This letter is in response to a case reported in the Archives by Ashchi et al1 titled, "Cardiac Complication From Use of Cocaine and Phenylephrine in Nasal Septoplasty." They describe a previously healthy young woman who had an acute myocardial infarction after receiving topical cocaine and phenylephrine during nasal septoplasty. They concluded that although cocaine and phenylephrine are widely used drugs, physicians must have a "heightened awareness" of the potential serious complications associated with these agents. Their report contains no discussion about alternative drugs that can be used for nasal procedures.
We have an interest in this very topic and have been involved in clinical studies that compare the anesthetic effects of various local anesthetic mixtures.2-4 In the first published study,2 cocaine was compared with a mixture of lidocaine and oxymetazoline. Both agents were found to be equally effective anesthetics. In this same study, nasal septal blood
Noorily SH, Noorily AD. Cocaine and Phenylephrine. Arch Otolaryngol Head Neck Surg. 1996;122(2):207-208. doi:10.1001/archotol.1996.01890140091024