Cocaine Use and Outcomes of General Anesthesia
| Status: | Completed |
|---|---|
| Conditions: | Hospital |
| Therapuetic Areas: | Other |
| Healthy: | No |
| Age Range: | 18 - 70 |
| Updated: | 8/16/2018 |
| Start Date: | April 2016 |
| End Date: | February 2018 |
Cocaine Use and General Anesthesia: A Prospective Study of Cardiovascular and Anesthetic Effects
In this prospective study, investigators plan to evaluate the outcome of general anesthesia
in the context of patients with a positive cocaine urine test. Patients with a positive urine
cocaine test who do not appear acutely toxic and have normal vital signs may not have an
increased rate of perioperative complications during elective surgery compared to similar
patients with negative urine cocaine screening tests. Patients who are chronic cocaine users
may have a higher anesthetic requirement.
in the context of patients with a positive cocaine urine test. Patients with a positive urine
cocaine test who do not appear acutely toxic and have normal vital signs may not have an
increased rate of perioperative complications during elective surgery compared to similar
patients with negative urine cocaine screening tests. Patients who are chronic cocaine users
may have a higher anesthetic requirement.
Patients with a history of cocaine abuse in the past year who are scheduled to undergo
surgery at Parkland Hospital will be asked to provide a urine sample for a screening
toxicology test on the day of surgery. Patients will also be asked to fill out a
questionnaire with questions pertaining to their drug use history. The remaining aspects of
perioperative care, including the general anesthetic technique, will be standardized for all
patients and will not differ from the standard of care. The anesthesia faculty, resident, or
CRNA will identify patients and obtain consent and ask the patient to fill out the
questionnaire. This prospective study is intended to enroll 300 cocaine positive and negative
patients over a 2 year period.
Blood samples will be collected for analysis of cardiac troponin T (cTnT) both before surgery
and again postoperatively.
Subjects will be followed for adverse intraoperative cardiovascular events that are defined
in two ways: 1) Proportion of total anesthesia duration that mean arterial pressure (MAP) <65
or >110 and 2) Proportion of total anesthesia duration that heart rate (HR) < 50 or >100.
Adverse postoperative cardiovascular events will be defined in two ways: 1) Increase in the
postoperative troponin value compared to the patient's baseline preoperative troponin value
and 2) Postoperative myocardial infarction, stroke, or death.
surgery at Parkland Hospital will be asked to provide a urine sample for a screening
toxicology test on the day of surgery. Patients will also be asked to fill out a
questionnaire with questions pertaining to their drug use history. The remaining aspects of
perioperative care, including the general anesthetic technique, will be standardized for all
patients and will not differ from the standard of care. The anesthesia faculty, resident, or
CRNA will identify patients and obtain consent and ask the patient to fill out the
questionnaire. This prospective study is intended to enroll 300 cocaine positive and negative
patients over a 2 year period.
Blood samples will be collected for analysis of cardiac troponin T (cTnT) both before surgery
and again postoperatively.
Subjects will be followed for adverse intraoperative cardiovascular events that are defined
in two ways: 1) Proportion of total anesthesia duration that mean arterial pressure (MAP) <65
or >110 and 2) Proportion of total anesthesia duration that heart rate (HR) < 50 or >100.
Adverse postoperative cardiovascular events will be defined in two ways: 1) Increase in the
postoperative troponin value compared to the patient's baseline preoperative troponin value
and 2) Postoperative myocardial infarction, stroke, or death.
Inclusion Criteria:
- 18-70 years old
- ASA physical status classification 1 to 3
- Personal history of cocaine abuse in the last year
- Scheduled for a non-emergent operation that requires general anesthesia
- Vital signs within generally accepted ranges for normal [HR 60-100, RR 12-20, SpO2 >
96% on room air, BP 90-140/60-90 unless a diagnosis of hypertension is present, T
36-38 degrees)
- Willing and able to consent in English or with use of appropriate language translator
Exclusion Criteria:
- Age less than 18 or older than 70
- Unable to give informed consent for participation in the study
- Patient refusal
- Monitored anesthesia care (MAC) or regional anesthesia planned
- Pregnant or nursing women
- Emergent surgery (designated with an E on the end of the ASA status)
- Patient on other illicit drugs except marijuana (e.g., amphetamine)
- Acute cocaine intoxication based on clinical symptomatology (hypertension,
tachycardia, agitation, delirium, hyperthermia)
- History of cardiac disease including coronary artery disease (CAD) and cardiac
dysrhythmia
- History of stroke
- History of seizure disorder
- On dialysis
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