Clinical Safety of Lidocaine in Patients With Cocaine-Associated Myocardial Infarction

Shih, Richard D.; Hollander, Judd E.; Burstein, Jonathan L.; Nelson, Lewis S.; Hoffmann, Roald; Quick, Annette

doi:10.1016/s0196-0644(95)70041-2

Cited by 67 publications

(27 citation statements)

References 24 publications

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“…In humans, the benefits of a-adrenergic blockade (phentolamine) have been demonstrated experimentally with regard to reversal of cocaine-induced coronary vasoconstriction [68] and clinically with regard to reversal of acute coronary syndrome [69,70], but not with regard to arrhythmias. As mentioned previously, data suggest safety and efficacy of lidocaine in humans [29], contraindications exist for b-adrenergic antagonists, and both type IA and IC antiarrhythmic agents. Although data on amiodarone are not supportive, evidence of harm is also lacking [32].The use of magnesium is interesting, but unsupported by any human data.…”

Section: Treatment Of Arrhythmias Resulting From Cocaine-associated Mmentioning

confidence: 64%

“…Additionally, in some models lidocaine is only effective in doses that would be clearly toxic to humans [28]. More convincingly, clinical experience with lidocaine in patients with cocaine-associated acute coronary syndromes has not only been beneficial, but was not associated with seizures [29].…”

Section: Treatment Of Arrhythmias Resulting From Cocaine-associated Smentioning

confidence: 99%

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Treatment of patients with cocaine‐induced arrhythmias: bringing the bench to the bedside

Hoffman

2010

Brit J Clinical Pharma

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Widespread use of cocaine and its attendant toxicity has produced a wealth of benchwork studies and small animal investigations that evaluated the effects of cocaine on the cardiovascular system. Despite this wealth of knowledge, very little is known about the frequency or types of arrhythmias in patients with significant cocaine toxicity. The likely aetiologies; catecholamine excess, sodium channel blockade, potassium channel blockade, calcium channel effects, or ischaemia may act alone or in concert to produce a vast array of clinical findings that are modulated by hyperthermia, acidosis, hypoxia and electrolyte abnormalities. The initial paper in the series by Wood & Dargan providing the epidemiological framework of cocaine use and abuse is followed by a detailed review of the electrophysiological effects of cocaine by O'Leary & Hancox. This review is designed to complement the previous papers and focuses on the diagnosis and treatment of patients with cocaine‐associated arrhythmias.

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Section: Treatment Of Arrhythmias Resulting From Cocaine-associated Mmentioning

confidence: 64%

Section: Treatment Of Arrhythmias Resulting From Cocaine-associated Smentioning

confidence: 99%

Treatment of patients with cocaine‐induced arrhythmias: bringing the bench to the bedside

Hoffman

2010

Brit J Clinical Pharma

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“…Lidocaine has been safely used in a small number of patients with cocaine-induced ventricular tachycardia and fibrillation [30] and was considered weighing the risks of Torsades de pointes and seizure in this particular patient as lidocaine may lower the seizure threshold [31]. The use of amiodarone for ventricular arrhythmias with recent cocaine ingestion has not been well defined [14].…”

