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Could Clonidine Contribute to a Reduction in Perioperative Mortality?

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Reducing Mortality in the Perioperative Period

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Abstract

A known antihypertensive medication, clonidine, has recently entered use in the perioperative setting under the premise of controlling the catecholamine-mediated postoperative stress response. Surgical trauma, inadequate control of pain [1], bleeding [2], hypovolemia, hypothermia [3, 4], and shivering all activate sympathetic tone and are associated with perioperative myocardial ischemia, a situation worsened in individuals with decreased coronary blood flow reserve. Left untreated, this may result in myocardial infarction (MI).

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References

  1. Mangano DT, Siliciano D, Hollenberg M et al (1992) Postoperative myocardial ischemia therapeutic trials using intensive analgesia following surgery. Anesthesiology 76:343–353

    Article  Google Scholar 

  2. Nelson AH, Fleisher LA, Rosenbaum SH (1993) Relationship between postoperative anaemia and cardiac morbidity in high-risk vascular patients in the intensive care unit. Crit Care Med 21:860–866

    Article  PubMed  CAS  Google Scholar 

  3. Frank S, Beattie C, Christopherson R et al (1993) Unintentional hypothermia is associated with postoperative myocardial ischemia. The perioperative ischemia randomized anesthesia trial study group. Anesthesiology 78:468–476

    Article  PubMed  CAS  Google Scholar 

  4. Frank S, Fleisher L, Breslow M et al (1997) Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA 277:1127–1134

    Article  PubMed  CAS  Google Scholar 

  5. Mangano DT (1990) Perioperative cardiac morbidity. Anesthesiology 72:153–184

    Article  PubMed  CAS  Google Scholar 

  6. Landesberg G (2003) The pathophysiology of perioperative myocardial infarction: facts and perspectives. J Cardiothorac Vasc Anesth 17:90–100

    Article  PubMed  Google Scholar 

  7. Priebe H-J (2005) Perioperative myocardial infarction—aetiology and prevention. Br J Anaesth 95:3–19

    Article  PubMed  Google Scholar 

  8. Grayburn PA, Hillis LD (2003) Cardiac events in patients undergoing noncardiac surgery: shifting the paradigm from noninvasive risk stratification to therapy. Ann Intern Med 138:506–551

    Article  PubMed  Google Scholar 

  9. Auerbach A, Goldman L (2006) Assessing and reducing cardiac risk of noncardiac surgery. Circulation 113:1361–1376

    Article  PubMed  Google Scholar 

  10. Ellis JE, Drijvers G, Pedlow S et al (1994) Premedication with oral and transdermal clonidine provides safe and efficacious postoperative sympatholysis. Anesth Analg 79:1133–1140

    Article  PubMed  CAS  Google Scholar 

  11. Muzi M, Goff DR, Kampine JP et al (1992) Clonidine reduces sympathetic activity but maintains baroreflex responses in normotensive humans. Anesthesiology 77:864–871

    Article  PubMed  CAS  Google Scholar 

  12. Dorman T, Clarkson K, Rosenfeld BA et al (1997) Effects of clonidine on prolonged postoperative sympathetic response. Crit Care Med 25:1147–1152

    Article  PubMed  CAS  Google Scholar 

  13. Wallace AW, Galindez D, Salahieh A et al (2004) Effect of clonidine on cardiovascular morbidity and mortality after noncardiac surgery. Anesthesiology 101:284–293

    Article  PubMed  CAS  Google Scholar 

  14. Stevens RD, Burri H, Tramer MR (2003) Pharmacologic myocardial protection in patients undergoing noncardiac surgery: a quantitative systematic review. Anesth Analg 97:623–633

    Article  PubMed  Google Scholar 

  15. Wijeysundera DN, Naik JS, Beattie WS (2003) Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complications: a meta-analysis. Am J Med 114:742–752

    Article  PubMed  CAS  Google Scholar 

  16. Wijeysundera DN, Bender JS, Beattie WS (2009) Alpha-2 adrenergic agonists for the prevention of cardiac complications among patients undergoing surgery. Cochrane Database Syst Rev CD:004126

    Google Scholar 

  17. Stuhmeier KD, Mainzer B, Cierpka J et al (1996) Small oral dose of clonidine reduces the incidence of intraoperative myocardial ischemia in patients having vascular surgery. Anesthesiology 85:706–712

    Article  PubMed  CAS  Google Scholar 

  18. Dorman BH, Zucker JR, Verrier ED et al (1993) Clonidine improves perioperative myocardial ischemia, reduces anesthetic requirement, and alters hemodynamic parameters in patients undergoing coronary artery bypass surgery. J Cardiothorac Vasc Anesth 7:386–395

    Article  PubMed  CAS  Google Scholar 

  19. Nishina K, Mikawa K, Uesugi T et al (2002) Efficacy of clonidine for prevention of perioperative myocardial ischemia. A critical appraisal and meta-analysis of the literature. Anesthesiology 96:323–329

    Article  PubMed  CAS  Google Scholar 

  20. Mangano DT, Browner WS, Hollenberg M et al (1990) Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The study of perioperative ischemia research group. N Engl J Med 323:1781–1788

    Article  PubMed  CAS  Google Scholar 

  21. Devereaux PJ, Yusuf S (2003) The evolution of the randomized controlled trial and its role in evidence-based decision making. J Intern Med 254:105–113

