April 11, 1980

Is Cocaine a Sympathetic Stimulant During General Anesthesia?

Author Affiliations

From the Department of Anesthesiology (Drs Barash and Kopriva), the Department of Medicine (Drs Langou and Stahl), the Department of Psychiatry (Drs VanDyke and Byck), and the Department of Laboratory Medicine (Dr Jatlow), Yale University School of Medicine, New Haven, Conn.

JAMA. 1980;243(14):1437-1439. doi:10.1001/jama.1980.03300400021021

Eighteen patients undergoing coronary artery surgery were observed to examine whether cocaine in a clinically used dose exerts sympathomimetic effects during general anesthesia. Eleven patients received cocaine hydrochloride as a 10% solution (1.5 mg/kg) applied topically to the nasal mucosa before nasotracheal intubation. Seven patients had a similar procedure without cocaine. Blood pressure, pulse rate, cardiac index, left ventricular stroke work index, total peripheral vascular resistance, and pulmonary vascular resistance were measured. There were no important differences in cardiovascular function between patient groups. The rapid rise in plasma cocaine concentration, reaching 331 ng/mL at 30 minutes and 320 ng/mL at 45 minutes, bore no apparent relationship to any changes in cardiovascular function. We conclude that under conditions of this study, administration of topical cocaine does not exert any clinically significant sympathomimetic effect and appears to be well tolerated in anesthetized patients with coronary artery disease.

(JAMA 243:1437-1439, 1980)