PMID- 32304462
OWN - NLM
STAT- MEDLINE
DCOM- 20210216
LR  - 20210216
IS  - 1526-7598 (Electronic)
IS  - 0003-2999 (Linking)
VI  - 132
IP  - 2
DP  - 2021 Feb 1
TI  - A Positive Cocaine Urine Toxicology Test and the Effect on Intraoperative 
      Hemodynamics Under General Anesthesia.
PG  - 308-316
LID - 10.1213/ANE.0000000000004808 [doi]
AB  - BACKGROUND: Cocaine has a short biological half-life, but inactive urine 
      metabolites may be detectable for a week following use. It is unclear if patients 
      who test positive for cocaine but have a normal electrocardiogram and vital signs 
      have a greater percentage of hemodynamic events intraoperatively. METHODS: A 
      total of 328 patients with a history of cocaine use who were scheduled for 
      elective noncardiac surgery under general anesthesia were enrolled. Patients were 
      categorized into cocaine-positive versus cocaine-negative groups based on the 
      results of their urine cocaine toxicology test. The primary aim of this study was 
      to evaluate whether asymptomatic cocaine-positive patients had similar 
      percentages of intraoperative hemodynamic events, defined as (1) a mean arterial 
      blood pressure (MAP) of <65 or >105 mm Hg and (2) a heart rate (HR) of <50 or 
      >100 beats per minute (bpm) compared to cocaine-negative patients. The study was 
      powered to assess if the 2 groups had an equivalent mean percent of 
      intraoperative hemodynamic events within specific limits using an equivalence 
      test of means consisting of 2 one-sided tests. RESULTS: The cocaine-positive 
      group had a blood pressure (BP) that was outside the set limits 19.4% (standard 
      deviation [SD] 17.7%) of the time versus 23.1% (SD 17.7%) in the cocaine-negative 
      group (95% confidence interval [CI], 0.5-7.0). The cocaine-positive group had a 
      HR outside the set limits 9.6% (SD 16.2%) of the time versus 8.2% (SD 14.9%) in 
      the cocaine-negative group (95% CI, 4.3-1.5). Adjusted for age, sex, body mass 
      index (BMI), smoking status, and the presence of comorbid hypertension, renal 
      disease, and psychiatric illness, the cocaine-positive and cocaine-negative 
      patients were similar within a 7.5% margin of equivalence for MAP data (beta 
      coefficient = 2%, P = .003, CI, 2-6) and within a 5% margin of equivalence for HR 
      data (beta coefficient = 0.2%, P < .001, CI, 4-3). CONCLUSIONS: Asymptomatic 
      cocaine-positive patients undergoing elective noncardiac surgery under general 
      anesthesia have similar percentages of intraoperative hemodynamic events compared 
      to cocaine-negative patients.
CI  - Copyright (c) 2020 International Anesthesia Research Society.
FAU - Moon, Tiffany S
AU  - Moon TS
AD  - From the Department of Anesthesiology and Pain Management, University of Texas 
      Southwestern Medical Center, Dallas, Texas.
FAU - Pak, Taylor J
AU  - Pak TJ
FAU - Kim, Agnes
AU  - Kim A
FAU - Gonzales, Michael X
AU  - Gonzales MX
FAU - Volnov, Yuri
AU  - Volnov Y
FAU - Wright, Evan
AU  - Wright E
FAU - Vu, Kevin Q
AU  - Vu KQ
FAU - Lu, Rachael D
AU  - Lu RD
FAU - Sharifi, Arghavan
AU  - Sharifi A
FAU - Minhajuddin, Abu
AU  - Minhajuddin A
FAU - Chen, Joy L
AU  - Chen JL
FAU - Fox, Pamela E
AU  - Fox PE
FAU - Gasanova, Irina
AU  - Gasanova I
FAU - Fox, Amanda A
AU  - Fox AA
FAU - Stewart, Jesse
AU  - Stewart J
FAU - Ogunnaike, Babatunde
AU  - Ogunnaike B
LA  - eng
SI  - ClinicalTrials.gov/NCT02692534
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Anesth Analg
JT  - Anesthesia and analgesia
JID - 1310650
RN  - 0 (Biomarkers)
RN  - I5Y540LHVR (Cocaine)
SB  - IM
CIN - Anesth Analg. 2021 Feb 1;132(2):305-307. PMID: 33449554
MH  - Adult
MH  - *Anesthesia, General/adverse effects
MH  - Arterial Pressure
MH  - Biomarkers/urine
MH  - Cocaine/*urine
MH  - Cocaine-Related Disorders/*diagnosis/physiopathology/urine
MH  - Elective Surgical Procedures
MH  - Female
MH  - Heart Rate
MH  - *Hemodynamics
MH  - Humans
MH  - Intraoperative Period
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Risk Factors
MH  - *Substance Abuse Detection
MH  - Time Factors
MH  - Urinalysis
COIS- The authors declare no conflicts of interest.
EDAT- 2020/04/19 06:00
MHDA- 2021/02/17 06:00
CRDT- 2020/04/19 06:00
PHST- 2020/04/19 06:00 [pubmed]
PHST- 2021/02/17 06:00 [medline]
PHST- 2020/04/19 06:00 [entrez]
AID - 00000539-202102000-00004 [pii]
AID - 10.1213/ANE.0000000000004808 [doi]
PST - ppublish
SO  - Anesth Analg. 2021 Feb 1;132(2):308-316. doi: 10.1213/ANE.0000000000004808.