Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados

Respuestas clínicas Cochrane

Topics

Temas

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Funnel plot of comparison: 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, outcome: 1.1 All‐cause mortality.
Figuras y tablas -
Figure 4

Funnel plot of comparison: 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, outcome: 1.1 All‐cause mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Funnel plot of comparison: 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, outcome: 1.3 Myocardial infarction.
Figuras y tablas -
Figure 5

Funnel plot of comparison: 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, outcome: 1.3 Myocardial infarction.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, Outcome 1 All‐cause mortality.
Figuras y tablas -
Analysis 1.1

Comparison 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, Outcome 1 All‐cause mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, Outcome 2 Cardiac mortality.
Figuras y tablas -
Analysis 1.2

Comparison 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, Outcome 2 Cardiac mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, Outcome 3 Myocardial infarction.
Figuras y tablas -
Analysis 1.3

Comparison 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, Outcome 3 Myocardial infarction.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, Outcome 4 Myocardial ischaemia.
Figuras y tablas -
Analysis 1.4

Comparison 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, Outcome 4 Myocardial ischaemia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, Outcome 5 Supraventricular tachyarrhythmia.
Figuras y tablas -
Analysis 1.5

Comparison 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, Outcome 5 Supraventricular tachyarrhythmia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, Outcome 6 Heart failure.
Figuras y tablas -
Analysis 1.6

Comparison 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, Outcome 6 Heart failure.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, Outcome 7 Acute stroke.
Figuras y tablas -
Analysis 1.7

Comparison 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, Outcome 7 Acute stroke.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, Outcome 8 Bradycardia.
Figuras y tablas -
Analysis 1.8

Comparison 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, Outcome 8 Bradycardia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, Outcome 9 Hypotension.
Figuras y tablas -
Analysis 1.9

Comparison 1 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery, Outcome 9 Hypotension.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 Alpha‐2 adrenergic agonists versus control in cardiac surgery, Outcome 1 All‐cause mortality.
Figuras y tablas -
Analysis 2.1

Comparison 2 Alpha‐2 adrenergic agonists versus control in cardiac surgery, Outcome 1 All‐cause mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 Alpha‐2 adrenergic agonists versus control in cardiac surgery, Outcome 2 Myocardial infarction.
Figuras y tablas -
Analysis 2.2

Comparison 2 Alpha‐2 adrenergic agonists versus control in cardiac surgery, Outcome 2 Myocardial infarction.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 Alpha‐2 adrenergic agonists versus control in cardiac surgery, Outcome 3 Myocardial ischaemia.
Figuras y tablas -
Analysis 2.3

Comparison 2 Alpha‐2 adrenergic agonists versus control in cardiac surgery, Outcome 3 Myocardial ischaemia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 Alpha‐2 adrenergic agonists versus control in cardiac surgery, Outcome 4 Supraventricular tachyarrhythmia.
Figuras y tablas -
Analysis 2.4

Comparison 2 Alpha‐2 adrenergic agonists versus control in cardiac surgery, Outcome 4 Supraventricular tachyarrhythmia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 Alpha‐2 adrenergic agonists versus control in cardiac surgery, Outcome 5 Heart failure.
Figuras y tablas -
Analysis 2.5

Comparison 2 Alpha‐2 adrenergic agonists versus control in cardiac surgery, Outcome 5 Heart failure.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 Alpha‐2 adrenergic agonists versus control in cardiac surgery, Outcome 6 Acute stroke.
Figuras y tablas -
Analysis 2.6

Comparison 2 Alpha‐2 adrenergic agonists versus control in cardiac surgery, Outcome 6 Acute stroke.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 Alpha‐2 adrenergic agonists versus control in cardiac surgery, Outcome 7 Bradycardia.
Figuras y tablas -
Analysis 2.7

Comparison 2 Alpha‐2 adrenergic agonists versus control in cardiac surgery, Outcome 7 Bradycardia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 Alpha‐2 adrenergic agonists versus control in cardiac surgery, Outcome 8 Hypotension.
Figuras y tablas -
Analysis 2.8

