The use of cocaine as an anesthetic in lacrimal surgery.
We investigated if the results of routine urine drug screening for cocaine metabolites would be positive after dacryocystorhinostomy. Postoperative urine specimens were analyzed for the presence of benzoylecgonine, the major metabolite of cocaine, using the Syva Emit assay with an inhouse cutoff of 50 ng/mL. Confirmation of the presence of benzoylecgonine was performed by liquid-liquid extraction using 5.0 mL of urine that was derivatized with iodobutane (Aldrich), followed by gas chromatographic/mass spectrometric (GC/MS) analysis using selective ion monitoring. The GC/MS assay had a limit of detection of 12.0 ng/mL and a limit of quantitation of 24.0 ng/mL benzoylecgonine. The results of urine tests of all 12 patients were positive for cocaine 24 hours postoperatively, nine (75%) were positive 48 hours postoperatively, and three (33%) had detectable levels 72 hours after surgery. Patients given cocaine at the time of lacrimal surgery should be warned that they may test positive for cocaine for at least three days postoperatively.
Patrinely
J R
JR
Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX 77030.
Cruz
O A
OA
Reyna
G S
GS
King
J W
JW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002675:Child, Preschool; D003042:Cocaine / Q000031:analogs & derivatives / Q000652:urine*; D003608:Dacryocystorhinostomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015813:Substance Abuse Detection
C005618:benzoylecgonine; D003042:Cocaine