Alpha2-adrenergic agonists and their role in the prevention of perioperative adverse cardiac events.

Alpha2-adrenergic agonists have been shown to reduce the incidence of perioperative myocardial morbidity and mortality. The purpose of this review article is to summarize the current data pertaining to alpha2-adrenergic agonists and their role in the prevention of perioperative adverse cardiac events. The MEDLINE and Cochrane databases were searched for randomized trials from 1980 to 2006 that assessed perioperative alpha2-agonists and myocardial ischemia, myocardial infarction, and mortality. All recently published studies were reviewed and the data summarized. The currently published randomized controlled trials indicate that alpha2-agonists reduce the incidence of myocardial ischemic episodes in patients with known or suspected coronary artery disease undergoing noncardiac surgery, and clonidine was shown to reduce mortality in noncardiac surgical patients. The authors of the studies concluded that while alpha2-agonists exert beneficial effects on hemodynamics and myocardial protection, large-scale, prospective, controlled trials are still needed.