Comparison 2 Alpha‐2 adrenergic agonists versus control in cardiac surgery, Outcome 8 Hypotension.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 3 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery ‐ stratified by vascular versus non‐vascular surgery, Outcome 1 All‐cause mortality.
Figuras y tablas -
Analysis 3.1

Comparison 3 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery ‐ stratified by vascular versus non‐vascular surgery, Outcome 1 All‐cause mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 3 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery ‐ stratified by vascular versus non‐vascular surgery, Outcome 2 Cardiac mortality.
Figuras y tablas -
Analysis 3.2

Comparison 3 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery ‐ stratified by vascular versus non‐vascular surgery, Outcome 2 Cardiac mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 3 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery ‐ stratified by vascular versus non‐vascular surgery, Outcome 3 Myocardial infarction.
Figuras y tablas -
Analysis 3.3

Comparison 3 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery ‐ stratified by vascular versus non‐vascular surgery, Outcome 3 Myocardial infarction.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 3 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery ‐ stratified by vascular versus non‐vascular surgery, Outcome 4 Myocardial ischaemia.
Figuras y tablas -
Analysis 3.4

Comparison 3 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery ‐ stratified by vascular versus non‐vascular surgery, Outcome 4 Myocardial ischaemia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 4 Alpha‐2 adrenergic agonists (stratified by drug) versus control in non‐cardiac surgery, Outcome 1 All‐cause mortality.
Figuras y tablas -
Analysis 4.1

Comparison 4 Alpha‐2 adrenergic agonists (stratified by drug) versus control in non‐cardiac surgery, Outcome 1 All‐cause mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 4 Alpha‐2 adrenergic agonists (stratified by drug) versus control in non‐cardiac surgery, Outcome 2 Cardiac mortality.
Figuras y tablas -
Analysis 4.2

Comparison 4 Alpha‐2 adrenergic agonists (stratified by drug) versus control in non‐cardiac surgery, Outcome 2 Cardiac mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 4 Alpha‐2 adrenergic agonists (stratified by drug) versus control in non‐cardiac surgery, Outcome 3 Myocardial infarction.
Figuras y tablas -
Analysis 4.3

Comparison 4 Alpha‐2 adrenergic agonists (stratified by drug) versus control in non‐cardiac surgery, Outcome 3 Myocardial infarction.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 4 Alpha‐2 adrenergic agonists (stratified by drug) versus control in non‐cardiac surgery, Outcome 4 Hypotension.
Figuras y tablas -
Analysis 4.4

Comparison 4 Alpha‐2 adrenergic agonists (stratified by drug) versus control in non‐cardiac surgery, Outcome 4 Hypotension.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 5 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery studies with blinding and concealed allocation, Outcome 1 All‐cause mortality.
Figuras y tablas -
Analysis 5.1

Comparison 5 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery studies with blinding and concealed allocation, Outcome 1 All‐cause mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 5 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery studies with blinding and concealed allocation, Outcome 2 Myocardial infarction.
Figuras y tablas -
Analysis 5.2

Comparison 5 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery studies with blinding and concealed allocation, Outcome 2 Myocardial infarction.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 5 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery studies with blinding and concealed allocation, Outcome 3 Myocardial ischaemia.
Figuras y tablas -
Analysis 5.3

Comparison 5 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery studies with blinding and concealed allocation, Outcome 3 Myocardial ischaemia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 6 Alpha‐2 adrenergic agonists versus control in studies that used strict definitions of myocardial infarction or ischaemia, Outcome 1 Myocardial infarction.
Figuras y tablas -
Analysis 6.1

Comparison 6 Alpha‐2 adrenergic agonists versus control in studies that used strict definitions of myocardial infarction or ischaemia, Outcome 1 Myocardial infarction.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 6 Alpha‐2 adrenergic agonists versus control in studies that used strict definitions of myocardial infarction or ischaemia, Outcome 2 Myocardial ischaemia.
Figuras y tablas -
Analysis 6.2

Comparison 6 Alpha‐2 adrenergic agonists versus control in studies that used strict definitions of myocardial infarction or ischaemia, Outcome 2 Myocardial ischaemia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 7 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery (excluding Oliver 1999 and Devereaux 2014), Outcome 1 All‐cause mortality.
Figuras y tablas -
Analysis 7.1

