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'Cocaine Mud'

Edward N. Willey, MD
JAMA. 1977;238(17):1813. doi:10.1001/jama.1977.03280180017014.
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To the Editor.—  In a recent case tried in the Circuit Court of the Second Judicial Circuit in and for Leon County, Florida (file No. 75-934), judgement was brought for the plaintiff.The case for plaintiff as supported by two pharmacologists, two anesthesiologists, and a pathologist was that death during septoplasty was caused by topical "cocaine mud" and injected local lidocaine anesthesia with excessive concentration of epinephrine with additional cardiac sensitization to catecholamines by halogenated hydrocarbon general anesthesia and by hypoxia and hypercarbia.The adverse potentiative effects of combined cocaine epinephrine have been known for many years.1 Current textbooks of pharmacology and otolaryngology2,3 and recent articles4-6 warn against the concurrent use of cocaine with epinephrine. A representative warning states, "dry cocaine powder is moistened with epinephrine solution to form so-called cocaine mud for use on the nasal mucosa. In view of the dangerous potentiative interaction between cocaine


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