Calcium is an essential mineral that plays multiple critical roles during surgical procedures, making it vital for patient safety and successful outcomes. It is fundamental for heart function, facilitating the contraction and relaxation of cardiac muscles to maintain proper rhythm during surgery. Calcium also plays a key role in blood clotting, activating necessary clotting factors to form stable clots and prevent excessive bleeding. Additionally, it influences vascular smooth muscle regulation, impacting blood pressure and flow, particularly as anesthetics modulate calcium signaling in these muscles. Moreover, calcium is pivotal for immune cell function, supporting the activation and differentiation of immune cells to help prevent infections during recovery. Lastly, it contributes to wound healing by facilitating hemostasis, promoting cellular migration and tissue repair, and supporting collagen formation, which strengthens the tissue as it heals. 

Mechanisms of Action and Benefits:

• Cardiomyocyte Function: Calcium is fundamental for excitation-contraction coupling in cardiomyocytes. It regulates the contraction and relaxation of heart muscles by controlling calcium influx through L-type calcium channels and release from the sarcoplasmic reticulum. This process ensures proper heart function and rhythmicity.(1)
• Coagulation and Anticoagulation: Calcium ions are critical in the blood coagulation cascade, facilitating the activation of clotting factors, particularly in the intrinsic and extrinsic pathways of coagulation. Deficiency in calcium can impair clot formation, while excessive calcium might promote coagulation.(2)
• Vascular Smooth Muscle Regulation: Calcium plays a central role in vascular smooth muscle contraction, affecting vascular tone and blood pressure. General anesthetics may modulate calcium signaling in vascular smooth muscle, influencing vasodilation or vasoconstriction during surgery.(3).
• Immune Cell Function: Calcium is a pivotal second messenger in immune cells. It regulates activation, differentiation, and cytokine production in T-cells, B-cells, and macrophages. Disruptions in calcium signaling can impair immune responses, affecting inflammation and pathogen defense.(4) 
• Wound Healing: Calcium plays a crucial role in various stages of wound healing. It is vital for hemostasis, acting as a cofactor in the coagulation cascade to form a stable fibrin clot and prevent further bleeding. Additionally, calcium facilitates cellular migration and proliferation, regulating the movement of keratinocytes and fibroblasts, which are necessary for tissue repair. It also aids in immune response by supporting the function of macrophages and neutrophils, clearing debris, and preventing infection. Finally, calcium is essential for collagen formation and tissue remodeling, contributing to tissue strength and proper wound closure during the healing process.(1,2,4)

References:

1. Gilbert G, Demydenko K, Dries E, et al. Calcium Signaling in Cardiomyocyte Function. Cold Spring Harb Perspect Biol. 2020;12(3) Published March 2, 2020.
2. Mikaelsson ME. The Role of Calcium in Coagulation and Anticoagulation. In: Sibinga CTS, Das PC, Mannucci PM, eds. Coagulation and Blood Transfusion. Developments in Hematology and Immunology. Vol 26. Springer; 1991.
3. Akata M, Warltier DC. General Anesthetics and Vascular Smooth Muscle: Direct Actions of General Anesthetics on Cellular Mechanisms Regulating Vascular Tone. Anesthesiology. 2007;106(2):365-391.
4. Vig M, Kinet JP. Calcium signaling in immune cells [published correction appears in Nat Immunol. 2009;10(2):223]. Nat Immunol. 2009;10(1):21-27.