Case Report

Acute Myocardial Infarction Following the Use of Intranasal Anesthetic Cocaine

Authors: John N. Makaryus, MD, Amgad N. Makaryus, MD, Michelle Johnson, MD

Abstract

The use of cocaine has become largely obsolete in modern medical practice; however, it is still used by otolaryngologists for topical anesthesia in head and neck surgeries. We present the case of a 68-year-old woman who developed a myocardial infarction after the use of topical cocaine during nasal sinus surgery, and review the literature regarding the use of cocaine as a topical anesthetic in otolaryngologic practice. Awareness is raised of a possible complication of myocardial infarction following topical cocaine anesthetic use.


Key Points


* The initial use of pure cocaine in anesthesia was in the 1880s as a topical agent in eye, nose, and throat surgeries because of its ability to provide anesthesia as well as to constrict blood vessels and limit bleeding.


* Although the medical use of cocaine has now for the most part become obsolete, it is still widely used by otolaryngologists for topical anesthesia in head and neck surgeries.


* The wide use of topical cocaine as a local anesthetic for otolaryngologic procedures necessitates the realization of the adverse effects of this agent.


* Although evidence documenting the cardiovascular toxicity of cocaine is noted in the pharmacologic literature, clinical cardiac injury has been emphasized to date only with the recreational use of cocaine. The risk of myocardial infarction with the use of intranasal cocaine must be realized, especially in patients with either a history of coronary disease or with risk factors for coronary disease.

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