Abstract：
BACKGROUND: Cocaine may be applied to decongest the nasal mucosa before nasotracheal intubation, but patients risk a criminal offence if cocaine is detected when patients drive a car shortly after surgery. We aimed to evaluate whether benzoylecgonine levels in saliva exceeded the cut-off point 24 h after administration in patients undergoing nasotracheal intubation and whether cocaine would be detectable above the Danish legal fixed limit in blood samples 1 and 24 h after surgery.
METHODS: We conducted a prospective study following approval from the local research ethics committee and the national medicine agency. Written informed consent was obtained from all patients. We included patients scheduled for surgery under general anaesthesia with nasotracheal intubation. They received 80 mg cocaine as a nasal spray 5 min before induction and nasotracheal intubation. The primary outcome was a dichotomous assessment of benzoylecgonine levels in saliva samples measured 24 h after administration of nasal cocaine with a cut-off limit of 200 ng/mL. Secondary outcomes were dichotomous assessments of cocaine in whole blood samples measured 1 and 24 h after administration of nasal cocaine with a cut-off limit of 0.01 mg/kg.
RESULTS: Overall, 70 patients had valid saliva samples and 75 had valid blood samples 24 h after cocaine administration. Benzoylecgonine in saliva was traceable above the cut-off in 9/70 patients (13%; CI95%: 6% to 23%), and cocaine in blood was detected above the cut-off in 2/75 patients (3%; CI95%: 0.3% to 9%).
CONCLUSIONS: We found benzoylecgonine traceable in saliva in 13% of patients and cocaine traceable in blood in 3% of patients 24 h after administration of 80 mg nasal cocaine. Patients should be informed when receiving cocaine and advised not to drive for at least 24 h.
METHODS: We conducted a prospective study following approval from the local research ethics committee and the national medicine agency. Written informed consent was obtained from all patients. We included patients scheduled for surgery under general anaesthesia with nasotracheal intubation. They received 80 mg cocaine as a nasal spray 5 min before induction and nasotracheal intubation. The primary outcome was a dichotomous assessment of benzoylecgonine levels in saliva samples measured 24 h after administration of nasal cocaine with a cut-off limit of 200 ng/mL. Secondary outcomes were dichotomous assessments of cocaine in whole blood samples measured 1 and 24 h after administration of nasal cocaine with a cut-off limit of 0.01 mg/kg.
RESULTS: Overall, 70 patients had valid saliva samples and 75 had valid blood samples 24 h after cocaine administration. Benzoylecgonine in saliva was traceable above the cut-off in 9/70 patients (13%; CI95%: 6% to 23%), and cocaine in blood was detected above the cut-off in 2/75 patients (3%; CI95%: 0.3% to 9%).
CONCLUSIONS: We found benzoylecgonine traceable in saliva in 13% of patients and cocaine traceable in blood in 3% of patients 24 h after administration of 80 mg nasal cocaine. Patients should be informed when receiving cocaine and advised not to drive for at least 24 h.
摘要：
背景：可卡因可用于在经鼻气管插管前消除鼻粘膜充血，但是，如果患者在手术后不久驾驶汽车时发现可卡因，患者将面临刑事犯罪。我们旨在评估经鼻气管插管的患者在给药后24小时唾液中的苯甲酰基野果宁水平是否超过临界点，以及在手术后1和24小时的血液样本中是否可以检测到可卡因高于丹麦法定固定限值。
方法：我们在当地研究伦理委员会和国家医药机构批准后进行了一项前瞻性研究。从所有患者获得书面知情同意书。我们纳入了计划在全身麻醉下经鼻气管插管手术的患者。在诱导和经鼻气管插管前5分钟，他们接受了80毫克可卡因作为鼻喷雾剂。主要结果是对鼻用可卡因给药后24小时测量的唾液样品中的苯甲酰芽子碱水平进行二分法评估，临界值为200ng/mL。次要结果是在给予鼻用可卡因后1和24小时测量的全血样品中可卡因的二分评估，其截止极限为0.01mg/kg。
结果：总体而言，可卡因给药后24小时，70例患者有有效唾液样本，75例患者有有效血液样本。在9/70的患者中，唾液中的苯甲酰孕激素可追溯到超过临界值（13％；CI95％：6％至23％），在2/75例患者中，血液中的可卡因检测到超过临界值（3％；CI95％：0.3％至9％）。
结论：我们发现，在服用80毫克鼻用可卡因24小时后，13%的患者唾液中可追踪到苯甲酰野果碱，3%的患者血液中可追踪到可卡因。接受可卡因时应告知患者，并建议至少24小时内不要开车。
方法：我们在当地研究伦理委员会和国家医药机构批准后进行了一项前瞻性研究。从所有患者获得书面知情同意书。我们纳入了计划在全身麻醉下经鼻气管插管手术的患者。在诱导和经鼻气管插管前5分钟，他们接受了80毫克可卡因作为鼻喷雾剂。主要结果是对鼻用可卡因给药后24小时测量的唾液样品中的苯甲酰芽子碱水平进行二分法评估，临界值为200ng/mL。次要结果是在给予鼻用可卡因后1和24小时测量的全血样品中可卡因的二分评估，其截止极限为0.01mg/kg。
结果：总体而言，可卡因给药后24小时，70例患者有有效唾液样本，75例患者有有效血液样本。在9/70的患者中，唾液中的苯甲酰孕激素可追溯到超过临界值（13％；CI95％：6％至23％），在2/75例患者中，血液中的可卡因检测到超过临界值（3％；CI95％：0.3％至9％）。
结论：我们发现，在服用80毫克鼻用可卡因24小时后，13%的患者唾液中可追踪到苯甲酰野果碱，3%的患者血液中可追踪到可卡因。接受可卡因时应告知患者，并建议至少24小时内不要开车。
