Comparison of the accuracy of noninvasive hemoglobin monitoring for preoperative evaluation between adult and pediatric patients: a retrospective study

Abstract

We measured noninvasive hemoglobin (SpHb) levels during the pre-anesthesia visit in patients planning elective surgery. Differences between SpHb and laboratory-measured hemoglobin (Hb) were compared between adult and pediatric patients. In the pre-anesthesia visiting office, we routinely monitor noninvasive Hb levels with oxygen saturation and heart rate using Masimo Radical-7® Pulse CO-Oximetry (Masimo Corp., Irvine, CA, USA). We attached the R1 20 (body weight, 10-50 kg) or R1 25 (body weight > 30 kg) probe on the index finger. After signal stabilization, SpHb and perfusion index (PI) were recorded. We retrospectively reviewed the recorded data and included patients who visited the anesthesiologist within 24 h after venous sampling. Bias was calculated by subtracting Hb from SpHb. We compared the biases of adult and pediatric patients (< 18 years) and evaluated correlation coefficients between the bias and Hb. Records of 105 patients were reviewed and 100 data points of 50 patients in each group were analyzed. The median ± interquartile range bias was - 2.6 ± 2.2 and - 1.2 ± 1.5 g/dL in adult and pediatric patients, respectively (P < 0.001); the corresponding mean ± standard deviation PIs were 4.4 ± 3.1 and 5.9 ± 2.7, respectively (P = 0.19). Bias was inversely proportional to Hb irrespective of age. The correlation coefficient between the bias and Hb was - 0.81 in adults and - 0.54 in pediatric patients (P < 0.001). SpHb and Hb measured during pre-anesthesia visits showed a smaller difference in pediatric than in adult patients. Lower Hb corresponded to higher accuracy.

Feasibility and accuracy of noninvasive continuous hemoglobin monitoring using transesophageal photoplethysmography in porcine model

“…In acute hemorrhagic patients, SpHb showed significantly lower readings than the laboratory measurement to assess Hb concentration [ 19 , 20 ]. Park YH et al reported that the bias between SpHb and laboratory measured Hb increased with poor peripheral perfusion [ 21 , 22 ]. These results suggest that the limited application of SpHb in critically ill patients may be mainly due to the susceptibility of peripheral spectroscopy signal to impaired tissue perfusion, hypotension, hypothermia, and infusion of vasopressor [ 1 , 5 , 23 ].…”

Feasibility and accuracy of noninvasive continuous hemoglobin monitoring using transesophageal photoplethysmography

“…In acute hemorrhagic patients, SpHb showed signi cantly lower readings than the laboratory measurement to assess Hb concentration [19,20]. Park YH et al reported that the bias between SpHb and laboratory measured Hb increased with poor peripheral perfusion [21,22]. These results suggest that the limited application of SpHb in critically ill patients may be mainly due to the susceptibility of peripheral spectroscopy signal to impaired tissue perfusion, hypotension, hypothermia, and infusion of vasopressor [1,5,23].…”

When Anesthesiologists Should Stop Ordering a Tray of Blood Laboratory Tests Preoperatively in Cardiac and Non-cardiac Surgery?

“…I think it is time for a revolution in ordering BTs before surgery. The anesthesiologists have noninvasive hemoglobin monitoring [10], along with arterial blood gas, blood sugar, electrolyte assessment, coagulation studies like rotational thromboelastometry (ROTEM), and many other laboratory tests available in seconds in both cardiac and non-cardiac operating rooms(OR). There are new monitoring devices, safer drugs, more available therapeutic options in the OR, expansion of anesthesiologists knowledge in every fields, sophisticated anesthetic drug delivery systems(inhalational and intravenous), and in a word a safer condition for anesthesia management even in currently more difficult cases.…”