This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Zaloga, G. P. Articles by Lake, C. R. Search for Related Content PubMed PubMed Citation Articles by Zaloga, G. P. Articles by Lake, C. R.

Circulation, Vol 81, 196-200, Copyright © 1990 by American Heart Association

ARTICLES

Calcium attenuates epinephrine's beta-adrenergic effects in postoperative heart surgery patients

GP Zaloga, RA Strickland, JF Butterworth 4th, LJ Mark, SA Mills and CR Lake
Department of Anesthesia, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27103.

Epinephrine and calcium possess both cardiac inotropic and vasopressor activity. In addition, epinephrine's cardiovascular effects are mediated via increases in intracellular calcium. As a result, many clinicians administer the two agents together in an attempt to augment their effects. Although this approach seems rational, it has never been proven effective. We evaluated the cardiovascular and hyperglycemic actions of epinephrine (10 and 30 ng/kg/min), with and without calcium chloride administration (10 mg/kg bolus followed by 2 mg/kg/hr infusion), in a prospective, randomized, blinded, crossover designed study. Twelve adult patients were studied 1 day after aortocoronary bypass surgery. Calcium chloride raised ionized calcium levels from 1.06 +/- 0.03 (mean +/- SEM) to 1.44 +/- 0.05 mM (p less than 0.05). Calcium raised mean arterial pressure from 85 +/- 1 to 94 +/- 2 mm Hg (p less than 0.05) but had no significant effect on cardiac index. Epinephrine alone at 10 and 30 ng/kg/min significantly raised cardiac index from 2.7 +/- 0.2 to 3.0 +/- 0.2 (p less than 0.05) and 3.6 +/- 0.3 (p less than 0.05) l/min/m2. After calcium, epinephrine failed to significantly increase cardiac index. Epinephrine at 30 ng/kg/min significantly increased mean arterial pressure from 87 +/- 1 to 95 +/- 2 mm Hg (p less than 0.05). After calcium, epinephrine had no significant effect on blood pressure. In addition, epinephrine's hyperglycemic effect was blunted by calcium. Plasma epinephrine levels were similar during control and calcium infusions. We conclude that calcium blunts epinephrine's beta-adrenergic actions in postoperative cardiac surgery patients.

This article has been cited by other articles:

				J. H. Levy, K. A. Tanaka, and J. M. Bailey Cardiac Surgical Pharmacology Card. Surg. Adult, January 1, 2008; 3(2008): 77 - 110. [Full Text]

				K. B. Walsh and Q. Cheng Intracellular Ca2+ regulates responsiveness of cardiac L-type Ca2+ current to protein kinase A: role of calmodulin Am J Physiol Heart Circ Physiol, January 1, 2004; 286(1): H186 - H194. [Abstract] [Full Text] [PDF]

				C.-Y. Li, T.-C. Chou, C.-H. Lee, C.-S. Tsai, S.-H. Loh, and C.-S. Wong Adrenaline Inhibits Lipopolysaccharide-Induced Macrophage Inflammatory Protein-1{alpha} in Human Monocytes: The Role of {beta}-Adrenergic Receptors Anesth. Analg., February 1, 2003; 96(2): 518 - 523. [Abstract] [Full Text] [PDF]

				J. M. Bailey, K. A. Tanaka, and J. H. Levy Cardiac Surgical Pharmacology Card. Surg. Adult, January 1, 2003; 2(2003): 85 - 118. [Full Text]

				K. B Walsh and G. E Parks Changes in cardiac myocyte morphology alter the properties of voltage-gated ion channels Cardiovasc Res, July 1, 2002; 55(1): 64 - 75. [Abstract] [Full Text] [PDF]

				P. B Baines, A. P J Thomson, W. D Fraser, and C A. Hart Hypocalcaemia in severe meningococcal infections Arch. Dis. Child., December 1, 2000; 83(6): 510 - 513. [Abstract] [Full Text]

				M. B. Vroom Pharmacologic Management of Acute Heart Failure: A Review Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 1998; 2(3): 191 - 203. [Abstract] [PDF]