Cocaine Use Is Associated With Adverse Events in Emergency Department Procedural Sedation

Study ObjectivesIn the emergency department (ED), patients commonly require procedural sedation (PS). This is performed in order to minimize the pain and anxiety associated with various diagnostic and therapeutic procedures. There is currently no large scale study which investigates how cocaine affects the incidence of adverse events (AE) in ED PS.Methods2931 consecutive ED PS patients from 2017 – 2021 at 20 hospitals (tertiary care center and 19 affiliate hospitals across 2 states) were reviewed retrospectively. 2275 ED PS were performed on adults (≥ 18 years old), and 656 on pediatric patients (≤ 17 years old). AE were complications: respiratory rate < 8 breaths/min, apnea, systolic blood pressure > 200 mmHg, heart rate < 60 or > 100 beats/min, and SpO2 < 90% plus side effects: emesis, nausea, emergence reaction, paradoxical reaction, itching/rash, cough, myoclonus, hiccups. Adults were divided into cocaine use and non use groups. Cocaine use was defined as recent or current use based on documentation from the ED visit or a recent primary care visit. Data was entered into a Redcap database. Statistical analysis was performed with P < 0.05 statistically significant.Results386 ED PS involved patients who were active drug users at the time of the sedation. Of these, 273 (70.7%) used marijuana, 40 (10.4%) cocaine, 31 (8.0%) heroin, 42 (10.9%) other drugs. Cocaine users had a mean (±SD) age of 44.2 (±13.3) years, BMI 27.4 (±6.5), and 40.0% were male. Non-cocaine users had a mean (±SD) age of 56.8 (±19.2), BMI 29.1 (±6.5) and 46.9% were male. Mean age, BMI and sex were all significantly (p < 0.001) different between cocaine and non-cocaine groups. Cocaine users were younger, had a lower BMI and less likely to be male than nondrug users. In the cocaine use group, 3 patients had a side effect (3/40 = 7.5%), 11 a complication (11/40 = 27.5%), and 0 had both (0/40 = 0%) for a total of 14 with an AE (14/40 = 35.0%). In the non-cocaine use group, 53 patients had a side effect (53/2236 = 2.4%), 324 a complication (324/2236 = 14.5%), and 26 had both (26/2236 = 1.2%) for a total of 403 with an AE (403/2236 = 18.0%). Comparing cocaine users to non-users, cocaine users had a significantly greater risk of complications (p=0.0311) and adverse events (p=0.0026), but not side effects (p=0.1837). The relative risk of a complication was 1.7569 (95% CI 1.0526 to 2.9324) and that of an AE was 1.9419 (95% CI 1.2614 to 2.9897).ConclusionCocaine use places individuals at increased risk for complications and AEs during ED PS, despite users being younger and having lower BMIs than non-users on average. Obtaining a thorough cocaine use history may be beneficial for management involving ED PS and preparing for potential AEs.No, authors do not have interests to disclose Study ObjectivesIn the emergency department (ED), patients commonly require procedural sedation (PS). This is performed in order to minimize the pain and anxiety associated with various diagnostic and therapeutic procedures. There is currently no large scale study which investigates how cocaine affects the incidence of adverse events (AE) in ED PS. In the emergency department (ED), patients commonly require procedural sedation (PS). This is performed in order to minimize the pain and anxiety associated with various diagnostic and therapeutic procedures. There is currently no large scale study which investigates how cocaine affects the incidence of adverse events (AE) in ED PS. Methods2931 consecutive ED PS patients from 2017 – 2021 at 20 hospitals (tertiary care center and 19 affiliate hospitals across 2 states) were reviewed retrospectively. 2275 ED PS were performed on adults (≥ 18 years old), and 656 on pediatric patients (≤ 17 years old). AE were complications: respiratory rate < 8 breaths/min, apnea, systolic blood pressure > 200 mmHg, heart rate < 60 or > 100 beats/min, and SpO2 < 90% plus side effects: emesis, nausea, emergence reaction, paradoxical reaction, itching/rash, cough, myoclonus, hiccups. Adults were divided into cocaine use and non use groups. Cocaine use was defined as recent or current use based on documentation from the ED visit or a recent primary care visit. Data was entered into a Redcap database. Statistical analysis was performed with P < 0.05 statistically significant. 