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The cocaine abusing parturient: a review of anesthetic considerations

[L’abus de cocaïne chez les parturientes : une revue des aspects anesthésiques]

From the Departments of Anesthesiology and Reproductive Medicine, University of California San Diego, San Diego, California, USA.

Address corresponcence to: Dr. Krzysztof M. Kuczkowski, Department of Anesthesiology, UCSD Medical Center, 200 W. Arbor Drive, San Diego, CA 92103-8770, USA. Phone: 619-543-5720; Fax: 619-543-5424; E-mail: kkuczkowski{at}ucsd.edu

Purpose: The prevalence of recreational drug abuse among young women, including in pregnancy, has increased markedly over the past two decades. Cocaine remains the drug commonly used for recreational purposes in pregnancy. However, there appears to be an absence of uniform guidelines for obstetric and anesthetic management of pregnant patients with a history of cocaine abuse.

Source: A Medline search for articles highlighting drug abuse in pregnancy, with particular emphasis on cocaine abuse in pregnancy, the drug’s impact on the fetus and implications for administration of obstetrical anesthesia was performed.

Main findings: Because the pharmacological actions of cocaine are complex, the clinical picture can be very unpredictable, the diagnosis often difficult, and management at times controversial. The diverse clinical symptomatology of cocaine intake combined with physiologic changes of pregnancy, and pathophysiology of co-existing pregnancy specific disease may lead to life-threatening complications and significantly impact the management of obstetrical anesthesia.

Conclusions: In the absence of uniform anesthetic guidelines for pregnant patients with a history of cocaine abuse the decision regarding the administration of peripartum analgesia or anesthesia should be individualized and conducted on a case-by-case basis. This article will attempt to heighten the awareness of cocaine use and abuse in pregnancy and review the perioperative anesthetic management of these high-risk parturients.

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