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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.
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Clinical features and usage of
-adrenoceptor agonists
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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
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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
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-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.