Plasma cocaine and tetracaine levels following application of topical anesthesia in children

Terndrup, Thomas E.; Walls, H. Chip; Mariani, Peter J.; Gavula, Denise; Madden, Celeste M; Cantor, Richard M.

doi:10.1016/s0196-0644(05)80152-0

Cited by 46 publications

(17 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The peak concentration observed was well above concentrations (0.1-20.9 mg/1; mean, 6.6 mg/1) reported in human lethal overdose with cocaine [34] although levels fell rapidly to under 5 mg/ml within 5 min. A postmortem concentration of 11.9 mg/1 was found in a 7.5-month-old human infant fol lowing misuse of tetracaine/adrenaline/co- caine (TAC) solution [3], In another study, plasma levels of BE were found to be in the range of 0.04-0.60 mg/liter 20-40 min after topical TAC application in children 1-14 years of age [4], Median serum cocaine levels in children (median age 5 years) of 0.001 mg/1 (range 0-0.112 mg/1) have been reported in samples taken 20 min after TAC application, and mean serum levels of 0.002 mg/1 (range 0-0.274 mg/1) were observed in samples col lected 25 or 40 min later [5], In pregnant macaque monkeys peak maternal and fetal cocaine concentrations were 0.218-0.312 and 0.018-0.067 mg/1, respectively, following 1.0 mg/kg cocaine (i.m.) to the mother [29],…”

Section: Cocaine Pharmacokinetics In Piglets 58mentioning

confidence: 99%

“…This report describes the disposition of a high in travenous dose of cocaine in 11-to 12-day-old piglets. The administration of labetalol (an ctiand ß-noradrenergic antagonist with partial ß2-agonist activity) was used to model an Perinatal cocaine exposure occurs clinical ly [1][2][3][4][5] and through nontherapeutic methods [6][7][8][9][10], Although adverse neurobiological and cerebrovascular effects of prenatal cocaine ex posure in humans and rodents have been reported [11][12][13][14][15], little information exists on the effects of neonatal cocaine exposure on cardiovascular and behavioral development in nonrodent models of human exposure. intervention strategy to manage the hyperten sion and tachycardia produced by cocaine [16,17].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of Labetalol on Cocaine Pharmacokinetics in Neonatal Piglets

et al. 1993

View full text Add to dashboard Cite

Developmental exposure to cocaine can produce adverse neurobehavioral and cardiovascular effects. Few animal models of human neonatal exposure have been established. A pharmacokinetic study was therefore conducted to characterize the disposition of cocaine and a major metabolite benzoylecgonine (BE) using piglets as an animal model. Eight piglets (postnatal days 8-9) were instrumented with a jugular cannula for drug administration and blood sampling. One group of subjects (controls) received 6.0 mg/kg of cocaine-HCl (i.v.) and blood samples were drawn over 0-24 h. In another group (labetalol), 0.25 mg/kg labetalol-HCl was coadministered 15 min following cocaine dosing. Plasma levels of cocaine and BE were determined using GC-MS methods. Pharmacokinetics were evaluated by using a model-independent approach and compartmental modeling. For controls model-independent results were as follows: AUC = 148.9 ± 9.0 mg/1 X min, systemic clearance = 0.041 ± 0.003 liters/min/kg, volume of distribution = 1.543 ± 0.470 liters/kg, and t ½β = 29.4 ± 6.8 min. Cocaine followed two-compartment model kinetics with distribution and elimination half-lives of 0.3 ± 0.1 and 58.0 ± 18.0 min, respectively. Labetalol significantly decreased systemic clearance to 0.029 ± 0.004 liters/min/kg. BE kinetics revealed a elimination half-life of 230.0 ± 83.2 min. The results demonstrate a rapid distribution and metabolism of cocaine to BE followed by a prolonged elimination phase which is extended by labetalol treatment.

show abstract

Section: Cocaine Pharmacokinetics In Piglets 58mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of Labetalol on Cocaine Pharmacokinetics in Neonatal Piglets

et al. 1993

View full text Add to dashboard Cite

show abstract

“…ont en effet montré qu'après application standardisée d'une solution anesthésiante TAC contenant 11,8 % cocaïne, associée à de la tétracaïne 0,5 % et à de l'épinéphrine 0,05 %, pour suturer des plaies chez des enfants de moins de 16 ans, il était retrouvé dans le sérum de 75 % de ces enfants de la cocaïne. La concentration moyenne était de 1 ng/mL et comprise entre 0 et 112 ng/mL pour le premier prélèvement (15 à 30 minutes après l'application) et 2 ng/mL 0-274 ng/mL pour le second (45 à 60 minutes après l'application) [18].…”

