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ASA: Preventive Clonidine Cuts Deaths After Non-Cardiac Surgery By Jill Stein SAN FRANCISCO, CA -- October 22, 2003 -- Prophylactic pre-operative administration of the alpha2-agonist clonidine significantly reduces the rate of preoperative myocardial ischaemia and postoperative mortality in patients who have or who are at risk for coronary artery disease (CAD) and undergo non-cardiac surgery, new data suggest. The results were announced on October 15th at the 2003 Annual Meeting of the American Society of Anesthesiologists. Perioperative myocardial ischaemia is a potentially avoidable risk factor associated with a nine-fold increase in cardiac morbidity before hospital discharge and a 2-fold greater long-term (2-year) risk. Reduction in perioperative myocardial ischaemia reduces mortality. "In prior trials, prophylactic beta blockade reduced the incidence of death after non-cardiac surgery," Dr. Arthur Wallace, with the University of California, San Francisco, United States, said. "The current trial demonstrates similar efficacy for the prevention of death with a drug in a different pharmacologic class." His group randomised 190 men with or at risk for CAD into a clonidine or placebo group in a 2:1 ratio. Clonidine 0.2 mg orally as well as the Catapres-TTS-2 patch or placebo was administered the night before surgery, and clonidine 0.2 mg orally or placebo on the morning of surgery. The patch remained on patients for 4 days and was then removed. The rate of intra- and postoperative myocardial ischaemia was significantly decreased with clonidine, with a 15% rate in patients taking clonidine versus 31% for the placebo group (P= 0.01). Clonidine also reduced the rate of postoperative mortality for up to two years, with a 15% rate in clonidine-treated patients versus 29% for placebo patients (P=0.009). Both perioperative myocardial ischaemia and randomisation to the placebo group were independent risk factors for death. Clonidine was well tolerated by most patients. Dr. Wallace emphasised that the study has several limitations. For example, it included only males, it used a single dose of clonidine and hypotension occurred in three patients just prior to surgery. While the hypotension responded to fluid administration, it is important that patients with critical aortic stenosis or who are hypotensive not being administered prophylactic clonidine therapy without careful medical supervision, he added. [Study title: Effect of Clonidine on Heart Rate Variability, Serum Catecholamine Levels, and Survival in a Long-Term Prospective Trial. Abstract 115] E-mail this page to a friend or colleague! To print, use this version