title: Unreliable Tracking Ability of the Third-Generation FloTrac/Vigileo™ System for Changes in Stroke Volume after Fluid Administration in Patients with High Systemic Vascular Resistance during Laparoscopic Surgery.
abstract: BACKGROUND
  The FloTrac/Vigileo™ system does not thoroughly reflect variable arterial tones, due to a lack of external calibration. The ability of this system to measure stroke volume and track its changes after fluid administration has not been fully evaluated in patients with the high systemic vascular resistance that can develop during laparoscopic surgery.
  
  
  METHODS
  In 42 patients undergoing laparoscopic prostatectomy, the stroke volume derived by the third-generation FloTrac/Vigileo™ system (SV-Vigileo), the stroke volume measured using transesophageal echocardiography (SV-TEE) as a reference method, and total systemic vascular resistance were evaluated before and after 500 ml fluid administration during pneumoperitoneum combined with the Trendelenburg position.
  
  
  RESULTS
  Total systemic vascular resistance was 2159.4 ± 523.5 dyn·s/cm5 before fluid administration. The SV-Vigileo was significantly higher than the SV-TEE both before (68.8 ± 15.9 vs. 57.0 ± 11.0 ml, P < 0.001) and after (73.0 ± 14.8 vs. 64.9 ± 12.2 ml, P = 0.003) fluid administration. During pneumoperitoneum combined with the Trendelenburg position, Bland-Altman analysis for repeated measures showed a 53.8% of percentage error between the SV-Vigileo and the SV-TEE. Four-quadrant plot (69.2% of a concordance rate) and polar plot analysis (20.6° of a mean polar angle, 16.4° of the SD of a polar angle, and ±51.5° of a radial sector containing 95% of the data points) did not indicate a good trending ability of the FloTrac/Vigileo™ system.
  
  
  CONCLUSIONS
  The third-generation FloTrac/Vigileo™ system may not be useful in patients undergoing laparoscopic surgery, based on unreliable performance in measuring the stroke volume and in tracking changes in the stroke volume after fluid administration during pneumoperitoneum combined with the Trendelenburg position.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Chin
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Wook-Jong
authors.initials: WJ
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, School of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Jeong-Hyun
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Yun A
authors.initials: YA
authors.lastname: Han
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Seon-Ok
authors.initials: SO
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Woo-Jong
authors.initials: WJ
authors.lastname: Choi
mesh_terms: D000368:Aged; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011027:Pneumoperitoneum / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D014655:Vascular Resistance; D020535:Video-Assisted Surgery / Q000379:methods*