FloTrac for monitoring arterial pressure and cardiac output during phaeochromocytoma surgery

Abstract

EDITOR: The recently introduced FloTrac device (FloTrac/ Vigileo; Edwards Lifescience, Irvine, CA, USA) has been proposed as a reliable semi-invasive device for cardiac output (CO) measurements. Its technology is based on arterial pressure waveform analysis and needs no calibration. We report its use during a haemodynamically unstable situation where the FloTrac device was compared to a pulmonary arterial catheter (PAC) for the measurement of CO. Case report A 34-yr-old female presented for surgical management of multiple endocrine neoplasia type IIa (MEN IIa). She was scheduled for elective bilateral adrenal tumour removal and total thyroidectomy. After induction of general anaesthesia, radial artery catheter and PAC (continuous CO 7.5 F catheter; Edwards Lifescience) were inserted. The FloTrac device was then attached to the arterial canula and connected to the Vigileo monitor (version 1.10). Concurrent recording of CO indexed to body surface area (cardiac index, CI) were performed on the FloTrac (CI_FloTrac) and the PAC (CI_PAC) during and after the surgery. Additional information collected included heart rate, arterial pressure, anaesthetic and surgical events. During phaeochromocytoma surgery, we observed an episode of severe hypertension (MAP 5140mmHg) treated by deepening of anaesthesia and a bolus of urapidil (25mg). After adrenalectomy, hypotension was treated with ephedrine boluses, neosynephrine and then norepinephrine (up to 0.6 mgkg 21 min 21 )