Perioperative adverse events attributed to α2-adrenoceptor agonists in patients not at risk of cardiovascular events: systematic review and meta-analysis
| Autor: | Migena Demiri, Tiago Antunes, Valeria Martinez, Dominique Fletcher |
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| Přispěvatelé: | Physiopathologie et Pharmacologie Clinique de la Douleur (LPPD), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ) |
| Rok vydání: | 2019 |
| Předmět: |
Bradycardia
[SDV]Life Sciences [q-bio] Clonidine 03 medical and health sciences Postoperative Complications 0302 clinical medicine 030202 anesthesiology Tachycardia Adrenergic alpha-2 Receptor Agonists medicine Humans General anaesthesia Dexmedetomidine Intraoperative Complications Adverse effect business.industry Perioperative 3. Good health Clinical trial Anesthesiology and Pain Medicine Systematic review Anesthesia Preoperative Period Hypotension medicine.symptom business medicine.drug |
| Zdroj: | British Journal of Anaesthesia British Journal of Anaesthesia, Oxford University Press (OUP), 2019, 123, pp.795-807. ⟨10.1016/j.bja.2019.07.029⟩ |
| ISSN: | 0007-0912 1471-6771 |
| DOI: | 10.1016/j.bja.2019.07.029 |
| Popis: | Background Several systematic reviews have reported the benefits of perioperative α2-adrenoceptor agonist use for various conditions, but safety evidence is poorly documented. Methods We performed a systematic review focusing on adverse events. We searched the MEDLINE, Embase, LILACS, Cochrane, and Clinical Trials Register databases for RCTs comparing the effects of α2-adrenoceptor agonists and placebo during non-cardiovascular surgery under general anaesthesia, for any indication, in patients not at risk of cardiovascular events. The primary outcome was the incidence of severe adverse events during or after α2-adrenoceptor agonist administration. The secondary endpoints were other adverse events. A meta-analysis was carried out on the combined data. Evidence quality was rated by the Grading of Recommendations Assessment, Development and Evaluation method. Results We included 56 studies (4868 patients). Our review, based on moderate-quality evidence, revealed that hypotension occurred frequently during the preoperative and postoperative periods, for both clonidine and dexmedetomidine. Bradycardia was reported only with dexmedetomidine. In contrast, dexmedetomidine seemed to protect against intraoperative hypertension and tachycardia. Subgroup analysis suggested that the risk of hypotension and bradycardia persisted after cessation of treatment. Interestingly, intraoperative hypotension and postoperative bradycardia were not observed with a bolus dosage of dexmedetomidine less than 0.5 μg kg−1 or with continuous administration alone. Conclusions Pooled data for the incidence of adverse events associated with use of α2-adrenoceptor agonists in various perioperative contexts provide high-confidence evidence for a risk of hypotension and bradycardia, and protective effects against hypertension and tachycardia. Protocol registration CRD42017071583. |
| Databáze: | OpenAIRE |
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