BMJ 1995;311:1089-1090 (21 October)

Letters

Other aspects of anaesthetic technique may have added to danger

EDITOR,--We take issue with K E A Nicholson and J E G Rogers's conclusions regarding use of the combination of cocaine paste with adrenaline for preparing the nose before nasal surgery.1 We agree that the recommended doses should not be exceeded, but the case for removing adrenaline from the mixture has not been made.

In cases 1 and 2 both children were given premedication of oral atropine, and the endogenous catecholamine concentration would therefore have been high because of anxiety. Anaesthesia was extremely light, and halothane, which predisposes to arrhythmias when used in combination with adrenaline, was used in both cases. The papaveretum given intramuscularly in case 2 would not have been effective at the time of the crisis. Both patients were breathing spontaneously and would have been hypercapnoeic. The insertion of cocaine and adrenaline paste and almost immediate use of instruments in the nose in a patient with high . . . [Full text of this article]


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Relevant Article

Lesson of the Week: Cocaine and adrenaline paste: a fatal combination?
K E A Nicholson and J E G Rogers
BMJ 1995 311: 250-251. [Extract] [Full Text]

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