title: A randomized, blinded, placebo-controlled evaluation of calcium chloride and epinephrine for inotropic support after emergence from cardiopulmonary bypass.
abstract: Forty hemodynamically stable patients were randomized to receive an intravenous bolus of either calcium chloride (5 mg/kg) (n = 20) or placebo (n = 20) (phase I). Six minutes later, they received either an epinephrine (30 ng.kg-1.min-1) (n = 20) or placebo (n = 20) infusion (phase II). Hemodynamic and ionized calcium measurements were obtained in phase I at baseline and at 3 and 6 min after the bolus, and in phase II, at 3 and 6 min (study times 9 and 12 min) after initiation of the infusion. Compared with placebo, calcium did not significantly increase cardiac index but significantly increased mean arterial pressure. Calcium improved cardiac index from 2.46 +/- 0.12 (mean +/- SEM) to 2.74 +/- 0.12 L.min-1.m-2; likewise, placebo improved cardiac index from 2.51 +/- 0.15 to 2.74 +/- 0.15 L.min-1.m-2. Mean arterial blood pressure increased with calcium from 74 +/- 2 to 82 +/- 3 mm Hg compared with a placebo change of 74 +/- 2 to 76 +/- 2 mm Hg. Patients who received the epinephrine infusion (n = 20) demonstrated a significant increase in cardiac index at time 12 min compared with patients receiving only placebo (n = 20). Cardiac index of the epinephrine group increased from 2.56 +/- 0.15 to 2.92 +/- 0.22 L.min-1.m-2, whereas in the placebo group it decreased from 2.86 +/- 0.13 to 2.78 +/- 0.12 L.min-1.m-2. Prior administration of calcium did not alter the subsequent response to epinephrine (n = 10) compared with patients receiving epinephrine alone (n = 10). We conclude that cardiac index improves with time without drug therapy after bypass. Calcium chloride increases mean arterial blood pressure but not cardiac index immediately after cardiopulmonary bypass, whereas low-dose epinephrine significantly increases both cardiac index and mean arterial blood pressure without causing tachycardia in these patients. Calcium chloride (5 mg/kg) did not augment or inhibit the hemodynamic response to an epinephrine infusion.
authors.affiliation: Department of Anesthesia, Wake Forest University Medical Center, Bowman Gray School of Medicine, Winston-Salem, North Carolina 27157-1009.
authors.forename: R L
authors.initials: RL
authors.lastname: Royster
authors.forename: J F
authors.initials: JF
authors.lastname: Butterworth
authors.forename: R C
authors.initials: RC
authors.lastname: Prielipp
authors.forename: P G
authors.initials: PG
authors.lastname: Robertie
authors.forename: N D
authors.initials: ND
authors.lastname: Kon
authors.forename: W Y
authors.initials: WY
authors.lastname: Tucker
authors.forename: L M
authors.initials: LM
authors.lastname: Dudas
authors.forename: G P
authors.initials: GP
authors.lastname: Zaloga
mesh_terms: D002118:Calcium / Q000097:blood; D002122:Calcium Chloride / Q000008:administration & dosage* / Q000494:pharmacology; D002315:Cardiopulmonary Bypass; D004347:Drug Interactions; D004837:Epinephrine / Q000008:administration & dosage* / Q000494:pharmacology; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period
chemical_list: D002122:Calcium Chloride; D002118:Calcium; D004837:Epinephrine