Alpha-2 Agonists May Also Impact Outcome

Luc Quintin, MD, PhD; Marco Ghignone, MD, FRCPC

To the Editor

Meiler et al. are to be commended for reviewing the effect of beta-blockers, statins, and “depth” of anesthesia on long-term morbidity following surgery.1 In addition to these interventions, following the introduction of alpha-2 agonists in human anesthesia,2 several large-scale trials or meta-analyses suggested that alpha-2 agonists decrease myocardial ischemia/infarction or mortality following cardiovascular surgery.3-5 A recent editorial6 stated that the “53% reduction in overall mortality [is] actually. . . more impressive than what has been found in the pooled beta-blocker studies.” Given the simplicity of oral administration of clonidine 2-6 µg/kg, clinicians should consider this intervention, with appropriate reduction in anesthetic doses and volume loading in coronary/ hypertensive patients presenting for major cardiovascular surgery.2 The above-mentioned editorial added that investigators should add alpha-2 agonists to the array of drugs under trial to further reduce mortality following surgery.6

Luc Quintin, MD, PhD
Lyon, France
Marco Ghignone, MD, FRCPC
West Palm Beach, FL

References

  1. Meiler SE, Monk TG, Mayfield JB, Head CA. Can we alter long-term outcome ? The role of anesthetic management and the inflammatory response. APSF Newsletter 2003;18:33-7.
  2. Ghignone M, Quintin L, Duke PC, et al. Effects of clonidine on narcotic requirements and hemodynamic response during induction of fentanyl anesthesia and endotracheal intubation. Anesthesiology 1986;64:36-42.
  3. Oliver MF, Goldman L, Julian DG, Holme I. Effect of mivazerol on perioperative cardiac complications during non-cardiac surgery in patients with coronary disease. Anesthesiology 1999;91:951-61.
  4. Nishina K, Mikawa K, Uesugi T, et al. Efficacy of clonidine for prevention of perioperative myocardial ischemia. Anesthesiology 2002;96:323-9.
  5. Wijeysundera DN, Naik JS, Beattie S. Alpha-2 adrenergic agonists to prevent cardiovascular complications. Am J Med 2003;114:742-52.
  6. Goldman L. Evidence-based perioperative risk reduction. Am J Med 2003;114:763-4.