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February 1987

Topical Cocaine Nasal Anesthesia-Reply

Arch Otolaryngol Head Neck Surg. 1987;113(2):211. doi:10.1001/archotol.1987.01860020103027

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In Reply.—We were very pleased to see the response by Dr Gordon, pertaining to our article entitled "Myocardial Infarction With Topical Cocaine Anesthesia for Nasal Surgery." Interference by cocaine with the reuptake of norepinephrine at the adrenergic nerve terminals increases the level of circulating catecholamines and sensitizes the target organs to the effects of sympathetic stimulation. Alpha- and/or β-adrenergic blockade, to counteract such an effect, will certainly be very useful in many instances, as happened in Dr Gordon's experience. We believe, however, that when an impending myocardial ischemic event is to be averted quickly, nitroglycerin would still be an important agent to consider for protection of the ischemic myocardium. Myocardial ischemia, whether imposed by coronary vasoconstriction or precipitated by increased oxygen demand on vessels with preexisting atherosclerosis, should be rapidly reversed to avoid irreversible injury. This would be even more important in elderly patients. Certainly the rise in blood pressure

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