Comparison 7 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery (excluding Oliver 1999 and Devereaux 2014), Outcome 1 All‐cause mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 7 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery (excluding Oliver 1999 and Devereaux 2014), Outcome 2 Cardiac mortality.
Figuras y tablas -
Analysis 7.2

Comparison 7 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery (excluding Oliver 1999 and Devereaux 2014), Outcome 2 Cardiac mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 7 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery (excluding Oliver 1999 and Devereaux 2014), Outcome 3 Myocardial infarction.
Figuras y tablas -
Analysis 7.3

Comparison 7 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery (excluding Oliver 1999 and Devereaux 2014), Outcome 3 Myocardial infarction.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 8 Alpha‐2 adrenergic agonists (excluding mivazerol) versus control in non‐cardiac surgery, Outcome 1 All‐cause mortality.
Figuras y tablas -
Analysis 8.1

Comparison 8 Alpha‐2 adrenergic agonists (excluding mivazerol) versus control in non‐cardiac surgery, Outcome 1 All‐cause mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 8 Alpha‐2 adrenergic agonists (excluding mivazerol) versus control in non‐cardiac surgery, Outcome 2 Cardiac mortality.
Figuras y tablas -
Analysis 8.2

Comparison 8 Alpha‐2 adrenergic agonists (excluding mivazerol) versus control in non‐cardiac surgery, Outcome 2 Cardiac mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 8 Alpha‐2 adrenergic agonists (excluding mivazerol) versus control in non‐cardiac surgery, Outcome 3 Myocardial infarction.
Figuras y tablas -
Analysis 8.3

Comparison 8 Alpha‐2 adrenergic agonists (excluding mivazerol) versus control in non‐cardiac surgery, Outcome 3 Myocardial infarction.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 8 Alpha‐2 adrenergic agonists (excluding mivazerol) versus control in non‐cardiac surgery, Outcome 4 Myocardial ischaemia.
Figuras y tablas -
Analysis 8.4

Comparison 8 Alpha‐2 adrenergic agonists (excluding mivazerol) versus control in non‐cardiac surgery, Outcome 4 Myocardial ischaemia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 8 Alpha‐2 adrenergic agonists (excluding mivazerol) versus control in non‐cardiac surgery, Outcome 5 Supraventricular tachyarrhythmia.
Figuras y tablas -
Analysis 8.5

Comparison 8 Alpha‐2 adrenergic agonists (excluding mivazerol) versus control in non‐cardiac surgery, Outcome 5 Supraventricular tachyarrhythmia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 8 Alpha‐2 adrenergic agonists (excluding mivazerol) versus control in non‐cardiac surgery, Outcome 6 Heart failure.
Figuras y tablas -
Analysis 8.6

Comparison 8 Alpha‐2 adrenergic agonists (excluding mivazerol) versus control in non‐cardiac surgery, Outcome 6 Heart failure.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 8 Alpha‐2 adrenergic agonists (excluding mivazerol) versus control in non‐cardiac surgery, Outcome 7 Acute stroke.
Figuras y tablas -
Analysis 8.7

Comparison 8 Alpha‐2 adrenergic agonists (excluding mivazerol) versus control in non‐cardiac surgery, Outcome 7 Acute stroke.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 8 Alpha‐2 adrenergic agonists (excluding mivazerol) versus control in non‐cardiac surgery, Outcome 8 Bradycardia.
Figuras y tablas -
Analysis 8.8

Comparison 8 Alpha‐2 adrenergic agonists (excluding mivazerol) versus control in non‐cardiac surgery, Outcome 8 Bradycardia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 8 Alpha‐2 adrenergic agonists (excluding mivazerol) versus control in non‐cardiac surgery, Outcome 9 Hypotension.
Figuras y tablas -
Analysis 8.9

Comparison 8 Alpha‐2 adrenergic agonists (excluding mivazerol) versus control in non‐cardiac surgery, Outcome 9 Hypotension.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 9 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery within past 20 years, Outcome 1 All‐cause mortality.
Figuras y tablas -
Analysis 9.1

