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

Evidence Summaries

Level of Evidence = C
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).

References

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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