Should surgery be cancelled when surreptitious cocaine use is discovered before elective non-cardiac surgery?

Answer: Patients presenting for elective non-cardiac surgery requiring general anesthesia who test positive for cocaine but are asymptomatic and clinically nontoxic are at no greater risk for surgical complications than cocaine-free patients. Routine cancellation of surgery for these patients is unwarranted. Such patients need careful preoperative history and physical examination along with screening electrocardiogram (ECG) looking for qT prolongation. Patients who display signs of acute cocaine intoxication or those with a prolonged qT interval will need to have elective surgery delayed. However, there is paucity in literature and no guidelines supporting this practice and clinician practicing perioperative medicine and anesthesia should be vigilant till more prospective studies are done to support this practice.