Cocaine toxicity and isoflurane anesthesia: Hemodynamic, myocardial metabolic, and regional blood flow effects in swine
Journal of Cardiothoracic and Vascular AnesthesiaPublished 1 October 1996
John F. Boylan, Davy Cheng, Alan N. Sandler, F. J. Carmichael, Gideon Koren, Christopher Feindel
Citations23
SJR quartileQ2
SJR score0.68
SNIP0.91
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Abstract
Moderately toxic cocaine levels occurring during isoflurane at 0.75 MAC and 1.5 MAC are associated with hemodynamic abnormalities, a marked increase in systemic vascular resistance, and a tendency to produce cardiac arrhythmias. A reversal of endo/epicardial myocardial perfusion ratio occurs associated with cocaine infusion during ISO anesthesia. This is probably not related to a primary redistribution of subendocardial blood flow and may be related to a combination of increased myocardial oxygen demand and epicardial coronary vasoconstriction. The reductions in cerebral and spinal cord perfusion observed may explain, in part, the neurologic sequelae of cocaine toxicity.
Keywords
MedicinePharmacology, Toxicology and Pharmaceutics
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The observations support the hypothesis that coronary vasospasm plays an important role in cocaine-related ischemic syndromes, as cocaine users frequently develop silent myocardial ischemia manifesting as episodes of ST elevation during the first weeks of withdrawal.
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It is concluded that under conditions of this study, administration of topical cocaine does not exert any clinically significant sympathomimetic effect and appears to be well tolerated in anesthetized patients with coronary artery disease.
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