Effect of preoperative administration of systemic alpha-2 agonists on postoperative pain: a systematic review and meta-analysis

A bidirectional relationship exists between hypertension and psychiatric disorders, including unipolar and bipolar depression, anxiety, post-traumatic stress disorder (PTSD), psychosis, schizophrenia, mania, and dementia/cognitive decline. Repurposing of antihypertensive drugs to treat mental disorders is thus being explored. A systematic knowledge of the mechanisms of action and clinical consequences of the use of antihypertensive agents on neuropsychiatric functions has not been achieved yet. In this article, we review the putative role of antihypertensive agents in psychiatric disorders, discuss the targets and mechanisms of action, and examine how and to what extent specific drug classes/molecules may trigger, worsen, or mitigate psychiatric symptoms. In addition, we review pharmacokinetics (brain penetration of drugs) and pharmacogenetics data that add important information to assess risks and benefits of antihypertensive drugs in neuropsychiatric settings. The scientific literature shows robust evidence of a positive effect of α1 blockers on PTSD symptoms, nightmares and sleep quality, α2 agonists on core symptoms, executive function and quality of life in Attention-Deficit/Hyperactivity Disorder, PTSD, Tourette’s syndrome, and β blockers on anxiety, aggression, working memory, and social communication. Renin-angiotensin system modulators exert protective effects on cognition, depression, and anxiety, and the loop diuretic bumetanide reduced the core symptoms of autism in a subset of patients. There is no evidence of clear benefits of calcium channel blockers in mood disorders in the scientific literature. These findings are mainly from preclinical studies; clinical data are still insufficient or of anecdotal nature, and seldom systematic. The information herewith provided can support a better therapeutic approach to hypertension, tailored to patients with, or with high susceptibility to, psychiatric illness. It may prompt clinical studies exploring the potential benefit of antihypertensive drugs in selected patients with neuropsychiatric comorbidities that include outcomes of neuropsychiatric interest and specifically assess undesirable effects or interactions.

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“… 36 Further effects of α2 agonists include the reduction of anaesthetic and opioid dose requirements in the context of surgery. 37 …”

Section: Adrenergic Modulatorsmentioning

confidence: 99%

Antihypertensive drugs and brain function: mechanisms underlying therapeutically beneficial and harmful neuropsychiatric effects

Carnovale

Perrotta

Baldelli

et al. 2022

Cardiovascular Research

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“…B. [ 24 ]). Insgesamt sind die Ergebnisse hier jedoch inkonsistent, sodass eine abschließende Beurteilung noch schwierig ist [ 48 ].…”

Section: Perioperative äNgsteunclassified

Perioperative Ängste und die Angst vor dem Tod

Mavrogiorgou

Zogas

et al. 2023

Anaesthesiologie

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ZusammenfassungIn der Anästhesiologie wird man häufig mit Patienten konfrontiert, die unter perioperativen Ängsten und speziell der Angst vor dem Tod leiden, dies gilt jedoch nicht nur für die Anästhesiologie, sondern auch für die Psychiatrie und die Psychotherapie. Bislang ist die Literaturlage hierzu begrenzt, und daher werden diesem Übersichtsartikel die wichtigsten Arten von perioperativer Angst, diagnostische Aspekte sowie Risikofaktoren thematisiert. Anxiolytisch werden klassischerweise Benzodiazepine eingesetzt, in den letzten Jahren ist jedoch die präoperative Angst reduzierende Wirkung von z. B. supportiven Gesprächen, Akupunktur, Aromatherapie und Entspannungsverfahren stärker in den Fokus geraten, da Benzodiazepine unter anderen ein postoperatives Delir mit Zunahme von Morbidität und Mortalität fördern. Perioperative Ängste vor dem Tod sollten jedoch klinisch und wissenschaftlich verstärkt in den Blick genommen werden, um nicht nur die Patienten präoperativ besser versorgen, sondern auch um nachteilige Folgen im Verlauf von Operationen und danach reduzieren zu können.

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“…Additionally, due to their sedative, analgesic and also opioid-sparing effects, α2 adrenergic agonists can be administered during surgery or postoperatively not only to reduce the postoperative pain but also decrease opioid consumption. While a meta-analysis from 2020 had trouble to increase the evidence of this, they are still suggesting further large randomized controlled studies for the problem [31].…”

Section: Future Perspectivesmentioning

confidence: 99%

Alpha adrenergic receptors in clinical practice – Present and future

Lechsner

Bán

2022

Acta Marisiensis - Seria Medica

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In this review we discuss the adrenergic pathways for alpha 1 and alpha 2 receptors and the current as well as potential future medication targeting these receptors. Overall, there is ongoing research into a multitude of directions with a promising outlook for alpha 1 and alpha 2 adrenergic receptors. The alpha 1-adrenergic receptor subfamily is currently modulating only a modest number of nervous system functions due the fact, that only a relatively small number of selective commercial products are available. Chronic stress can affect the long-term depression of alpha 1 receptors. Recent studies are searching for new molecular targets which might act on these receptors. Presynaptic alpha 2 receptors play an important role in modulating release of several neurotransmitters in the central nervous system. The future of alpha 2 adrenergic receptors in clinical practice looks even more promising and versatile than that of alpha 1 adrenergic receptors. Alpha 2 adrenergic receptors show different responses, especially regarding hypertension and heart failure treatment, and current research suggests a genetic component as a cause, which is being explored further.

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Effect of preoperative administration of systemic alpha-2 agonists on postoperative pain: a systematic review and meta-analysis

Cited by 6 publications

References 21 publications

Antihypertensive drugs and brain function: mechanisms underlying therapeutically beneficial and harmful neuropsychiatric effects

Antihypertensive drugs and brain function: mechanisms underlying therapeutically beneficial and harmful neuropsychiatric effects

Perioperative Ängste und die Angst vor dem Tod

Alpha adrenergic receptors in clinical practice – Present and future

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