Recent cocaine use and the incidence of hemodynamic events during general anesthesia: A retrospective cohort study

Moon, Tiffany S.; Gonzales, Michael X.; Sun, Joshua; Kim, Agnes; Fox, Pamela E.; Minhajuddin, Abu; Pak, Taylor; Ogunnaike, Babatunde

doi:10.1016/j.jclinane.2018.12.028

Cited by 13 publications

(9 citation statements)

References 14 publications

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“…17 For example, acute cocaine intoxication increases blood pressure, but chronic cocaine use followed by abstinence increases the need for blood pressure support during anesthesia. 18 Our current study highlights the possible impact of prior, but nonacute, cannabis exposure on blood pressure perturbations during anesthetic FIG. 1.…”

Section: Discussionmentioning

confidence: 66%

Cannabis Exposure Decreases Need for Blood Pressure Support During General Anesthesia in Orthopedic Trauma Surgery

Yeung

Michael

Scolaro

et al. 2022

Cannabis and Cannabinoid Research

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Introduction: As cannabis use continues to increase in popularity, it is important to investigate how it impacts public health in all sectors of the population, including patients undergoing anesthetic management. This retrospective study focuses on the orthopedic trauma population presenting through an emergency department (ED) and receiving a urine drug screen (UDS) with subsequent urgent surgical intervention. We aimed to evaluate differences in response to general anesthesia in patients with exposure to THC, a major cannabinoid, compared to controls that screened negative for THC. Materials and Methods: All ED visits at UC Irvine, a level 1 trauma center between November 4, 2017 and January 7, 2020, were evaluated in this study. Only adult patients who received a UDS and underwent urgent orthopedic trauma surgery within 48 h of ED visit were included in this study. Additional inclusion criteria required an anesthesia time greater than 1 h as well as anesthesia induction and intubation while in the operating room. Overall, we analyzed a total of 221 adult patients. Discussion: When adjusting for demographic variability, there were statistically significant differences in response to general anesthesia between these two groups. The THC-positive (THC( + )) group was less likely to receive intraoperative vasopressors, had higher mean arterial blood pressure and mean diastolic blood pressure, needed less total fluid input and had a lower overall fluid balance. Chronic exposure to THC has been shown to downregulate cannabinoid 1 receptors and cause alterations in endocannabinoid tone. These are two potential mechanisms by which the THC( + ) group in our study may have become more resistant to the typically observed hypotensive effects of general anesthesia. Conclusion:The present study suggests that prior use of cannabis, objectively assessed by urinalysis, results in a decreased need for blood pressure support during general anesthesia. The physiological basis for this phenomenon is unclear, but possible causes might include the downregulation of vascular cannabinoid receptor 1 and/or altered endocannabinoid levels after exposure to cannabis.

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Section: Discussionmentioning

confidence: 66%

Cannabis Exposure Decreases Need for Blood Pressure Support During General Anesthesia in Orthopedic Trauma Surgery

Yeung

Michael

Scolaro

et al. 2022

Cannabis and Cannabinoid Research

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“…Although cumulatively there were more reported periprocedural adverse events in patients with active cocaine use compared to patients with remote cocaine use undergoing endoscopy, the primary result of this study was that ultimately this difference was statistically insignificant. Moreover, the statistically significant differences in preprocedural and postprocedural hemodynamics both within and across groups were, much like in the Baxter et al [ 13 ] study, not deemed clinically significant[ 14 ]. There was no reported mortality in any of the groups.…”

Section: Discussionmentioning

confidence: 93%

“…Baxter and Alexandrov[ 13 ] showed statistically significantly higher baseline systolic pressure, mean arterial pressure, and heart rate differences in the cocaine-positive cohort, but ultimately these were not deemed clinically significant values. More recently, Moon et al [ 14 ] determined that cocaine positive patients did not demonstrate significantly different medication requirements as compared to cocaine-negative patients.…”

