Cardiac Complication From Use of Cocaine and Phenylephrine in Nasal Septoplasty

Cocaine hydrochloride is widely used as a topical anesthetic for otolaryngologic surgery. Cardiovascular complications, including myocardial injury, are well-documented side effects of illicit cocaine use. We describe a 23-year-old woman without coronary artery disease who had an acute non—Q-wave myocardial infarction and stunned myocardium after receiving topical phenylephrine hydrochloride and cocaine anesthesia for elective nasal septoplasty. These cases are rare; however, we hope to heighten the awareness of the potential lethal complications of using cocaine, phenylephrine, or the combination of both as topical anesthetics in otolaryngologic practice. (Arch Otolaryngol Head Neck Surg. 1995;121:681-684)