Myocardial Infarction With Topical Cocaine Anesthesia for Nasal Surgery

Pharmacological Interactions of Epinephrine at Concentrations Used in Dental Anesthesiology: An Updated Narrative Review

“…Although there are many reports of serious, even fatal, complications from the combined use of cocaine and epinephrine, only one animal study [ 50 ] has examined low-dose epinephrine, suggesting that normal vascular reactivity may recover with continued exposure to cocaine, similar to what is seen with tricyclic antidepressants. Another study [ 87 ], using higher doses of epinephrine, found that the combined administration of epinephrine and 200 mg of cocaine did not significantly alter average blood pressure or heart rate and concluded that epinephrine is safe and effective when added to cocaine for nasal use, provided that cocaine doses do not exceed 200 mg. Additionally, one case report [ 88 ] described a pharmacologic interaction between high epinephrine dose and 2 mL of cocaine used as a combined local anesthetic, in which the patient experienced mild myocardial ischemia, presenting as intense chest tightness. Based on these findings, it appears that the co-administration of controlled doses of cocaine and epinephrine may not necessarily result in severe complications, particularly in cases of localized or medically supervised use.…”

Chest pain in the recovery room, following topical intranasal cocaine solution use

“…Cocaine’s toxic effects when used illicitly are well known, but cardiotoxicity from therapeutic use in nasal surgery is relatively rare. A search of the literature reveals only eight case reports of significant cardiotoxicity 2–6 10–12. These are mostly due to myocardial ischaemia, ranging from non-ST elevation myocardial infarction to ST elevation myocardial infarction with or without cardiogenic shock 2–6 10 12.…”

“…A search of the literature reveals only eight case reports of significant cardiotoxicity 2–6 10–12. These are mostly due to myocardial ischaemia, ranging from non-ST elevation myocardial infarction to ST elevation myocardial infarction with or without cardiogenic shock 2–6 10 12. There is also a case reported of ventricular fibrillation associated with topical cocaine solution 11…”

Management of prolonged epistaxis in pregnancy: case report

“…The surgical field and visualisation in endoscopic sinus surgery can be improved with the use of Moffat's solution (a variable mixture of adrenaline and cocaine), which produces a relatively bloodless field. However, cocaine can be systemically absorbed, 13 and has been documented to cause ventricular tachycardia, myocardial infarction and death 14 . It also has the potential to reduce uterine blood flow, 15 and its use may have devastating consequences for both mother and fetus.…”