Medical use of cocaine and perioperative morbidity following sinonasal surgery—A population study

Abstract

Background Topical cocaine is favoured by many surgeons for sinonasal surgery due to its superior vasoconstrictive and anesthetic properties. However, historical reports suggesting cocaine is associated with an increased risk of cardiac events have led many surgeons to turn to alternative topical medications. The objective of this study was to determine whether cocaine use during sinonasal surgery is associated with an increased risk of perioperative cardiac events and death. Methods We conducted a population-based analysis of patients undergoing sinonasal surgery from 2009-2016 using linked administrative health care data sets in Ontario, Canada. We compared patients treated at institutions that primarily use topical cocaine (exposed group) to those treated at institutions that do not use cocaine (unexposed group). Our primary outcome was a composite of major cardiac events or all-cause mortality within 48 hours of surgery. Due to low event rates, the outcome was compared using a Fisher's exact test. Results Of 10,549 patients who were included in the study, 27.4% were treated at an institution that uses topical cocaine. The rate of the composite of perioperative major cardiac event or allcause mortality within 48 hours of surgery in the exposed and unexposed groups was, �0.2% and 0 (p-value>0.05), respectively. Conclusions In this large real-world cohort of patients undergoing sinonasal surgery, there does not appear to be any significant increased risk of morbidity or mortality associated with cocaine use. These findings have important implications for surgeons performing this procedure.

Drug Design Strategies, Modes of Action, Synthesis and Industrial Challenges Behind Trifluoromethylated New Chemical Entities

“…is an analog of Terifl unomide (16) which contains a cyclopropyl moiety instead of a methyl group, as depicted in fi gure 2. Lafl unimos is still in the Phase IIa trial to evaluate the effi cacy in subjects with peripheral post-surgical neuropathic pain [53].…”

“…Terifl unomide: Terifl unomide (16), commercially available under the tradename AUBAGIO ® by Sanofi , [81] is a once-daily oral immunomodulatory Disease-Modifying Therapy (DMT) presently approved in several regions, including Europe, North America, Latin America and Australia, for the treatment of Relapsing Forms of Multiple Sclerosis (RMS; RRMS). The therapeutic mode of action of Terifl unomide in Multiple Sclerosis (MS) continues to be investigated [82].…”

“…It is also used to treat medical conditions [15]. Besides being favored by many surgeons for sinonasal surgery due to its superior vasoconstrictive and anesthetic properties, historical reports suggested cocaine was associated with an increased risk of cardiac events [16]. For this reason, cocaine was modifi ed structurally to produce other anesthetic drugs with diff erent properties such as procaine [17], tetracaine [18] and lidocaine [19].…”

Perioperative Considerations for Patients Exposed to Psychostimulants

“…26 Outside of cultural, ancestral, and traditional uses, cocaine has a legitimate medical use in otolaryngological surgeries as a combined vasoconstrictor and local anesthetic and does not specifically elevate the risk of cardiac complications during these procedures. 27,28 Outside of this limited scope and other traditional uses, it is seen as a substance of abuse. 14 Cocaine has a dual mechanism-as a local anesthetic due to sodium channel blockade, while its stimulant properties result primarily because of its effects as a presynaptic reuptake inhibitor of monoamines, including epinephrine, norepinephrine, serotonin, and dopamine.…”

“…26 Outside of cultural, ancestral, and traditional uses, cocaine has a legitimate medical use in otolaryngological surgeries as a combined vasoconstrictor and local anesthetic and does not specifically elevate the risk of cardiac complications during these procedures. 27,28 Outside of this limited scope and other traditional uses, it is seen as a substance of abuse. 14…”