Comparison 9 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery within past 20 years, Outcome 1 All‐cause mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 9 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery within past 20 years, Outcome 2 Cardiac mortality.
Figuras y tablas -
Analysis 9.2

Comparison 9 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery within past 20 years, Outcome 2 Cardiac mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 9 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery within past 20 years, Outcome 3 Myocardial infarction.
Figuras y tablas -
Analysis 9.3

Comparison 9 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery within past 20 years, Outcome 3 Myocardial infarction.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 9 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery within past 20 years, Outcome 4 Myocardial ischaemia.
Figuras y tablas -
Analysis 9.4

Comparison 9 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery within past 20 years, Outcome 4 Myocardial ischaemia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 9 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery within past 20 years, Outcome 5 Heart failure.
Figuras y tablas -
Analysis 9.5

Comparison 9 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery within past 20 years, Outcome 5 Heart failure.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 9 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery within past 20 years, Outcome 6 Acute stroke.
Figuras y tablas -
Analysis 9.6

Comparison 9 Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery within past 20 years, Outcome 6 Acute stroke.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 10 Alpha‐2 adrenergic agonists versus control in cardiac surgery within past 20 years, Outcome 1 All‐cause mortality.
Figuras y tablas -
Analysis 10.1

Comparison 10 Alpha‐2 adrenergic agonists versus control in cardiac surgery within past 20 years, Outcome 1 All‐cause mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 10 Alpha‐2 adrenergic agonists versus control in cardiac surgery within past 20 years, Outcome 2 Myocardial infarction.
Figuras y tablas -
Analysis 10.2

Comparison 10 Alpha‐2 adrenergic agonists versus control in cardiac surgery within past 20 years, Outcome 2 Myocardial infarction.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 10 Alpha‐2 adrenergic agonists versus control in cardiac surgery within past 20 years, Outcome 3 Myocardial ischaemia.
Figuras y tablas -
Analysis 10.3

Comparison 10 Alpha‐2 adrenergic agonists versus control in cardiac surgery within past 20 years, Outcome 3 Myocardial ischaemia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 10 Alpha‐2 adrenergic agonists versus control in cardiac surgery within past 20 years, Outcome 4 Supraventricular tachyarrhythmia.
Figuras y tablas -
Analysis 10.4

Comparison 10 Alpha‐2 adrenergic agonists versus control in cardiac surgery within past 20 years, Outcome 4 Supraventricular tachyarrhythmia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 10 Alpha‐2 adrenergic agonists versus control in cardiac surgery within past 20 years, Outcome 5 Heart failure.
Figuras y tablas -
Analysis 10.5

Comparison 10 Alpha‐2 adrenergic agonists versus control in cardiac surgery within past 20 years, Outcome 5 Heart failure.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 10 Alpha‐2 adrenergic agonists versus control in cardiac surgery within past 20 years, Outcome 6 Acute stroke.
Figuras y tablas -
Analysis 10.6

Comparison 10 Alpha‐2 adrenergic agonists versus control in cardiac surgery within past 20 years, Outcome 6 Acute stroke.

Ir a la figura de la revisiónAbrir en una pestaña nueva
Summary of findings for the main comparison. Alpha‐2 adrenergic agonists compared to control in non‐cardiac surgery

Alpha‐2 adrenergic agonists compared to control in non‐cardiac surgery

Patient or population: adults undergoing non‐cardiac surgery
Setting: hospital inpatient care
Intervention: α‐2 adrenergic agonist
Comparison: placebo or inactive control

Outcomes

Anticipated absolute effects* (95% CI)

Risk ratio
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with control

Risk with α‐2 adrenergic agonists

All‐cause mortality

(within 30‐days after surgery: any reported death)

Study population

RR 0.80
(0.61 to 1.04)

14,081
(16 RCTs)

⊕⊕⊕⊕
High1,2

‐

17 per 1000

13 per 1000
(10 to 17)

Cardiac mortality

(within 30‐days after surgery: sudden death or death resulting from a primarily identifiable cardiac cause.)

