Alpha-2 adrenergic agonists for the prevention of cardiac complications among patients undergoing cardiac surgery

Evidence Summaries

Level of Evidence = B
Alpha-2 adrenergic agonists appear to have no effect on the risk of mortality and myocardial infarction (MI) during cardiac surgery. They appear to increase the risk of bradycardia.

A Cochrane review 1 included 47 studies with a total of 17,039 subjects. 24 trials (n=2672) included participants undergoing cardiac surgery. Overall, α-2 adrenergic (clonidine, dexmedetomidine, or mivazerol) agonists appeared to have no effect on the risk of mortality or myocardial infarction, but they appeared to increase the risk of bradycardia when compared to placebo. The quality of evidence was inadequate to draw conclusions regarding the effects of α-2 agonists on stroke or hypotension during cardiac surgery.

SOF table (licence required) https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004126.pub3/fu...

Comment: The quality of evidence is downgraded by imprecise results (wide confidence intervals).

References

1. Duncan D, Sankar A, Beattie WS et al. Alpha-2 adrenergic agonists for the prevention of cardiac complications among adults undergoing surgery. Cochrane Database Syst Rev 2018;(3):CD004126.  [PMID:29509957]


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