Clinical use of cocaine.
A review of the risks and benefits
by
Middleton RM, Kirkpatrick MB
US Air Force Medical Center Keesler,
Keesler Air Force Base, Mississippi.
Drug Saf 1993 Sep; 9(3):212-7
ABSTRACT
Following the isolation of cocaine from the extract of coca leaves in the
late 1700s by Albert Neiman, the local anaesthetic properties of the drug have
been evaluated. The anaesthetic effect of cocaine is believed to be the result
of reversible blockade of nervous impulse conduction by the prevention of sodium
ion movement within the cell membrane. The many undesired effects, however, are
the result of adrenergic stimulation by means of prevention of noradrenaline
(norepinephrine) uptake. The clinical use of cocaine in the modern era is
associated primarily with surgical procedures involving the manipulation of
mucous membranes, particularly those of the upper respiratory tract. Recently,
based on problems with the potential for illicit use and adverse effects,
alternative regimens have been investigated. In some settings these have been
superior to cocaine. Further studies comparing various anaesthetic regimens are
warranted.
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