Study population

RR 0.86
(0.60 to 1.23)

12,525
(5 RCTs)

⊕⊕⊕⊕
High1,2

‐

10 per 1000

8 per 1000
(6 to 12)

Myocardial infarction

(within 30‐days after surgery: as detected on an electrocardiogram or trans‐oesophageal echocardiogram)

Study population

RR 0.94
(0.69 to 1.27)

13,907
(12 RCTs)

⊕⊕⊕⊝
Moderate1,2,3

‐

59 per 1000

55 per 1000
(41 to 75)

Acute stroke

(within 30‐days after surgery: new focal neurologic deficit with signs and symptoms lasting longer than 24 hours)

Study population

RR 0.93
(0.55 to 1.56)

11,542
(7 RCTs)

⊕⊕⊕⊕
High1

‐

5 per 1000

4 per 1000
(3 to 8)

Bradycardia

(requiring pharmacological or pacemaker treatment during the period of study drug administration)

Study population

RR 1.59
(1.18 to 2.13)

14,035
(16 RCTs)

⊕⊕⊕⊝
Moderate1,2,4

‐

75 per 1000

119 per 1000
(89 to 160)

Hypotension

(requiring treatment with inotropes or vasopressors during the period of study drug administration)

Study population

RR 1.24
(1.03 to 1.48)

13,738
(15 RCTs)

⊕⊕⊕⊝
Moderate1,2,4

‐

304 per 1000

377 per 1000
(313 to 450)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RCT: randomized controlled trial; RR: risk ratio.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate quality: We are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low quality: Our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect.
Very low quality: We have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.

1Risk of bias was not serious. Although multiple studies lacked proper allocation concealment and blinding, outcome unlikely to be influenced. Not downgraded.

2Indirectness not serious. Intervention (mivazerol) used in one large study not available for clinical use. Not downgraded.

3Evidence of publication bias in funnel plot of analysis. Downgraded by one level.

4Serious inconsistency between studies indicated by substantial heterogeneity. Downgraded by one level.

Figuras y tablas -
Summary of findings for the main comparison. Alpha‐2 adrenergic agonists compared to control in non‐cardiac surgery
Ir a la tabla de la revisión
Summary of findings 2. Alpha‐2 adrenergic agonists compared to control in cardiac surgery

Alpha‐2 adrenergic agonists compared to control in cardiac surgery

Patient or population: adults undergoing cardiac surgery
Setting: hospital inpatient care
Intervention: α‐2 adrenergic agonist
Comparison: placebo or inactive control

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with control

Risk with α‐2 adrenergic agonists

All‐cause mortality

(within 30‐days after surgery: any reported death)

Study population

RR 0.52
(0.26 to 1.04)

1947
(16 RCTs)

⊕⊕⊕⊝
Moderate1,2

‐

21 per 1000

11 per 1000
(5 to 21)

Cardiac mortality

(within 30‐days after surgery: sudden death or death resulting from a primarily identifiable cardiac cause)

1 death from 12 participants in clonidine arm, and no deaths in 10 participants in control arm.

Not estimable

22

(1 RCT)

Not estimable

We did not GRADE evidence for this outcome as accurate estimation of RRs is not possible for such low event rates.

Myocardial infarction

(within 30‐days after surgery: sudden death or death resulting from a primarily identifiable cardiac cause)

Study population

RR 1.01
(0.43 to 2.40)

782
(8 RCTs)

⊕⊕⊕⊝
Moderate1,2

‐

20 per 1000

21 per 1000
(9 to 49)

Acute stroke

(within 30‐days after surgery: new focal neurologic deficit with signs and symptoms lasting longer than 24 hours)

Study population

RR 0.37
(0.15 to 0.93)

1175
(7 RCTs)

⊕⊕⊝⊝
Low1,3

Total of 18 acute stokes reported, with 14 in control group and 4 in treatment group.

24 per 1000

9 per 1000
(4 to 22)

Bradycardia

(requiring pharmacological or pacemaker treatment during the period of study drug administration)

Study population

RR 1.88
(1.35 to 2.62)

1477
(10 RCTs)

⊕⊕⊕⊝
Moderate1,4

‐

64 per 1000

120 per 1000
(86 to 167)

Hypotension

(requiring treatment with inotropes or vasopressors during the period of study drug administration)

Study population

RR 1.19
(0.87 to 1.64)

1413
(9 RCTs)

⊕⊕⊝⊝
Low1,2,5

‐

332 per 1000

395 per 1000
(289 to 544)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RCT: randomized controlled trial; RR: risk ratio.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate quality: We are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low quality: Our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect.
Very low quality: We have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.

