INTRAOPERATIVE PULMONARY-EDEMA IN A YOUNG COCAINE SMOKER

This is a case of a 28-yr-old man who underwent general anaesthesia fo r emergency repair of a right lid laceration and lacrimal apparatus. F ollowing induction of anaesthesia and local nasal application of pheny lephrine (0.25%) he developed transient elevation of brood pressure, w hich was treated immediately with labetalol. Subsequently the patient developed acute pulmonary oedema which responded to treatment with mor phine and furosemide. The diagnosis of pulmonary oedema was confirmed by blood gas studies chest x-ray and serial echocardiograms. Subsequen t investigation revealed that he was a cocaine user, as the urine rest ed positive for cocaine. Considering that the patient was young and ot herwise healthy and that the hypertension was transient, it is unlikel y that phenylephrine was the main cause of pulmonary oedema. Cardiac m orbidity was most likely precipitated by the interaction of phenylephr ine-induced hypertension with a cocaine-depressed myocardium.