Calcium plays a central role in a large number of physiological actions that are essential for life. It is important therefore that the anaesthetist understands calcium pathophysiology. In this review, the physiology, regulation, clinical features, causes and treatment of alterations in circulating calcium will be discussed. In addition, the effects that acid-base status, massive blood transfusion and cardiopulmonary bypass may have on circulating calcium will be highlighted. Finally, the role that calcium plays in ischaemic/reperfusion injury and myocardial stunning will be summarised.
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