Calcium chloride minimizes the hemodynamic effects of propofol in patients undergoing coronary artery bypass grafting

Related Experiment Video

Updated: Oct 23, 2026

Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft

Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft

Published on: September 15, 2023

L Tritapepe¹, P Voci, P Marino

¹Department of Anesthesia and Intensive Care, University of Rome La Sapienza, Azienda Ospedaliera S Giovanni e Addolorata, Italy.

Journal of Cardiothoracic and Vascular Anesthesia

|May 7, 1999

Insights

Calcium chloride (CaCl2) administration during anesthesia induction mitigates propofol's negative cardiac effects in coronary artery bypass grafting patients. This intervention preserves hemodynamic stability, crucial for cardiac surgery outcomes.

Area of Science:

Cardiovascular Anesthesiology
Pharmacology
Cardiac Surgery

Background:

Propofol is a common anesthetic agent.
Anesthetic induction can negatively impact cardiac function, especially in patients with compromised cardiovascular systems.
Coronary artery bypass grafting (CABG) patients are particularly vulnerable to hemodynamic changes during surgery.

Purpose of the Study:

To evaluate the hemodynamic effects of propofol during anesthesia induction.
To determine if calcium chloride (CaCl2) can counteract propofol-induced negative cardiac effects.
To assess the safety and efficacy of this intervention in CABG patients.

Main Methods:

A prospective, randomized study was conducted with 58 patients undergoing elective CABG.
Patients received fentanyl, pancuronium, and propofol for anesthesia induction.
Group A received saline, while Group B received calcium chloride (CaCl2) concurrently with propofol.

Main Results:

Propofol significantly decreased heart rate, mean arterial pressure, stroke volume index, cardiac index, and cardiac output in the control group (Group A).
In contrast, patients receiving CaCl2 (Group B) exhibited negligible changes in these hemodynamic parameters.
Mean arterial pressure decreased significantly in both groups, but less so in the CaCl2 group.

Conclusions:

Simultaneous administration of calcium chloride (CaCl2) during propofol induction minimizes adverse effects on cardiac function.
This strategy is beneficial for maintaining hemodynamic stability in patients undergoing cardiac surgery.
CaCl2 can be a valuable adjunct to propofol anesthesia in CABG patients.

Read full analysis

Abstract

Objective:

To assess the hemodynamic effects of propofol and the counteracting effect of calcium chloride (CaCl2) in patients undergoing coronary artery bypass grafting (CABG).

Design:

Prospective, randomized study.

Setting:

University hospital, department of cardiac surgery.

Participants:

Fifty-eight patients undergoing elective CABG, divided into group A (n = 29) and group B (n = 29).

Interventions:

Anesthesia was induced with a combination of fentanyl, 7 microg/kg; pancuronium, 0.1 mg/kg; and propofol, 1.5 mg/kg, administered over 60 seconds. A blinded investigator administered saline in group A patients and 10 mg/kg of CaCl2 in group B patients at the same speed and same time as propofol administration through another lumen of the central venous catheter.

Measurements And Main Results:

Hemodynamic data were obtained at baseline (T0), 2 minutes after anesthesia induction (T1), and 2 minutes after tracheal intubation (T2). Heart rate decreased significantly in group A patients (86.2+/-11.3 beats/min at T0 and 72.8+/-7.5 beats/min at T2; p < 0.001). Mean arterial pressure decreased significantly in patients in both groups (group A, 108.0+/-12.0 mmHg at T0; 74.6+/-14.6mmHg at T2;p < 0.001 and group B, 106.0+/-10.2 mmHg at T0; 90.4+/-10.0 mmHg at T2; p < 0.05). Stroke volume index, cardiac index, and cardiac output decreased in group A patients (39.4+/-4.1 mL/beat/m2 at T0 and 28.8+/-5.2 mL/beat/m2 at T2; p < 0.05; 3.4+/-0.6 L/min/m2 at T0 and 1.9+/-0.3 L/min/m2 at T2; p < 0.001; 5.9+/-0.9 L/min at T0 and 3.4+/-0.4 L/min at T2; p < 0.001, respectively), whereas in group B patients, changes were negligible (38.1+/-7.0 mL/beat/m2 at T0 v 35.7+/-6.6 mL/beat/m2 at T2; (NS) 3.3+/-0.5 L/min/m2 at T0 v 2.7+/-0.3 L/min/m2 at T2; (NS) 5.7+/-0.9 L/min at T0 v 4.7+/-0.5 L/min at T2; (NS), respectively).