    Article  PubMed  CAS  Google Scholar 

  22. Oliver MF, Goldman L, Julian DG et al (1999) Effect of mivazerol on perioperative cardiac complications during non-cardiac surgery in patients with coronary heart disease: the Eur Mivazerol Trial (EMIT). Anesthesiology 91:951–961

    Article  PubMed  CAS  Google Scholar 

  23. Fleisher LA, Beckman JA, Brown KA et al (2007) ACC/AHA 2007 guidelines on perioperative cardiovascular care and care for noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation 116:1971–1996

    Article  PubMed  Google Scholar 

  24. Poldermans D, Bax JJ, Boersma E et al (2009) Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery: the task force for preoperative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA). Eur Heart J 3027:69–2812

    Google Scholar 

  25. Blaudszun G, Lysakowski C, Elia N et al (2012) Effect of perioperative systemic α2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. Anesthesiology 116:1312–1322

    Article  PubMed  CAS  Google Scholar 

  26. Kranke P, Eberhart LH, Roewer N et al (2002) Pharmacological treatment of postoperative shivering: a quantitative systematic review of randomized controlled trials. Anesth Analg 94:453–460

    PubMed  CAS  Google Scholar 

  27. Quintin L, Viale JP, Annat G et al (1991) Oxygen uptake after major abdominal surgery: effect of clonidine. Anesthesiology 74:236–241

    Article  PubMed  CAS  Google Scholar 

  28. Wu CT, Jao SW, Borel CO et al (2004) The effect of epidural clonidine on perioperative cytokine response, postoperative pain, and bowel function in patients undergoing colorectal surgery. Anesth Analg 99:502–509

    Article  PubMed  CAS  Google Scholar 

  29. Nader ND, Ignatowski TA, Kurek CJ et al (2001) Clonidine suppresses plasma and cerebrospinal fluid concentrations of TNFα during the perioperative period. Anesth Analg 93:363–369

    PubMed  CAS  Google Scholar 

  30. Toon S, Hopkins KJ, Aarons L et al (1989) Rate and extent of absorption of clonidine from a transdermal therapeutic system. J Pharm Pharmacol 41:17–21

    Article  PubMed  CAS  Google Scholar 

  31. Wallace AW (2006) Clonidine and modification of perioperative outcome (review). Curr Opin Anaesthesiol 19:411–417

    Article  PubMed  Google Scholar 

  32. Spaulding TC, Fielding S, Venafro JJ et al (1979) Antinociceptive activity of clonidine and its potentiation of morphine analgesia. Eur J Pharmacol 58:19–25

    Article  PubMed  CAS  Google Scholar 

  33. Bailey PL, Sperry RJ, Johnson JK et al (1991) Respiratory effects of clonidine alone and combined with morphine in humans. Anesthesiology 74:43–48

    Article  PubMed  CAS  Google Scholar 

  34. POISE Study Group (2008) Effect of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 31(371):1839–1847

    Google Scholar 

  35. Darvish-Kazem S, Alderazi AE, Walsh M et al (2009) Vascular safety and efficacy of perioperative clonidine treatment in patients undergoing noncardiac surgery: Systematic review and meta-analysis [abstract—Canadian Cardiovascular Congress 2009. Accessed at: http://www.pulsus.com/ccc2009/abs/369.htm]. Can J Cardiol 25B:158

  36. Devereaux PJ, Sessler DI (2012) The potential role of alpha-2 agonists for noncardiac surgery. Anesthesiology 116:1192–1194

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Anesthesia and Intensive Care Unit, Cardiovascular Department, Città di Lecce Hospital GVM Care and Research, via provinciale per Arnesano, km 4, 73100, Lecce, Italy

    Massimiliano Conte

  2. Cardiology and Interventional Cardiology Unit, Cardiovascular Department, Città di Lecce Hospital GVM Care and Research, via provinciale per Arnesano, km 4, 73100, Lecce, Italy

    Roberto Martino

  3. Emeritus Professor of Surgery/Anesthesiology and Molecular Pharmacology/Physiology, University of South Florida, Tampa General Hospital, Tampa, FL, 33606, USA

    Enrico M. Camporesi

Authors
  1. Massimiliano Conte
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  2. Roberto Martino
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  3. Enrico M. Camporesi
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Correspondence to Massimiliano Conte .

Editor information

Editors and Affiliations

  1. Anesthesia and Intensive Care, Hospital San Raffaele, Milano, Milano, Italy

    Giovanni Landoni

  2. Anesthesia and Intensive care, San Raffaele Hospital, Milano, Milano, Italy

    Laura Ruggeri

  3. Anesthesia and Intensive Care, Hospital San Raffaele, Milano, Milano, Italy

    Alberto Zangrillo

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Conte, M., Martino, R., Camporesi, E.M. (2014). Could Clonidine Contribute to a Reduction in Perioperative Mortality?. In: Landoni, G., Ruggeri, L., Zangrillo, A. (eds) Reducing Mortality in the Perioperative Period. Springer, Cham. https://doi.org/10.1007/978-3-319-02186-7_8

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  • DOI: https://doi.org/10.1007/978-3-319-02186-7_8

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-02186-7

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