Medicinal cocaine has been used as a local anaesthetic since the 1880s, and the alkaloid is one of the first recorded anaesthetic agents. Some rhinologists use cocaine for its vasoconstrictive properties to improve the field of vision by reducing bleeding during endoscopic sinus surgery. The European Medicines Compendium advises on a maximum dose of 1.5mg/kg in fit adults (topical mucosal Cocaine Hydrochloride Solution 10% w/v). 1,2 The addition of adrenaline will reduce systemic absorption of cocaine, lowering the solution's toxicity while simultaneously offering more significant local vasoconstriction. 3 Increasing the solution's pH via sodium bicarbonate increases the anaesthetic properties while having no effect on toxicity. A solution of cocaine, adrenaline and sodium bicarbonate is eponymously termed Moffett's solution. 4 In the UK, recreational cocaine use is relatively common, and among the 16-24 age group, 6% of individuals reported using cocaine. There is currently no testing method that can distinguish between medical and recreational use. 5 Despite the controversy among the rhinology community, we could not find any published medical literature that explores patient perceptions of cocaine. The use of cocaine as a recreational drug and the consequent introduction of occupational drug testing is a factor that has not previously been emphasised.Given the physician's duty of candour and more patient-centred clinical practice, there is a strong case for involving patients in the decision to use cocaine during their surgery. In this study, we would like to focus on patients' perceptions concerning the use of medicinal cocaine.
| PATIENTS AND ME THODS
| PatientsWe prospectively surveyed 63 patients attending a rhinology clinic in University Hospital Lewisham, London. We designed a questionnaire (Appendix 1) that assesses the patient demographic and perceptions around the use of medical cocaine in sinonasal surgery. Inclusion criteria were adults (>18 years old) attending a postoperative consultation, or who had a preoperative consultation and were awaiting surgery.
BackgroundThere are large regional variations in tonsillectomy rates. It is concerning from a public health perspective as it suggests patients with the same condition are being offered different treatments based on where they live. The most common theory for how this variation arises is called the "Surgical Signature", where it is hypothesised that surgeons in one region align their preference to a specific treatment , whereas surgeons in a different region align to a different treatment.However, all previous studies have focused on tonsillectomy rates between regions and assumed that the disease burden -recurring tonsillitis -is the same between regions.
This graph shows the rate of recurring tonsillitis by region in our dataset, and as you can see there seems to be considerable variation from region to regionThis graph shows the rate of tonsillectomy in patients with recurring tonsillitis by region in our dataset, and as you can see there seems to be considerably less variation from region to region
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