1Risk of bias was not serious. Although multiple studies lack proper allocation concealment and blinding, outcome unlikely to be influenced. Not downgraded.

2Serious imprecision, because analysis was below optimal information size and confidence interval includes significant benefit and harm. Downgraded by one level.

3Very serious imprecision, because analysis is below optimal information size and number of events was very small. Downgraded by two levels.

4Serious imprecision, because analysis was below optimal information size. Downgraded by one level

5Serious inconsistency between studies indicated by substantial heterogeneity. Downgraded one level.

Figuras y tablas -
Summary of findings 2. Alpha‐2 adrenergic agonists compared to control in cardiac surgery
Ir a la tabla de la revisión
Comparison 1. Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 All‐cause mortality Show forest plot

16

14081

Risk Ratio (M‐H, Fixed, 95% CI)

0.80 [0.61, 1.04]

2 Cardiac mortality Show forest plot

5

12525

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.60, 1.23]

3 Myocardial infarction Show forest plot

12

13907

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.69, 1.27]

4 Myocardial ischaemia Show forest plot

12

1379

Risk Ratio (M‐H, Random, 95% CI)

0.73 [0.53, 1.02]

5 Supraventricular tachyarrhythmia Show forest plot

2

44

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [0.05, 24.07]

6 Heart failure Show forest plot

8

10802

Risk Ratio (M‐H, Fixed, 95% CI)

1.21 [0.83, 1.75]

7 Acute stroke Show forest plot

7

11542

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.55, 1.56]

8 Bradycardia Show forest plot

16

14035

Risk Ratio (M‐H, Random, 95% CI)

1.59 [1.18, 2.13]

9 Hypotension Show forest plot

15

13738

Risk Ratio (M‐H, Random, 95% CI)

1.24 [1.03, 1.48]
Figuras y tablas -
Comparison 1. Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery
Ir a la tabla de la revisión
Comparison 2. Alpha‐2 adrenergic agonists versus control in cardiac surgery

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 All‐cause mortality Show forest plot

16

1947

Risk Ratio (M‐H, Fixed, 95% CI)

0.52 [0.26, 1.04]

2 Myocardial infarction Show forest plot

8

782

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.43, 2.40]

3 Myocardial ischaemia Show forest plot

13

1134

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.56, 0.86]

4 Supraventricular tachyarrhythmia Show forest plot

6

1044

Risk Ratio (M‐H, Fixed, 95% CI)

0.77 [0.50, 1.16]

5 Heart failure Show forest plot

4

549

Risk Ratio (M‐H, Fixed, 95% CI)

0.90 [0.49, 1.63]

6 Acute stroke Show forest plot

7

1175

Risk Ratio (M‐H, Fixed, 95% CI)

0.37 [0.15, 0.93]

7 Bradycardia Show forest plot

10

1477

Risk Ratio (M‐H, Fixed, 95% CI)

1.88 [1.35, 2.62]

8 Hypotension Show forest plot

9

1413

Risk Ratio (M‐H, Random, 95% CI)

1.19 [0.87, 1.64]
Figuras y tablas -
Comparison 2. Alpha‐2 adrenergic agonists versus control in cardiac surgery
Ir a la tabla de la revisión
Comparison 3. Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery ‐ stratified by vascular versus non‐vascular surgery

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 All‐cause mortality Show forest plot

13

3713

Risk Ratio (M‐H, Fixed, 95% CI)

0.63 [0.40, 0.98]

1.1 Vascular surgery

8

1798

Risk Ratio (M‐H, Fixed, 95% CI)

0.46 [0.25, 0.88]

1.2 Non‐vascular surgery

6

1915

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.46, 1.67]

2 Cardiac mortality Show forest plot

4

2515

Risk Ratio (M‐H, Fixed, 95% CI)

0.51 [0.27, 0.93]

2.1 Vascular surgery

4

1522

Risk Ratio (M‐H, Fixed, 95% CI)

