Miyazaki 2009.

Methods	RCT, parallel group
Participants	Total number of randomized participants: 63 Inclusion criteria: elderly (> 70 years of age); with or without hypertension; scheduled for surgery under GA Exclusion criteria: ASA status III, IV or V; atrioventricular block > 1st degree; history of drug allergy; asthma; bronchospasm; COPD; coronary artery disease; HR < 50 bpm; SBP < 80 mmHg 1 min before administration of landiolol Type of surgery: orthopaedic or gynaecological surgery Baseline characteristics Intervention group (landiolol ‐ hypertensive participants) Age, mean (SD): 74 (± 4) years Intervention group (landiolol ‐ normotensive participants) Age, mean (SD): 73 (± 3) years Control group (placebo ‐ hypertensive participants) Age, mean (SD): 75 (± 4) years Control group (placebo ‐ normotensive participants) Age, mean (SD): 76 (± 5) years Country: Japan Setting: single centre; hospital
Interventions	Intervention group (landiolol ‐ hypertensive and normotensive participants) Randomized, n = 32; losses = 0; analysed, n = 32 (use of ITT analysis not reported) Details: landiolol infusion 0.125 mg/kg/min for 1 min started during emergence from anaesthesia, then decreased to 0.04 mg/kg/min until extubation Control group (placebo ‐ hypertensive and normotensive participants) Randomized, n = 31; losses = 0; analysed, n = 31 Details: normal saline given same as the intervention group
Outcomes	Outcomes measured/reported by study authors: haemodynamic parameters; bradycardia (HR < 50 bpm) Outcomes relevant to the review: bradycardia
Notes	Funding/declarations of interest: not reported Study dates: not reported Notes: study investigators stratified randomized participants who had hypertension or who were normotensive into landiolol or control group, thus reporting four groups. We combined data in analysis for hypensive and normotensive participants
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Use of a random‐number table
Allocation concealment (selection bias)	Unclear risk	Not specified
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Quote: "All persons present during the study were blinded to the identity of the infusion being administered"
Blinding of outcome assessors (detection bias) All outcomes	Low risk	See above
Incomplete outcome data (attrition bias) All outcomes	Low risk	No apparent losses
Selective reporting (reporting bias)	Unclear risk	Study authors did not report prospective clinical trial registration or publication of a protocol. It was not feasible to effectively assess risk of reporting bias
Other bias	Low risk	Not detected