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Perioperative use of adrenoceptor agonists and the cardiac patient Tariq Alzahrani Demonstrator College of Medicine King Saud University Introduction The net effect of -adrenoceptor agonists, exerted via central and spinal receptors, is sympatholytic (or ‘provagal’) and leads to moderate reductions in blood pressure (BP) and heart rate (HR), as well as a range of analgesic, anaesthetic and sedative effects, the exact balance of which varies according to the agent used. Clinical features and usage of -adrenoceptor agonists 1. Reduction of the anaesthetic doses needed to induce and maintain anaesthesia as well as reduction in opioid analgesic requirements. 2. Intraoperative suppression of potentially deleterious stress responses related to excessive activity of the sympathetic nervous system. 3. Sedation without respiratory depression, particularly during intensive care. Paediatric use of dexmedetomidine Dexmedetomidine is not currently indicated for use in patients aged 18 years. The drug has occasionally been used in critically ill children, however, and the largest summary of experience in paediatric patients was broadly positive and encouraging . Dexmedetomidine has also been used with success to facilitate prompt withdrawal of opioids and benzodiazepines in paediatric heart transplant recipients. postoperative shivering Conclusions and perspective -adrenoceptor agonists such as clonidine and dexmedetomidine represent a valuable, and arguably still underexploited, resource in the management of high-risk patients. Their potential uses extend from perioperative risk management in patients vulnerable to the cardiac complications of surgery to easing and expediting the progress of patients through intensive care. A faster offset of effect than clonidine is one distinguishing feature of dexmedetomidine that may be advantageous in the critical care setting.