0.36 [0.16, 0.79]

2.2 Non‐vascular surgery

1

993

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.35, 2.77]

3 Myocardial infarction Show forest plot

9

3539

Risk Ratio (M‐H, Random, 95% CI)

0.71 [0.44, 1.17]

3.1 Vascular surgery

7

1766

Risk Ratio (M‐H, Random, 95% CI)

0.52 [0.27, 1.00]

3.2 Non‐vascular surgery

3

1773

Risk Ratio (M‐H, Random, 95% CI)

1.09 [0.55, 2.15]

4 Myocardial ischaemia Show forest plot

9

961

Risk Ratio (M‐H, Random, 95% CI)

0.78 [0.52, 1.17]

4.1 Vascular surgery

6

865

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.54, 1.29]

4.2 Non‐vascular surgery

3

96

Risk Ratio (M‐H, Random, 95% CI)

0.23 [0.04, 1.34]
Figuras y tablas -
Comparison 3. Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery ‐ stratified by vascular versus non‐vascular surgery
Ir a la tabla de la revisión
Comparison 4. Alpha‐2 adrenergic agonists (stratified by drug) versus control in non‐cardiac surgery

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 All‐cause mortality Show forest plot

16

14081

Risk Ratio (M‐H, Fixed, 95% CI)

0.80 [0.61, 1.04]

1.1 Clonidine

7

10787

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.64, 1.23]

1.2 Dexmedetomidine

7

1097

Risk Ratio (M‐H, Fixed, 95% CI)

0.49 [0.15, 1.58]

1.3 Mivazerol

2

2197

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.42, 1.15]

2 Cardiac mortality Show forest plot

5

12525

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.60, 1.23]

2.1 Clonidine

3

10328

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.71, 1.75]

2.2 Mivazerol

2

2197

Risk Ratio (M‐H, Fixed, 95% CI)

0.51 [0.27, 0.98]

3 Myocardial infarction Show forest plot

12

13907

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.69, 1.27]

3.1 Clonidine

6

10756

Risk Ratio (M‐H, Random, 95% CI)

1.05 [0.57, 1.92]

3.2 Dexmedetomidine

4

954

Risk Ratio (M‐H, Random, 95% CI)

0.55 [0.20, 1.49]

3.3 Mivazerol

2

2197

Risk Ratio (M‐H, Random, 95% CI)

0.60 [0.17, 2.08]

4 Hypotension Show forest plot

15

13738

Risk Ratio (M‐H, Random, 95% CI)

1.24 [1.03, 1.48]

4.1 Clonidine

7

10485

Risk Ratio (M‐H, Random, 95% CI)

1.29 [1.23, 1.35]

4.2 Dexmedetomidine

6

1056

Risk Ratio (M‐H, Random, 95% CI)

1.81 [1.07, 3.06]

4.3 Mivazerol

2

2197

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.82, 1.10]
Figuras y tablas -
Comparison 4. Alpha‐2 adrenergic agonists (stratified by drug) versus control in non‐cardiac surgery
Ir a la tabla de la revisión
Comparison 5. Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery studies with blinding and concealed allocation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 All‐cause mortality Show forest plot

7

13066

Risk Ratio (M‐H, Random, 95% CI)

0.68 [0.41, 1.11]

2 Myocardial infarction Show forest plot

6

13026

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.95, 1.23]

3 Myocardial ischaemia Show forest plot

3

412

Risk Ratio (M‐H, Random, 95% CI)

0.77 [0.40, 1.48]
Figuras y tablas -
Comparison 5. Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery studies with blinding and concealed allocation
Ir a la tabla de la revisión
Comparison 6. Alpha‐2 adrenergic agonists versus control in studies that used strict definitions of myocardial infarction or ischaemia

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Myocardial infarction Show forest plot

11

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Non‐cardiac surgery

8

13003

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.70, 1.36]

1.2 Cardiac surgery

3

275

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.19, 2.98]

2 Myocardial ischaemia Show forest plot

17

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Non‐cardiac surgery

9

1175

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.54, 1.07]

2.2 Cardiac surgery

8

820

Risk Ratio (M‐H, Random, 95% CI)

