Lesson of the Week: Cocaine and adrenaline paste: a fatal combination?

Combination is still widely used

“…I agree with K E A Nicholson and J E G Rogers1 that nasal surgery is rarely life saving and that a heightened awareness of the possible complications and interactions of the drugs being given is to be encouraged.…”

“…EDITOR,--The use of cocaine and adrenaline paste is a controversial issue among otolaryngologists 1. In 1991 the British Association of Otolaryngologists—Head and Neck Surgeons surveyed all consultant surgeons who were members and found that 63.5% used cocaine without adrenaline, 19.5% used cocaine and adrenaline, and 17% used cocaine with and without adrenaline 2.…”

A Lesson Confirmed

“…The Lesson of the Week “Cocaine and adrenaline paste: a fatal combination” calls to mind my own experience of this combination of drugs being used intranasally 1. In the early 1970s the neurosurgeon with whom I worked, the late Mr Huw Griffith, adopted the transnasal approach for hypophysectomy.…”

A novel method of application of cocaine to the nasal mucosa for use in endoscopic sinus surgery

“…A number of reports exist in the medical literature concerning the myocardial complications of cocaine when used as a preparation for routine surgery [5, 61. These include ventricular tachycardia, myocardial infarction and ventricular fibrillation with death. It is not clear from these reports whether the dose of cocaine was greater than recommended, but another report [7] detailed the cases of three patients who had twice the recommended dosage of cocaine applied to their nasal mucosa in the form of 25% cocaine paste with 0.18% adrenaline. Two children in this report went into ventricular fibrillation but both were successfully converted to sinus rhythm.…”