidity with Anesthesia.

Blade

Probably done entirely on the New Orleans gangsta population....doctors in operating rooms across the city fix 'em up so they can be discharged to shoot more people....

....how many of the gangstas do you think are high on crack? And their mortality isnt from the cocaine....

 

[urgewrx]

Recent study (in the last 3-4 months) in one of our Journals shows cocaine use/abuse by patients does not lead to increased morbidity with Anesthesia.

Blade

Missed that one. Searched A+A and anesthesiology online but nothing shows up. Can you post the reference?

 

[BLADEMDA]

Missed that one. Searched A+A and anesthesiology online but nothing shows up. Can you post the reference?

British Journal of Anesthesia 2006 Nov;97 (5): 654-657

CONCLUSIONS: These results demonstrate that the non-toxic cocaine abusing patient can be administered general anesthesia with no greater risk
than comparable age and ASA matched drug-free patients.

Blade

 

[SexPanther]

That would probably work but there is another much easier way. I'm also not talking about cocaine overdose and surgery (I should have been more clear) but just a cocaine overdose, say in the ER.

Are you talking about something that provides both alpha & beta antagonism (so that there is no unopposed alpha effect)? A CCB? What about Labetalol since it has both properties?

 

[Noyac]

I'm talking about valium. It surprised me on the simulator session and I never forgot it.