0.71 [0.55, 0.91]
Figuras y tablas -
Comparison 6. Alpha‐2 adrenergic agonists versus control in studies that used strict definitions of myocardial infarction or ischaemia
Ir a la tabla de la revisión
Comparison 7. Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery (excluding Oliver 1999 and Devereaux 2014)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 All‐cause mortality Show forest plot

14

2174

Risk Ratio (M‐H, Fixed, 95% CI)

0.45 [0.22, 0.93]

2 Cardiac mortality Show forest plot

3

618

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.10, 2.25]

3 Myocardial infarction Show forest plot

10

2000

Risk Ratio (M‐H, Random, 95% CI)

0.56 [0.25, 1.25]
Figuras y tablas -
Comparison 7. Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery (excluding Oliver 1999 and Devereaux 2014)
Ir a la tabla de la revisión
Comparison 8. Alpha‐2 adrenergic agonists (excluding mivazerol) versus control in non‐cardiac surgery

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 All‐cause mortality Show forest plot

14

11884

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.62, 1.16]

2 Cardiac mortality Show forest plot

3

10328

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.71, 1.75]

3 Myocardial infarction Show forest plot

10

11710

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.59, 1.53]

4 Myocardial ischaemia Show forest plot

11

1079

Risk Ratio (M‐H, Random, 95% CI)

0.68 [0.48, 0.97]

5 Supraventricular tachyarrhythmia Show forest plot

2

44

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [0.05, 24.07]

6 Heart failure Show forest plot

7

10502

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [0.85, 1.84]

7 Acute stroke Show forest plot

6

11242

Risk Ratio (M‐H, Fixed, 95% CI)

0.90 [0.49, 1.63]

8 Bradycardia Show forest plot

14

11838

Risk Ratio (M‐H, Random, 95% CI)

1.66 [1.17, 2.36]

9 Hypotension Show forest plot

13

11541

Risk Ratio (M‐H, Random, 95% CI)

1.33 [1.15, 1.55]
Figuras y tablas -
Comparison 8. Alpha‐2 adrenergic agonists (excluding mivazerol) versus control in non‐cardiac surgery
Ir a la tabla de la revisión
Comparison 9. Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery within past 20 years

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 All‐cause mortality Show forest plot

11

13378

Risk Ratio (M‐H, Fixed, 95% CI)

0.80 [0.61, 1.06]

2 Cardiac mortality Show forest plot

2

11907

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.61, 1.29]

3 Myocardial infarction Show forest plot

7

13195

Risk Ratio (M‐H, Random, 95% CI)

1.08 [0.93, 1.24]

4 Myocardial ischaemia Show forest plot

6

634

Risk Ratio (M‐H, Random, 95% CI)

0.51 [0.28, 0.93]

5 Heart failure Show forest plot

5

10424

Risk Ratio (M‐H, Fixed, 95% CI)

1.34 [0.89, 2.03]

6 Acute stroke Show forest plot

5

11218

Risk Ratio (M‐H, Fixed, 95% CI)

0.92 [0.50, 1.70]
Figuras y tablas -
Comparison 9. Alpha‐2 adrenergic agonists versus control in non‐cardiac surgery within past 20 years
Ir a la tabla de la revisión
Comparison 10. Alpha‐2 adrenergic agonists versus control in cardiac surgery within past 20 years

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 All‐cause mortality Show forest plot

13

1782

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.23, 0.97]

2 Myocardial infarction Show forest plot

4

593

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.22, 3.03]

3 Myocardial ischaemia Show forest plot

7

908

Risk Ratio (M‐H, Fixed, 95% CI)

0.72 [0.54, 0.96]

4 Supraventricular tachyarrhythmia Show forest plot

5

964

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.44, 1.19]

5 Heart failure Show forest plot

2

445

Risk Ratio (M‐H, Fixed, 95% CI)

0.92 [0.48, 1.77]

6 Acute stroke Show forest plot

6

1095

Risk Ratio (M‐H, Fixed, 95% CI)

0.37 [0.14, 0.98]
Figuras y tablas -
Comparison 10. Alpha‐2 adrenergic agonists versus control in cardiac surgery within past 20 years
Ir a la tabla de la revisión