2931 consecutive ED PS patients from 2017 – 2021 at 20 hospitals (tertiary care center and 19 affiliate hospitals across 2 states) were reviewed retrospectively. 2275 ED PS were performed on adults (≥ 18 years old), and 656 on pediatric patients (≤ 17 years old). AE were complications: respiratory rate < 8 breaths/min, apnea, systolic blood pressure > 200 mmHg, heart rate < 60 or > 100 beats/min, and SpO2 < 90% plus side effects: emesis, nausea, emergence reaction, paradoxical reaction, itching/rash, cough, myoclonus, hiccups. Adults were divided into cocaine use and non use groups. Cocaine use was defined as recent or current use based on documentation from the ED visit or a recent primary care visit. Data was entered into a Redcap database. Statistical analysis was performed with P < 0.05 statistically significant. Results386 ED PS involved patients who were active drug users at the time of the sedation. Of these, 273 (70.7%) used marijuana, 40 (10.4%) cocaine, 31 (8.0%) heroin, 42 (10.9%) other drugs. Cocaine users had a mean (±SD) age of 44.2 (±13.3) years, BMI 27.4 (±6.5), and 40.0% were male. Non-cocaine users had a mean (±SD) age of 56.8 (±19.2), BMI 29.1 (±6.5) and 46.9% were male. Mean age, BMI and sex were all significantly (p < 0.001) different between cocaine and non-cocaine groups. Cocaine users were younger, had a lower BMI and less likely to be male than nondrug users. In the cocaine use group, 3 patients had a side effect (3/40 = 7.5%), 11 a complication (11/40 = 27.5%), and 0 had both (0/40 = 0%) for a total of 14 with an AE (14/40 = 35.0%). In the non-cocaine use group, 53 patients had a side effect (53/2236 = 2.4%), 324 a complication (324/2236 = 14.5%), and 26 had both (26/2236 = 1.2%) for a total of 403 with an AE (403/2236 = 18.0%). Comparing cocaine users to non-users, cocaine users had a significantly greater risk of complications (p=0.0311) and adverse events (p=0.0026), but not side effects (p=0.1837). The relative risk of a complication was 1.7569 (95% CI 1.0526 to 2.9324) and that of an AE was 1.9419 (95% CI 1.2614 to 2.9897). 386 ED PS involved patients who were active drug users at the time of the sedation. Of these, 273 (70.7%) used marijuana, 40 (10.4%) cocaine, 31 (8.0%) heroin, 42 (10.9%) other drugs. Cocaine users had a mean (±SD) age of 44.2 (±13.3) years, BMI 27.4 (±6.5), and 40.0% were male. Non-cocaine users had a mean (±SD) age of 56.8 (±19.2), BMI 29.1 (±6.5) and 46.9% were male. Mean age, BMI and sex were all significantly (p < 0.001) different between cocaine and non-cocaine groups. Cocaine users were younger, had a lower BMI and less likely to be male than nondrug users. In the cocaine use group, 3 patients had a side effect (3/40 = 7.5%), 11 a complication (11/40 = 27.5%), and 0 had both (0/40 = 0%) for a total of 14 with an AE (14/40 = 35.0%). In the non-cocaine use group, 53 patients had a side effect (53/2236 = 2.4%), 324 a complication (324/2236 = 14.5%), and 26 had both (26/2236 = 1.2%) for a total of 403 with an AE (403/2236 = 18.0%). Comparing cocaine users to non-users, cocaine users had a significantly greater risk of complications (p=0.0311) and adverse events (p=0.0026), but not side effects (p=0.1837). The relative risk of a complication was 1.7569 (95% CI 1.0526 to 2.9324) and that of an AE was 1.9419 (95% CI 1.2614 to 2.9897). ConclusionCocaine use places individuals at increased risk for complications and AEs during ED PS, despite users being younger and having lower BMIs than non-users on average. Obtaining a thorough cocaine use history may be beneficial for management involving ED PS and preparing for potential AEs.No, authors do not have interests to disclose Cocaine use places individuals at increased risk for complications and AEs during ED PS, despite users being younger and having lower BMIs than non-users on average. Obtaining a thorough cocaine use history may be beneficial for management involving ED PS and preparing for potential AEs.