Clonidine and modification of perioperative outcome

Purpose of review Perioperative cardiac risk reduction using perioperative beta-blockade is being widely adopted. Recent research has identified a second-line agent, perioperative clonidine, that can be used to reduce the risk of perioperative cardiac mortality. Perioperative clonidine has some advantages over perioperative beta-blockers because it has less risk of bronchospasm in asthmatics and it comes in a transcutaneous form that can be used in patients who are not taking oral medications ('NPO'). Recent findings Clonidine has been used for many purposes, including reduction of blood pressure in hypertension, reduction in alcohol and drug withdrawal phenomena, reduction in nicotine withdrawal symptoms during smoking cessation, analgesia, reduction in stress response, and now as an anti-ischemic agent to reduce the risk of perioperative myocardial ischemia and perioperative mortality. Summary Administration of perioperative clonidine can reduce the risk of perioperative myocardial ischemia and mortality in patients undergoing non-cardiac surgery. Perioperative clonidine comes in a patch form that can be used in patients who are not taking medications by mouth, and can be used when beta-blockers are contraindicated (for asthmatics or pateints with high-grade atrioventicular block).