Obesity Surgery

, Volume 19, Issue 1, pp 131–133 | Cite as

Reply to Letter: Agreed: “PRAM May be Useful to Assess the Cardiovascular Changes in Obese Patients During Laparoscopy”

  • Donald P. BernsteinEmail author
Letter to the Editor

To the Editor:

I thank Dr. Forfori et al. for their critique of my commentary [1], but certain statements presented by them as fact must be clarified. First, notwithstanding an inherent reproducibility error of ±15–20% [2], pulmonary artery thermodilution cardiac output (TDCO) provides mean values at normal cardiac indices that agree with other reference standards. Fact: thermodilution is still the clinical gold-standard which all pretenders of equivalence must mimic. Other methods, if to be accepted as an equivalent or replacement for TDCO, must provide a small bias and reproducibility error, and limits of agreement within ±30%. In the face of this, Forfori et al. trivialize the studies of Nguyen et al. [3] and Artuso et al. [4], which both used TDCO as their test method to determine CO and the derived indices of cardiac index (CI) stroke volume SV, stroke index (SI) and systemic vascular resistance (SVR) and SVRI. Alleging equivalence to TDCO, the authors emphasize that their...


Sevoflurane Cardiac Index Systemic Vascular Resistance Stroke Index Impedance Cardiography 
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Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of Anesthesiology, Palomar Medical Center and the Palomar-Pomerado Research InstitutePalomar Medical CenterEscondidoUSA
  2. 2.Rancho Santa FeUSA

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