Cocaine‐induced cardiomyopathy in a paediatric patient

Abstract

Summary A 23‐month‐old healthy female presented for irrigation of obstructed nasolacrimal ducts under general anaesthesia. Induction of anaesthesia was uneventful and a supraglottic airway device was inserted. During the surgical procedure, gauze pledgets soaked in a solution containing 4% cocaine and 1:1000 adrenaline were inserted into both nostrils. The nasolacrimal ducts were irrigated with the same solution. The procedure lasted approximately twenty minutes and the pledgets were removed at the end. No adverse intraoperative events were noted. In the recovery room, the patient became agitated and developed signs of respiratory distress. Bilateral infiltrates consistent with pulmonary oedema were evident on the chest radiograph and a bedside echocardiogram demonstrated significantly impaired left ventricular function. Lateral T‐wave inversion was seen on the electrocardiogram and cardiac troponin levels were elevated. Following the exclusion of other causes of myocardial dysfunction, ischaemic cardiomyopathy due to cocaine‐induced vasospasm was considered to be the most likely diagnosis. This case highlights the hazards associated with the systemic absorption of cocaine, particularly when used in combination with adrenaline. Safe dosing regimens were not adhered to in this case and the dose of cocaine in the irrigation solution was not calculated. We suggest that cocaine should only be used in clinical practice when no safer alternative is available.