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The POISE-2 clonidine trial tested whether starting clonidine around the time of noncardiac surgery could reduce perioperative cardiovascular events. The strategy did not reduce the risk of the primary cardiovascular outcome and was associated with clinically important adverse effects, including increased risk of hypotension and nonfatal cardiac arrest. The findings are a useful reminder that aggressive perioperative pharmacologic manipulation is not automatically beneficial. Clonidine can alter sympathetic activity and blood pressure, but perioperative physiology is complex, and medication effects may be harmful when applied broadly without a clear indication. For surgeons and perioperative teams, the practical message is to prioritize evidence-based hemodynamic management and avoid routine prophylactic clonidine for cardiovascular event prevention. Medication decisions should be individualized according to the patient’s baseline treatment, autonomic status, blood-pressure control and operative risk. The trial also reinforces the need to evaluate both efficacy and harm when considering interventions intended to improve surgical outcomes.
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The POISE-2 clonidine trial tested whether starting clonidine around the time of noncardiac surgery could reduce perioperative cardiovascular events. The strategy did not reduce the risk of the primary cardiovascular outcome and was associated with clinically important adverse effects, including increased risk of hypotension and nonfatal cardiac arrest. The findings are a useful reminder that aggressive perioperative pharmacologic manipulation is not automatically beneficial. Clonidine can alter sympathetic activity and blood pressure, but perioperative physiology is complex, and medication effects may be harmful when applied broadly without a clear indication. For surgeons and perioperative teams, the practical message is to prioritize evidence-based hemodynamic management and avoid routine prophylactic clonidine for cardiovascular event prevention. Medication decisions should be individualized according to the patient’s baseline treatment, autonomic status, blood-pressure control and operative risk. The trial also reinforces the need to evaluate both efficacy and harm when considering interventions intended to improve surgical outcomes.
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