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
Marco Ghignone, MD, FRCPC
West Palm Beach, FL
- 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.
- 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.
- 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.
- Nishina K, Mikawa K, Uesugi T, et al. Efficacy of clonidine for prevention of perioperative myocardial ischemia. Anesthesiology 2002;96:323-9.
- Wijeysundera DN, Naik JS, Beattie S. Alpha-2 adrenergic agonists to prevent cardiovascular complications. Am J Med 2003;114:742-52.
- Goldman L. Evidence-based perioperative risk reduction. Am J Med 2003;114:763-4.