Cocaine Pharmacology

Abstract

Abstract Cocaine came into Western medicine as the first local anesthetic, unique due to its combined properties of local anesthesia with intense vasoconstriction. Today in modern medicine, cocaine can be used as a topical intranasal anesthetic agent for sinus surgery or, less commonly, for awake intubation in a 4% solution. It is an illicit drug originating from the leaves of the erthryoxylon coca plant that is both harmful and dangerous to the human body due to its toxic abilities and highly addictive properties. This effect can carry over to the perioperative period, creating a potentially challenging anesthetic scenario due to the numerous physiologic effects of cocaine. In addition to local anesthetic effects, cocaine has both peripheral and centrally acting sympathomimetic actions. This chapter discusses the pharmacologic and physiologic effects of cocaine while considering the anesthetic implications.