Johns M E, Henderson R L
Trans Sect Otolaryngol Am Acad Ophthalmol Otolaryngol. 1977 Nov-Dec;84(6):969-73.
The unique characteristics of cocaine--anesthesia and vasoconstriction--make it a valuable nasal anesthetic which is a safe topical anesthetic when used properly. The safe dose limit for cocaine used topically in the nose is surely greater than 200 mg, as evidenced by 826 otolaryngologists using greater than 200 mg in their daily practice without ever having experienced a cocaine reaction. Cocaine reactions are not simply dose-dependent, as evidenced by reactions occurring with as little as 10 mg. Fatalities secondary to topical application of cocaine to the nasal mucous membranes are exceedingly rare; only 15 fatalities have been seen in the entire clinical practices of the 2,434 physicians responding in this survey. Establishing 200 mg as the safe limit for cocaine in our literature, althugh it is not based on experimental evidence, is haphazard and carries far-reaching medicolegal implication to 48% of otolaryngologists who use greater than 200 mg of cocaine. A controlled scientific study to elucidate experimental data regarding the toxicity of cocaine in clinically useful doses is urgently needed.
可卡因的独特特性——麻醉和血管收缩作用——使其成为一种有价值的鼻腔麻醉剂，若使用得当，它是一种安全的局部麻醉剂。鼻腔局部使用可卡因的安全剂量限度肯定大于200毫克，826名耳鼻喉科医生在日常实践中使用超过200毫克剂量但从未发生过可卡因反应就证明了这一点。可卡因反应并非简单地取决于剂量，因为低至10毫克时也会发生反应。鼻腔黏膜局部应用可卡因继发的死亡极为罕见；在本次调查中做出回应的2434名医生的全部临床实践中，仅发现15例死亡病例。在我们的文献中将200毫克确定为可卡因的安全限度，尽管并非基于实验证据，但这是随意的，并且对48%使用超过200毫克可卡因的耳鼻喉科医生具有深远的法医学意义。迫切需要进行一项对照科学研究，以阐明关于临床有用剂量可卡因毒性的实验数据。
