A Positive Cocaine Urine Toxicology Test and the Effect on Intraoperative Hemodynamics Under General Anesthesia

• Published in: Anesthesia and analgesia Vol. 132; no. 2; pp. 308 - 316
• Main Authors: Moon, Tiffany S., Pak, Taylor J., Kim, Agnes, Gonzales, Michael X., Volnov, Yuri, Wright, Evan, Vu, Kevin Q., Lu, Rachael D., Sharifi, Arghavan, Minhajuddin, Abu, Chen, Joy L., Fox, Pamela E., Gasanova, Irina, Fox, Amanda A., Stewart, Jesse, Ogunnaike, Babatunde
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkin 01.02.2021; International Anesthesia Research Society
• Subjects: Adult; Anesthesia, General - adverse effects; Arterial Pressure; Biomarkers - urine; Cocaine - urine; Cocaine-Related Disorders - diagnosis; Cocaine-Related Disorders - physiopathology; Cocaine-Related Disorders - urine; Elective Surgical Procedures; Female; Heart Rate; Hemodynamics; Humans; Intraoperative Period; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Risk Factors; Substance Abuse Detection; Time Factors; Urinalysis
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/ANE.0000000000004808

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 (β coefficient = 2%, P = .003, CI, 2–6) and within a 5% margin of equivalence for HR data (βcoefficient = 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.