Dexmedetomidine prevents epinephrine-induced arrhythmias through stimulation of central alpha 2 adrenoceptors in halothane-anesthetized dogs

Comparative effects of idazoxan, prazosin, and yohimbine on coronary ligation-induced arrhythmias in spontaneously hypertensive rats

We investigated whether certain drugs with alpha-adrenergic antagonist activity display anti-arrhythmic effects in hypertensive animals subjected to acute coronary artery ligation. The left anterior descending coronary artery (LAD) was ligated in open-chest pentobarbital-anesthetized spontaneously hypertensive rats (SHR); arrhythmias were subsequently recorded for 30 min. Drugs were administered intravenously, (i.v.) 5 min before ligation. The effects of yohimbine and idazoxan were compared with those of prazosin. Prazosin (100 mu g/kg) increased the occurrence of ventricular tachycardia (VT). In contrast, yohimbine 1.6 mg/kg decreased both the occurrence and the duration of VT and the occurrence and the duration of ventricular fibrillation, (VF). The results obtained with idazoxan 1 mg/kg were similar to those with yohimbine. The ECG alterations induced by coronary artery ligation in rats treated with yohimbine and idazoxan were more pronounced than in controls and in rats treated with prazosin, suggesting that the antiarrhythmic effects observed were not mediated by antiischemic activity. The protective effects against ligation-induced arrhythmias were preceded by a hypotensive effect and a decrease in the rate-pressure product in yohimbine-treated but not in idazoxan-treated animals. In rats treated with prazosin, more arrhythmic events were observed, although hemodynamics were similar to those in rats treated with yohimbine. Our results suggest that the yohimbine-induced antiarrhythmic action is not due to an alteration of conduction or repolarization rates. In this model, yohimbine and idazoxan appear to protect against ligation-induced arrhythmias. These data suggest that drugs with alpha-adrenergic properties might influence the nervous drive to the heart in SHR with cardiac ischemia. However, further investigations are needed to ascertain whether the alpha-adrenoceptor blockade participates in this effect.

Alpha2-adrenergic agonists in cardiovascular anesthesia

At this time, the unique attributes of alpha 2-agonists in anesthesia lie in their ability to blunt the adrenergic response to the stresses of major surgery, in patients in whom this response is especially undesirable, without incurring the penalty of respiratory depression that attends the use of opioids. It has become more and more apparent that sympathetic/adrenergic activation often has adverse consequences for patient morbidity and mortality, and modification of such activation by drugs may be a valuable option for the anesthesiologist. However, at present, the evidence supporting this statement is "soft," such as improved hemodynamic and metabolic stability. What must be done is to generate solid support in the form of well-designed outcome studies. The potential value of alpha 2-agonists is greatest in major surgery in brittle patients involving the risk of significant adverse outcome. There are plenty of adequate anesthesia regimens to cover lesser surgical interventions. In these cases, it is not the choice of a specific anesthetic agent or technique, but rather the competence and diligence of the anesthesiologist that is most important for outcome. In contrast, in major cardiovascular surgery in high-risk patients, the optimal anesthetic approach attains more importance, and is still undecided. The final consensus as to whether or not this optimal approach will include the use of alpha 2-adrenergic agonists will depend on the results of more extensive clinical investigations.

Clinical interactions with alpha-2-adrenergic agonists in anesthetic practice

With the continued use of alpha-2-adrenergic agonists in anesthetic practice, careful attention should be given to the potential for drug interactions. Based on a review of the basic and applied pharmacology of this class of compound, we have made recommendations for the safe and efficacious use of alpha-2-adrenergic agonists in the clinical setting.