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.

中文翻译：

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在没有心血管事件风险的患者中，归因于α2-肾上腺素受体激动剂的围手术期不良事件：系统评价和荟萃分析

背景

几项系统评价报告了围手术期使用α2-肾上腺素受体激动剂在各种情况下的益处，但安全性证据文献不足。

方法

我们对不良事件进行了系统的审查。我们在MEDLINE，Embase，LILACS，Cochrane和临床试验注册数据库中搜索了RCT，比较了在无心血管事件风险的患者中，在全身麻醉下进行非心血管手术时，α2-肾上腺素受体激动剂和安慰剂的作用，以比较任何适应症。主要结果是在使用α2-肾上腺素受体激动剂期间或之后发生严重不良事件的发生率。次要终点是其他不良事件。对合并数据进行荟萃分析。证据质量通过“建议评估，制定和评估方法分级”进行评级。

结果

我们纳入了56项研究（4868例患者）。我们的审查基于中等质量的证据，显示可乐定和右美托咪定的术前和术后低血压频发。据报道仅使用右美托咪定可引起心动过缓。相反，右美托咪定似乎可以预防术中高血压和心动过速。亚组分析表明，停药后仍存在低血压和心动过缓的风险。有趣的是，当右美托咪定的推注剂量小于0.5μgkg ^-1或仅连续给药时，未观察到术中低血压和术后心动过缓。

结论

在各种围手术期中，与使用α2-肾上腺素受体激动剂相关的不良事件发生率的汇总数据为低血压和心动过缓的风险以及对高血压和心动过速的保护作用提供了高可信度的证据。

协议注册

CRD42017071583。