Cocaine Intoxication and Hypertensive Emergency

Abstract

Cocaine is a highly addictive, illegal drug with sympathomimetic properties that is responsible for nearly 500,000 emergency room visits per year. In at least one study, nearly 40% of trauma surgery patients and 1% of patients presenting for elective surgery tested positive for recent cocaine use. Given these numbers, anesthesiology providers must understand the physiological effects of cocaine and be able to safely manage these patients in both the intraoperative and perioperative phases. Anesthetic management of cocaine-using patients should focus on avoiding hemodynamic extremes and minimizing the ischemic consequences of vasospasm. This chapter reviews the basic pharmacology of cocaine, the physiologic effects of cocaine use, and the anesthetic management of the cocaine-using patient.