Hypothesis: To assess whether patients who test positive for cocaine but have a normal electrocardiogram and vital signs have a greater percentage of hemodynamic events intraoperatively.
Methods:
328 patients who had a history of cocaine use in the past 5 years were analyzed over a 20 month period.
Inclusion criteria included patients who were ASA I-III, age 18-70, had a normal preop EKG and vital signs, and were scheduled for elective surgery with general anesthesia and endotracheal intubation.
Multiple exclusion criteria included high-risk surgery and a history of cardiovascular, cerebrovascular, or renal disease.
Results: The percentage of patients with a MAP of <65 or >105 mmHg and/or a heart rate of <50 or >100 bpm was equivalent between the cocaine-positive and the cocaine-negative groups.
Strengths:
Power calculations were appropriate for primary outcomes
The anesthetic plan was standardized
Topic is very clinically relevant
A wide range of surgical procedures were included in the study
Weaknesses:
Single center, unblinded study
Significant percentage of possible subjects declined to participate
Exclusion of other medical comorbidities
Not specific on how high or low extremes were for patient vitals
The sample size was not large enough to power secondary outcomes
Key Point: A positive urine toxicology test for cocaine may not be an absolute contraindication to surgery if the patient has a normal EKG, normal vital signs, and is asymptomatic.