Conclusion:

Simultaneous administration of CaCl2 during the induction of anesthesia minimizes the potential negative effect of propofol on cardiac function in cardiac patients.

More Related Videos

Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction

Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction

Published on: May 28, 2019

Related Concept Videos

Depolarizing Blockers: Pharmocokinetics

Depolarizing Blockers: Pharmocokinetics

Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...

Antianginal Drugs: Calcium Channel Blockers and Ranolazine

Antianginal Drugs: Calcium Channel Blockers and Ranolazine

Angina pectoris, a primary symptom of ischemic heart disease, requires careful pharmacological interventions. In this context, calcium channel blockers (CCBs) and ranolazine have emerged as crucial pharmacotherapeutic agents, providing deep insights into the complexities of angina management.
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...

Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers

Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers

Class IV antiarrhythmic drugs, such as verapamil and diltiazem, block calcium channels. They primarily affect the heart, slowing the conduction in calcium-dependent tissues like the SA and AV nodes. These drugs manage reentrant supraventricular tachycardia (SVT) and reduce ventricular rate in atrial flutter/fibrillation.
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...

Antiarrhythmic Drugs: Class I Agents as Sodium Channel Blockers

Antiarrhythmic Drugs: Class I Agents as Sodium Channel Blockers

Class I antiarrhythmic drugs are used to treat various types of arrhythmias or irregular heart rhythms. These drugs block the sodium (Na+) channels in the cardiac cells, thereby affecting the movement of electrical impulses across the heart. Class I antiarrhythmic drugs are divided into three subgroups: Class IA, Class IB, and Class IC, each with distinct mechanisms of action and effects on the heart.
Class 1A Antiarrhythmic Drugs: These drugs work by moderately blocking sodium channels,...

Parenteral Anesthetics: Overview

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.

Antihypertensive Drugs: Action of Calcium Channel Blockers

Antihypertensive Drugs: Action of Calcium Channel Blockers

Calcium ions are essential to contract smooth muscle cells in blood vessels. They enter these cells through voltage-dependent calcium channels, specifically L-type calcium channels in the cell membrane. These L-type calcium channels are integral to the excitation-contraction coupling process in smooth muscle. When a stimulus is received by smooth muscle cells, their membrane depolarizes. This alteration in membrane potential instigates the opening of L-type calcium channels. As a result,...

Articles linked to this work by shared authors, journal, and citation graph.

Real-world effectiveness comparison of first-line palbociclib, ribociclib or abemaciclib plus endocrine therapy in advanced HR-positive/HER2-negative BC patients: results from the multicenter PALMARES-2 study.

Annals of oncology : official journal of the European Society for Medical Oncology·2025

Has serum CA 125 assay at the time of relapse a prognostic relevance for patients with recurrent ovarian carcinoma after primary cytoreduction and platinum- and paclitaxel-based chemotherapy?

European journal of gynaecological oncology·2016

Mechanical circulatory support in advanced heart failure: single-center experience.

Transplantation proceedings·2014

Treatment with daptomycin for Corynebacterium Jeikeium left-sided prosthetic valve endocarditis.

Minerva anestesiologica·2011

Nosocomial infections in heart surgery patients: active surveillance in two Italian hospitals.

Annali di igiene : medicina preventiva e di comunita·2005

[Active surveillance of nosocomial infections in heart surgery patients: implementation of the American National Nosocomial Infections Surveillance (NNIS) System in a large hospital in Rome].

Annali di igiene : medicina preventiva e di comunita·2003

See all related articles