Section: Introductionmentioning

confidence: 99%

Safety of upper endoscopy in patients with active cocaine use

Cartelle

Nguyen

Desai

et al. 2021

WJGE

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BACKGROUND Cocaine is a synthetic alkaloid initially viewed as a useful local anesthetic, but which eventually fell out of favor given its high addiction potential. Its predominantly sympathetic effects raise concern for cardiovascular, respiratory, and central nervous system complications in patients undergoing procedures. Peri-procedural cocaine use, often detected via a positive urine toxicology test, has been mostly addressed in the surgical and obstetrical literature. However, there are no clear guidelines on how to effectively risk stratify patients found to be positive for cocaine in the pre-operative setting, often leading to costly procedure cancellations. Within the field of gastroenterology, there is no current data available regarding safety of performing esophagogastroduodenoscopy (EGD) in patients with recent cocaine use. AIM To compare the prevalence of EGD related complications between active (≤ 5 d) and remote (> 5 d) users of cocaine. METHODS In total , 48 patients who underwent an EGD at John H. Stroger, Jr. Hospital of Cook County from October 2016 to October 2018 were found to have a positive urine drug screen for cocaine (23 recent and 25 remote). Descriptive statistics were compiled for patient demographics. Statistical tests used to analyze patient characteristics, procedure details, and preprocedural adverse events included t -test, chi-square, Wilcoxon rank sum, and Fisher exact test. RESULTS Overall, 20 periprocedural events were recorded with no statistically significant difference in distribution between the two groups (12 active vs 8 remote, P = 0.09). Pre- and post-procedure hemodynamics demonstrated only a statistically, but not clinically significant drop in systolic blood pressure and increase in heart rate in the active user group, as well as drop in diastolic blood pressure and oxygen saturation in the remote group ( P < 0.05). There were no significant differences in overall hemodynamics between both groups. CONCLUSION Our study found no significant difference in the rate of periprocedural adverse events during EGD in patients with recent vs remote use of cocaine. Interestingly, there were significantly more patients (30%) with active use of cocaine that required general anesthesia as compared to remote users (0%).

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“… 13–16 This is further validated by recent studies examining the incidence of hemodynamic events under anesthesia to be similar between patients who screen positive for stimulants and patients who have a negative UDS, with the rates of vasopressor use during surgery similar between both groups. 17–19 …”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15][16] This is further validated by recent studies examining the incidence of hemodynamic events under anesthesia to be similar between patients who screen positive for stimulants and patients who have a negative UDS, with the rates of vasopressor use during surgery similar between both groups. [17][18][19] It can be difficult to separate the effects of acute and chronic stimulant use. While we do not know the duration of substance use for each patient, 28.6% and 31.6% of the amphetamine and cocaine group, respectively, in our population had a documented history of chronic substance use.…”

Section: Discussionmentioning

confidence: 99%

Urine drug screen positive for cocaine and amphetamine is not an adverse risk factor for cardiovascular morbidity or mortality in trauma

Satish

Freeman

Culhane

2021

Trauma Surg Acute Care Open

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BackgroundUrine drug screening (UDS) is a component of trauma workup and of perioperative risk evaluation. Illicit stimulant use has been associated with cardiovascular complications. This study investigates the impact of stimulant use and its interaction with surgery on cardiovascular complications in trauma patients.MethodsPatients were identified from the 2017 National Trauma Data Bank. Univariate and multivariate analyses were used to evaluate the effect of amphetamine and cocaine on mortality, myocardial infarction (MI), and stroke. We evaluated three subsets: all screened patients, those who underwent surgery, and those whose surgery was immediate. Significance was tested with χ2 test for categorical variables, Student’s t-test for continuous variables, and logistic regression for multivariate analysis.Results317 688 (32.1%) patients underwent UDS. Multivariate analysis showed protective association between cocaine and mortality OR 0.9 (p=0.028). Cocaine was a non-significant predictor of MI and stroke: OR 0.63 (p=0.065) and 0.91 (p=0.502), respectively. Amphetamine was a non-significant predictor of mortality, MI, and stroke: OR 0.97 (p=0.405), 0.80 (p=0.283), and 1.02 (p=0.857), respectively.On univariate analysis, amphetamine showed a protective association with MI for all screened patients: relative risk (RR) 0.58 (p=0.005), and for surgical patients: RR 0.58 (p=0.019). Amphetamine showed a protective association with mortality for all three subsets: RR 0.83 (p<0.001), 0.78 (p<0.001), and 0.71 (p<0.001), respectively. Cocaine showed a protective association with MI for all screened patients: RR 0.45 (p=0.001), and for surgical patients: RR 0.44 (p=0.005). Cocaine showed a protective association with mortality for all three subsets: RR 0.76 (p<0.001), 0.71 (p<0.001), and 0.63 (p<0.001), respectively.DiscussionUDS positive for cocaine or amphetamine is not an adverse risk factor in trauma, including trauma patients who underwent surgery. The apparent protective effects of illicit drugs warrant further investigation.Level of evidenceTherapeutic/care management, level IV.

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Recent cocaine use and the incidence of hemodynamic events during general anesthesia: A retrospective cohort study

Cited by 13 publications

References 14 publications

Cannabis Exposure Decreases Need for Blood Pressure Support During General Anesthesia in Orthopedic Trauma Surgery

Cannabis Exposure Decreases Need for Blood Pressure Support During General Anesthesia in Orthopedic Trauma Surgery

Safety of upper endoscopy in patients with active cocaine use

Urine drug screen positive for cocaine and amphetamine is not an adverse risk factor for cardiovascular morbidity or mortality in trauma

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