Section: La Cocaïneunclassified

Dépression respiratoire après ingestion de méthadone et découverte d’une polyintoxication chronique, ou d’une polytoxicomanie, chez un enfant de 10 ans par une analyse segmentaire des cheveux

et al. 2010

View full text Add to dashboard Cite

Résumé -Un enfant de 10 ans est admis en réanimation pédiatrique après avoir été pris en charge à son domicile par le SAMU dans ses vomissures, cyanosé et bradycarde. Les analyses toxicologiques du sang et des urines à son entrée mettent en évidence la présence de méthadone et de benzodiazépines. Aucune cause toxique n'avait été évoquée lors de son entrée ; des analyses toxicologiques complémentaires sont demandées par le médecin réanimateur. Pour vérifier le caractère « naïf » de ce jeune garçon vis-à-vis de la méthadone, une mèche de cheveux est prélevée. L'analyse segmentaire de cette mèche de 6 cm met en évidence la présence, dans tous les segments, de la cocaïne et ses métabolites, d'opiacés (6-MAM, morphine, codéine, pholcodine), de la méthadone et de son métabolite et des traces non quantifiables de prazépam, nordiazépam et de citalopram. L'interprétation des concentrations dans les cheveux est difficile et sujette à caution. Les deux parents se sont déclarés initialement comme d'anciens toxicomanes suivant uniquement un traitement à domicile de substitution par la méthadone. Ces déclarations ont été mises à mal par l'analyse segmentaire des cheveux. Ils ont reconnu au vu des résultats une consommation quotidienne de cocaïne et d'héroïne sous forme de « fumettes ». De nombreuses études relatent des cas enfants pour lesquels des concentrations plus ou moins importantes de stupéfiants sont retrouvées. Il est toujours difficile de conclure : s'agit-il uniquement de contamination passive ? Par inhalation, par contact cutané, par des objets souillés portés à la bouches ou bien encore une consommation plus ou moins épisodique, accidentelle ou volontaire de ces substances par l'enfant. Mots clés : Polyintoxication, dépression respiratoire, méthadone, cocaïne, cheveuxAbstract -A ten-year old boy, found at home in his vomit, cyanotic with bradycardia, is transferred by the mobile emergency unit of Lille to the paediatric intensive care unit. At the entrance, toxicological analysis of blood and urine showed the presence of methadone and benzodiazepines. The parents gave a history which was essentially uneventful, and there was no indication of drug intake; additional toxicological analysis were requested, using the hair, to confirm or infirm the "naïve" status of the boy. The segmental analysis of a 6-cm lock of hair highlights the regular presence of cocaine and metabolites, opiates (6-monoacetylmorphine, morphine, codeine and pholcodine), methadone and metabolite and traces of prazepam, nordiazepam and citalopram. The interpretation of the concentrations of these substances in hair is difficult and unreliable. The two parents were originally reported as old drug's consumers, and now being participants in a methadone program. These statements are not in agreement with the hair segmental analysis. According to the results, they have recognized a daily consumption of cocaine and heroin by smoking. Numerous studies reported cases where drugs were found in more or less high concentrations in the body fluids and/or hai...

show abstract

“…36,37 However, systemic levels of cocaine have been documented after simple application of TAC soaked-pledgets to an open wound, thus, emphasizing the need for calculating and limiting the dose of cocaine administered. 53 A "safe" dose is not calculated by using the length of a laceration or the age of a patient, but by using the patient's size and the site of administration. Strict limitation of the total dose of each component according to the patient's lean body weight is crucial.…”

Section: Toxic Effectsmentioning

confidence: 99%

“…57 Measurable cocaine levels have been found in 75% of children who received 3.0 mL of standard TAC on nonmucosal lacerations. 53 With the widespread use of this drug combination, physicians must be familiar with the potential toxic effects. 57,58 The vasoconstrictive action of this drug combination also suggests that it should not be applied to areas with limited collateral circulation, such as the penis, fingers, or toes.…”

Section: Toxic Effectsmentioning

confidence: 99%

Alternative Routes of Drug Administration—Advantages and Disadvantages (Subject Review)

Berlin¹,

May-McCarver²,

Notterman³

et al. 1997

Pediatrics

100

View full text Add to dashboard Cite

During the past 20 years, advances in drug formulations and innovative routes of administration have been made. Our understanding of drug transport across tissues has increased. These changes have often resulted in improved patient adherence to the therapeutic regimen and pharmacologic response. The administration of drugs by transdermal or transmucosal routes offers the advantage of being relatively painless.12 Also, the potential for greater flexibility in a variety of clinical situations exists, often precluding the need to establish intravenous access, which is a particular benefit for children. This statement focuses on the advantages and disadvantages of alternative routes of drug administration. Issues of particular importance in the care of pediatric patients, especially factors that could lead to drug-related toxicity or adverse responses, are emphasized.

show abstract

Plasma cocaine and tetracaine levels following application of topical anesthesia in children

Cited by 46 publications

References 18 publications

Effects of Labetalol on Cocaine Pharmacokinetics in Neonatal Piglets

Effects of Labetalol on Cocaine Pharmacokinetics in Neonatal Piglets

Dépression respiratoire après ingestion de méthadone et découverte d’une polyintoxication chronique, ou d’une polytoxicomanie, chez un enfant de 10 ans par une analyse segmentaire des cheveux

Alternative Routes of Drug Administration—Advantages and Disadvantages (Subject Review)

Contact Info

Product

Resources

About