Cocaine Use and General Anesthesia: A Prospective Study of Cardiovascular Effects

BACKGROUND: Cocaine usage in surgical patients is a concern for many hospitals. In large urban hospitals, up to 1.0% of elective surgical patients and 38% of major trauma victims may test positive for cocaine preoperatively. Previous retrospective studies have shown that cocaine positive surgical patients do NOT have an increase in adverse hemodynamic events, length of stay, or mortality compared to cocaine negative controls. However, prospective studies evaluating the impact of recent cocaine use on intraoperative hemodynamics plus inflammatory and cardiac biomarkers have not been undertaken. HYPOTHESIS: This study will test the hypothesis that patients who have 1) a preoperative toxicity screen that demonstrates recent cocaine use, are 2) undergoing non-emergent surgery with general anesthesia, and 3) have normal vital signs will NOT experience an increased incidence of adverse perioperative cardiovascular events compared to similar control patients with a negative toxicity screen. METHODS: This prospective study stratifies patients into cocaine positive and cocaine negative cohorts. Cocaine positive patients were non-toxic with positive urine toxicology, while cocaine negative patients were defined as having used cocaine in the past year with negative urine toxicology. Anesthesia protocol was standardized. The primary outcomes measured were intraoperative hemodynamics and vasoactive medications, with a secondary outcome of pre- vs. post-operative troponin levels. DATA: Preliminary outcome analysis of cocaine positive (N = 59) and cocaine negative patients (N = 40) are shown in the table below: Primary Hemodynamic Outcomes as Percentage of Anesthesia Duration Hemodynamic Events Cocaine Negative Cocaine Positive MAP <55 or >110 mmHG 1.8 1.4 HR <50 or >100 BPM 3.2 2.7 Perioperative Change in Troponin T No Change 95.0% 100.0% Decrease 2.5% 0.0% Increase 2.5% 0.0% CONCLUSION: The data supports the idea that positive cocaine urine toxicology tests in non-toxic individuals are not associated with increased cardiovascular instability or troponin elevation. Thus, automatic cancellation of these patients may not be warranted. Further analysis of the full study cohort (N = 300) will be completed at the end of 2017.