Alpha-2 adrenergic agonists may decrease mortality and myocardial infarction (MI) during vascular surgery. These potential benefits are counterbalanced by increased risks for perioperative hypotension and bradycardia.
A Cochrane review 1 included 31 studies with a total of 4,578 subjects. Overall, α-2 adrenergic (clonidine, dexmedetomidine, or mivazerol) agonists reduced mortality (RR 0.66; 95% CI 0.44 to 0.98; P = 0.04) and myocardial ischaemia (RR 0.68; 95% CI 0.57 to 0.81; P < 0.0001). However, their effects appeared to vary with the surgical procedure. The most encouraging data pertained to vascular surgery, where they reduced mortality (RR 0.47; 95% CI 0.25 to 0.90; P = 0.02), cardiac mortality (RR 0.36; 95% CI 0.16 to 0.79; P = 0.01), and myocardial infarction (RR 0.66; 95% CI 0.46 to 0.94; P = 0.02). With regard to adverse effects, α-2 adrenergic agonists significantly increased perioperative hypotension (RR 1.32; 95% CI 1.07 to 1.62; P = 0.009) and bradycardia (RR 1.66; 95% CI 1.14 to 2.41; P = 0.008).
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment and blinding).
1. Wijeysundera DN, Bender JS, Beattie WS. Alpha-2 adrenergic agonists for the prevention of cardiac complications among patients undergoing surgery. Cochrane Database Syst Rev 2009 Oct 7;(4):CD004126. [PMID:19821319]
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"Alpha-2 Adrenergic Agonists for the Prevention of Cardiac Complications Among Patients Undergoing Surgery." Evidence-Based Medicine Guidelines, Duodecim Medical Publications Limited, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/EBMG/453087/all/Alpha_2_adrenergic_agonists_for_the_prevention_of_cardiac_complications_among_patients_undergoing_surgery.
Alpha-2 adrenergic agonists for the prevention of cardiac complications among patients undergoing surgery. Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. https://evidence.unboundmedicine.com/evidence/view/EBMG/453087/all/Alpha_2_adrenergic_agonists_for_the_prevention_of_cardiac_complications_among_patients_undergoing_surgery. Accessed October 18, 2019.
Alpha-2 adrenergic agonists for the prevention of cardiac complications among patients undergoing surgery. (2019). In Evidence-Based Medicine Guidelines. Available from https://evidence.unboundmedicine.com/evidence/view/EBMG/453087/all/Alpha_2_adrenergic_agonists_for_the_prevention_of_cardiac_complications_among_patients_undergoing_surgery
Alpha-2 Adrenergic Agonists for the Prevention of Cardiac Complications Among Patients Undergoing Surgery [Internet]. In: Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. [cited 2019 October 18]. Available from: https://evidence.unboundmedicine.com/evidence/view/EBMG/453087/all/Alpha_2_adrenergic_agonists_for_the_prevention_of_cardiac_complications_among_patients_undergoing_surgery.
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