Section: Cardiacmentioning

confidence: 99%

Perioperative care of the cocaine-dependent neurosurgical patient

Dwarakanath¹,

Cook²,

Fahy³

2013

J Anesthesiol Clin Sci

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Purpose: Cocaine, a commonly abused drug, can cause life-threatening complications, significantly impacting patient management. Cocaine is associated with an increased risk of stroke including subarachnoid hemorrhage (SAH) that may require expectant surgical management. Patients presenting for anesthesia with acute cocaine toxicity pose additional concerns. Clinical Features: A 48 year old woman presented with a seizure, acute cocaine intoxication, and was diagnosed with a SAH. Further diagnostic evaluation revealed a bleeding cerebral aneurysm requiring urgent surgical aneurysm clipping. Her perioperative course was complicated by hypertension requiring treatment to minimize further aneurysm bleeding before clipping. Cocaine-associated cardiac complications impacting management included a non-ST elevation myocardial infarction and severe anteroseptal hypokinesis on echocardiogram. Conclusion: Hemodynamic management with a recent SAH and acute cocaine intoxication required special considerations. Perioperative SAH management initially focused to prevent additional bleeding before clipping and then after clipping to minimize cerebral ischemia. Benzodiazepines were used early in this case to treat seizures and cocaine-associated hemodynamic effects. Specific treatments for life-threatening ventricular arrhythmias are discussed including sodium bicarbonate as a first line treatment and potential benefits of magnesium administration. With prolongation of a QT interval secondary to cocaine and/ or SAH, medications that often are utilized during the perioperative period may further prolong the QT interval and should be avoided.

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“…Nearly every type of dysrhythmia has been reported with cocaine use, [4] and it stands to reason that sudden death related to cocaine could be due to lethal dysrhythmias. Ventricular dysrhythmias are a well-recognized complication of myocardial infarction, and ventricular dysrhythmias certainly occur in the setting of cocaine-induced myocardial ischemia [32]. However cocaine induced ventricular dysrhythmias unrelated to myocardial ischemia are thought to occur [3,31].…”

Section: Cocainementioning

confidence: 99%

The effect of amiodarone pretreatment on survival of mice with cocaine toxicity

et al. 2005

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Introduction: Cocaine is a common drug of abuse and use has been associated with ventricular dysrhythmias. Published guidelines suggest that amiodarone is the first line antidysrhythmic for ventricular tachycardia and fibrillation. However, the effects amiodarone in the setting of cocaine toxicity are unknown and unstudied. The purpose of this study was to evaluate the safety and efficacy of amiodarone pretreatment in a murine model of acute cocaine toxicity.Methods: This was a randomized, blinded, placebo controlled investigation using male CF-1 mice weighing 29-37 g. First, the safety of an intraperitoneal dose of amiodarone (40 mg/kg) was confirmed in 5 mice. Second, based on preliminary investigations, an approximate intraperitoneal LD 50 dose of cocaine (110 mg/kg) was identified and used as the cocaine dose in this study. Animals were then randomized to 2 groups. The control group received 0.5 mL of intraperitoneal 0.9% saline 30 minutes before cocaine. The study group received 40 mg/kg of intraperitoneal amiodarone (40 mg/kg) 30 minutes before cocaine. A blinded observer monitored mice for 2 hours after cocaine administration.Results: No mice in the amiodarone-only group developed any signs of toxicity or died. In the saline ϩ cocaine group 31/32 (96.9%; 95% CI 83.8 to 99.9) mice seized with a median time to seizure of 2.5 minutes, and 23/32 (71.9%; 95% CI 52.3 to 86.3) died with a median time to death of 5.5 minutes. In the amiodarone ϩ cocaine group 31/33 (93.9%; 95% CI 79.0 to 99.3) mice seized with a median time to seizure of 2.0 minutes, and 24/33 (72.7%; 95% CI 54.5 to 86.7) died with a median time to death of 6.0 minutes. All animals that died did so within 9 minutes. The difference in the proportion of animals dying in the amiodarone ϩ cocaine group compared to the saline ϩ cocaine group was 0.008 (Ϫ21 to 22%).Conclusions: In this study, pretreatment with amiodarone in cocaine poisoned mice resulted in no change in seizure incidence or mortality. However, definite conclusions about the reason for these findings cannot be drawn from this model.

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Clinical Safety of Lidocaine in Patients With Cocaine-Associated Myocardial Infarction

Cited by 67 publications

References 24 publications

Treatment of patients with cocaine‐induced arrhythmias: bringing the bench to the bedside

Treatment of patients with cocaine‐induced arrhythmias: bringing the bench to the bedside

Perioperative care of the cocaine-dependent neurosurgical patient

The effect of amiodarone pretreatment on survival of mice with cocaine toxicity

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