Which substance must be monitored before surgery due to its stimulant properties that can lead to severe tachycardia?

Cocaine is known for its potent stimulant properties, which can lead to significant cardiovascular effects, including severe tachycardia. The drug acts by inhibiting the reuptake of norepinephrine, dopamine, and serotonin, leading to increased sympathetic activity. This heightened sympathetic tone can precipitate a range of cardiovascular complications, making it critical to monitor its levels prior to surgery.

In surgical patients, the risk of perioperative cardiac events is elevated in those who use cocaine due to the potential for increased heart rate and blood pressure, which can complicate anesthesia management and recovery. Understanding a patient's substance use history, particularly with stimulants like cocaine, is crucial for preoperative assessment and planning.

While amphetamines also possess stimulant properties and can impact cardiovascular function, the context of cocaine’s acute effects and commonality in recreational use often lead to it being more closely monitored in a preoperative setting. Nicotine and alcohol are typically addressed differently in surgical protocols, focusing on withdrawal management and other health impacts rather than immediate cardiovascular stimulatory effects characteristic of cocaine.