Esmolol in the Management of Epinephrine-and Cocaine-Induced Cardiovascular Toxicity

Pollan, S.; Tadjziechy, M.

doi:10.1213/00000539-198911000-00019

Cited by 34 publications

(5 citation statements)

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“…79 -82 The use of the selective ␤ 1 antagonist metoprolol has not been studied in cocaine-associated chest pain, but the short-acting selective ␤ 1 antagonist esmolol resulted in significant increases in blood pressure in up to 25% of patients. 83,84 Although ␤-blocker administration is recommended for patients with MI unrelated to cocaine because it can lead to lower mortality rates, deaths from cocaine-associated MI are exceedingly low, altering the riskbenefit ratio. 47 The ACC/AHA ST-segment-elevation MI guidelines state, "Beta-blockers should not be administered to patients with STEMI precipitated by cocaine use because of the risk of exacerbating coronary spasm" (p E38).…”

Section: ␤-Blockersmentioning

confidence: 99%

Management of Cocaine-Associated Chest Pain and Myocardial Infarction

McCord¹,

Jneid²,

Hollander³

et al. 2008

Circulation

365

131

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Section: ␤-Blockersmentioning

confidence: 99%

Management of Cocaine-Associated Chest Pain and Myocardial Infarction

McCord¹,

Jneid²,

Hollander³

et al. 2008

Circulation

365

131

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“…For the treatment of severe hypertension, α-adrenergic blockers such as phentolamine are recommended, and β-adrenergic blockers are recommended for the treatment of tachycardia. Esmolol, the short acting β1-selective blocker, is preferred because it has a short half-life; it can be used by volume titration depending on the heart rate; and it can reduce the risk of hypertension and coronary spasm due to the excessive α-stimulation that is found in nonspecific β-blockers [ 13 ]. Calcium-channel blockers, such as verapamil and diltiazem, are also used for hypertension, tachycardia, and arrhythmia.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular crisis after small dose local infiltration of epinephrine in patient with asymptomatic subarachnoid hemorrhage -A case report-

Bae

Woo

Kim

et al. 2010

Korean J Anesthesiol

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The infiltration of dilute epinephrine solution has been used for many years to provide hemostasis. However, epinephrine has adverse cardiovascular effects, such as arrhythmia, pulmonary edema, and even cardiac arrest. We have experienced epinephrine-induced cardiovascular crisis, with severe hypertension, tachycardia, and cardiac arrest after subcutaneous infiltration of a 2% lidocaine and 1 : 200,000 epinephrine solution in a patient with an asymptomatic subarachnoid hemorrhage. We provided successfully advanced cardiac life support in the operating room and cardioverted the patient back into a sinus rhythm with no untoward effects. The patient recovered without any apparent sequelae after intensive care.

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“…Propranolol has been used for the control of acute hypertension in cocaine intoxication but may increase hypertension and coronary vasoconstriction because of unopposed ␣ adrenoceptor stimulation 15 . For this reason labetalol 16 , which antagonizes ␣ and ␤ adrenergic receptors, and esmolol 17 , the short-acting ␤1 selective antagonist, may be more appropriate agents to use. Hydralazine controls hypertension but does not restore uterine blood flow 18 .…”

Section: Discussionmentioning

confidence: 99%

Unrecognized “crack” cocaine abuse in pregnancy

Campbell

Parr

Shutt

1996

British Journal of Anaesthesia

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SummaryWe report a case of "crack" cocaine abuse in a pregnant patient associated with haematuria, proteinuria, haemolytic anaemia, renal impairment, thrombocytopenia and pulmonary oedema. The case illustrates the problems for clinicians where unrecognized cocaine abuse interferes with the diagnosis and management of a complicated pregnancy. In addition, we discuss the principles for the safe conduct of anaesthesia in the pregnant cocaine abuser. (Br. J. Anaesth. 1996;77:553-555) Key words Anaesthesia, obstetric. Complications, cocaine abuse. Pregnancy."Crack" cocaine abuse in pregnancy is well recognized in the USA. In the UK the level of awareness to this increasingly common problem needs to be improved 1 . This case illustrates the difficulties in differentiating the effects of cocaine abuse from the more usual complications of pregnancy. Cocaine has complex effects on many systems. It was not apparent until post-partum that the patient continued to abuse crack cocaine even while an inpatient. In retrospect the relationship between drug abuse and the course of her illness became clear.Crack cocaine abuse increases maternal morbidity, fetal morbidity and death [2][3][4] . It is likely that maternal crack cocaine abuse will be an increasing problem in the UK and at present the clinical effects may not be fully recognized. Case reportA 32-yr old, gravida 5, para 3, Afro-Caribbean woman presented to her general practitioner for antenatal assessment at 10 weeks' gestation. Her haemoglobin concentration was 10.1 g dl 91 and the blood film showed macrocytosis. Cervical and high vaginal swabs were infected with Gonococcus and Trichomonas. Her infection was treated and she attended again at 19 weeks' gestation when urinalysis showed moderate haematuria and mild proteinuria. Arterial pressure was 120/70 mm Hg.She did not attend again until 31 weeks' gestation when she complained of fatigue and dyspnoea on exercise. On physical examination her conjunctivae were pale, arterial pressure was 125/70 mm Hg and she had bilateral pitting oedema of the ankles. Cardiovascular and respiratory system examinations were otherwise unremarkable. Abdominal examination was consistent with a 31-week pregnancy with normal fetal heart sounds and movements. Urinalysis showed excessive blood and moderate protein. The full blood count result a week later showed haemoglobin 6.8 g dl 91, mean cell volume 110 fl and platelets 63 10 9 litre 91, and therefore hospital admission was arranged.In hospital, physical examination revealed an apical ejection systolic murmur. Deep tendon reflexes were normal. Her blood film showed a reticulocyte count of 4.9%. Serum creatinine concentration was 99 mmol litre 91 , which is high for a pregnant patient. Urea and electrolyte concentrations, liver function tests, uric acid and clotting screen were within normal limits. Autoimmune profile, lupus and platelet antibodies and haemosiderin were within normal limits but haptoglobin concentrations were low at 0.2 g litre 91. The 24-h urine volume was 2125 ml and p...

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Esmolol in the Management of Epinephrine-and Cocaine-Induced Cardiovascular Toxicity

Cited by 34 publications

References 0 publications

Management of Cocaine-Associated Chest Pain and Myocardial Infarction

Management of Cocaine-Associated Chest Pain and Myocardial Infarction

Cardiovascular crisis after small dose local infiltration of epinephrine in patient with asymptomatic subarachnoid hemorrhage -A case report-

Unrecognized “crack” cocaine abuse in pregnancy

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