TAC use and absorption of cocaine in a pediatric emergency department

Fitzmaurice, Laura; Wasserman, Gary S.; Knapp, Jane F.; Roberts, David K.; Waeckerle, Joseph F.; Fox, Mary

doi:10.1016/s0196-0644(05)82180-8

Cited by 34 publications

(7 citation statements)

References 13 publications

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“…Plasma levels of cocaine and its metabolites in adult virgin male and female rats as well as in postpartum females after a 10 mg/kg dose of cocaine are within the range achieved in human use [8,30,31,63,74,77]. They are also similar to levels in children after cutaneous administration of an anesthetic containing 11.76% cocaine [25]. A recent study in young rats reported that cocaine levels after perioral administration were within the range of adult rats after s.c. administration [53,74].…”

Section: Introductionmentioning

confidence: 86%

Behavioral responses during the initial exposures to a low dose of cocaine in late preweanling and adult rats

Smith

Morrell

2008

Neurotoxicology and Teratology

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Human drug experimentation begins during late childhood and early adolescence, a critical time in physical and CNS development, when the immature CNS is vulnerable to the long-term effects of psychoactive drugs. Few preclinical animal studies have investigated responses to such drugs in a developmental stage equivalent to late childhood of humans. We used a rodent model to examine behavioral responses of female Sprague-Dawley late preweanling and adult rats during acute and repeated exposures to a low dose of cocaine. Results show that after cocaine injection, preweanling rats (18-21 days old) have locomotor responses that differ from adults, but after postnatal day 22, the responses are indistinguishable from adults even though rats are still not weaned. Before day 22, locomotor effects of cocaine differ from those in adults in three ways: preweanlings are active for a longer time after cocaine injection at day 18; preweanling activity peaks more rapidly after subcutaneous administration; and after only three injections of cocaine, a tolerance-like pattern is seen in preweanlings whereas an emerging pattern of sensitization to cocaine is seen in adults. The behavioral patterns of this age group offer a preclinical model of the early effects of drugs of abuse.

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Section: Introductionmentioning

confidence: 86%

Behavioral responses during the initial exposures to a low dose of cocaine in late preweanling and adult rats

Smith

Morrell

2008

Neurotoxicology and Teratology

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“…There may be enhanced sedative effects when the highest recommended doses of local anesthetic drugs are used in combination with other sedatives or narcotics (see Tables 2 and 3 for limits and conversion tables of commonly used local anesthetics). 64,[144][145][146][147][148][149][150][151][152][153][154][155][156][157] In general, when administering local anesthetic drugs, the practitioner should aspirate frequently to minimize the likelihood that the needle is in a blood vessel; lower doses should be used when injecting into vascular tissues. 158 …”

Section: Local Anesthetic Agentsmentioning

confidence: 99%

Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: An Update

Coté¹,

Wilson²

2006

Pediatrics

500

150

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The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical supervision; careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications; appropriate fasting for elective procedures and a balance between depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure; a focused airway examination for large tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction; a clear understanding of the pharmacokinetic and pharmacodynamic effects of the medications used for sedation, as well as an appreciation for drug interactions; appropriate training and skills in airway management to allow rescue of the patient; age-and size-appropriate equipment for airway management and venous access; appropriate medications and reversal agents; sufficient numbers of people to carry out the procedure and monitor the patient; appropriate physiologic monitoring during and after the procedure; a properly equipped and staffed recovery area; recovery to presedation level of consciousness before discharge from medical supervision; and appropriate discharge instructions. This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children. INTRODUCTIONInvasive diagnostic and minor surgical procedures on pediatric patients outside the traditional operating room setting have increased in the last decade. As a consequence of this change and the increased awareness of the importance of providing analgesia and anxiolysis, the need for sedation for procedures in physician offices, dental offices, subspecialty procedure suites, imaging facilities, emergency departments, and ambulatory surgery centers has also markedly increased. In recognition of this need for both elective and emergency use of sedation in nontraditional

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“…This was recorded by the treating doctor. While awaiting onset of anaesthesia, patients were closely observed for any previously reported adverse reactions 13–17 . Examples included flushing of skin, urticaria, drowsiness, respiratory depression, dyspnoea, nausea, vomiting, convulsions or cardiac dysrhythmias.…”

Section: Methodsmentioning

confidence: 99%

“…Excess solution may drip onto mucous membranes and this has been implicated in reports of side effects 7 and in one reported death 12 . There is low systemic absorption of cocaine when the solution is confined to the wound and surrounding areas of skin 13,14 . By using a gel we hoped to minimise accidental run‐off and at the same time maintain anaesthetic efficacy.…”

Section: Introductionmentioning

confidence: 99%

Comparison of lignocaine 1% injection and adrenaline‐cocaine gel for local anaesthesia in repair of lacerations

Dart

1998

Emergency Medicine

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ObjectiveTo compare adrenaline-cocaine gel (adrenaline 1:1000 [0.5ml], cocaine 12%[1ml]) with injectable lignocaine 1 % solution in efficacy, side effects and safety, cosmetic and patient acceptability in the repair of dermal lacerations on patients who attend the emergency department. DesignRandomised, prospective, singleblinded clinical trial. SettingRural base hospital emergency department. ParticipantsPatients presenting to the emergency department aged six years and over with dermal lacerations to face, scalp, trunk and limbs, excluding areas below knee or with end-artery blood supply. Those patients with altered mental state were also excluded. InterventionPatients with lacerations were randomly assigned to local anaesthesia with either topical adrenaline-cocaine gel or injection of lignocaine 1 % solution. Patients were then asked to rate the pain on application of either adrenaline-cocaine gel or lignocaine 1% solution. The emergency doctor who performed the local anaesthesia then sutured in the usual way. A blinded observer recorded pain response using verbal and visual indicators. MeasurementNinety patients participated in the trial: 49 randomised to lignocaine 1% solution and 41 to adrenaline-cocaine gel. A total of 924 skin punctures were recorded and measured. ConclusionAdrenaline-cocaine gel compared favourably with lignocaine 1% solution efficacy, side effects and cosmetic results. It was less painful on application than lignocaine 1%. Adrenaline-cocaine gel may be considered as an alternative for anaesthesia in the repair of selected dermal lacerations. 38 Emergency Medicine 1998 • Vol 10Comparison of lignocaine 1 % injection and adrenaline-cocame gel for local anaesthesia m repair of lacerations

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TAC use and absorption of cocaine in a pediatric emergency department

Cited by 34 publications

References 13 publications

Behavioral responses during the initial exposures to a low dose of cocaine in late preweanling and adult rats

Behavioral responses during the initial exposures to a low dose of cocaine in late preweanling and adult rats

Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: An Update

Comparison of lignocaine 1% injection and adrenaline‐cocaine gel for local anaesthesia in repair of lacerations

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