Impact of acute changes in perfusion index and blood pressure on the accuracy of non-invasive continuous hemoglobin concentration measurements during induction of anesthesia

Saito, Junichi; Kitayama, Masato; Amanai, Erika; Toyooka, Kentaro; Hirota, Kazuyoshi

doi:10.1007/s00540-017-2306-6

Cited by 5 publications

(6 citation statements)

References 10 publications

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“…Furthermore, Michel and Phillips 18 showed that an abruptly lowered capillary pressure caused an reabsorption of fluid from the tissues to the capillary, which supports our finding of a hypotension‐induced transient fluid absorption. Finally, we have in a previous study reported a similar decrease in Hct and an increase in PV in parallel to a decrease in MAP, 15 which is in line with studies by Sano and Saito 19,20 …”

Section: Discussionsupporting

confidence: 91%

“…No adverse effects were encountered during the study protocol on heart rate, ST-segment, cerebral oxygenation or arterial lactate. 19,20 Our data on TER, the disappearance rate of radiolabelled albumin from plasma, are in line with previous studies showing a diffusion of albumin over endothelial structures with a rate of 5.0%…”

Section: Ta B L E 1 Patient Demographics and Characteristicssupporting

confidence: 91%

“…We conducted a single-centre, prospective randomized study at Sahlgrenska University Hospital, Gothenburg, Sweden. The study was approved by the Regional Ethical Review Board in Gothenburg (protocol number: 389-16), by the Sahlgrenska Radiation Safety Committee (protocol number [16][17][18][19][20] and by the Swedish Medical Products Agency (EduraCT number 2016-004961-16). The trial was registered at http://www.Clini calTr ials.gov (NCT02832596) before enrolment and performed according to Good Clinical Practice and the Declaration of Helsinki.…”

Section: Ethicsmentioning

confidence: 99%

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Effects of different mean arterial pressure targets on plasma volume, ANP and glycocalyx—A randomized trial

Damén

Saadati

Forssell-Aronsson

et al. 2020

Acta Anaesthesiol Scand

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Section: Discussionsupporting

confidence: 91%

Section: Ta B L E 1 Patient Demographics and Characteristicssupporting

confidence: 91%

Section: Ethicsmentioning

confidence: 99%

See 1 more Smart Citation

Effects of different mean arterial pressure targets on plasma volume, ANP and glycocalyx—A randomized trial

Damén

Saadati

Forssell-Aronsson

et al. 2020

Acta Anaesthesiol Scand

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“…Pulse CO-Oximetry is a promising technique that provides noninvasive, continuous detection of anemia but cannot be used as a substitute for invasive Hb measurements. Multiple factors, such as serious anemia and large amounts of vascular drugs leading to poor peripheral perfusion [11, 12], can reduce the accuracy of SpHb monitoring. We also found the decreased accuracy during blood loss.…”

Section: Discussionmentioning

confidence: 99%

Continuous noninvasive hemoglobin monitoring estimates timing for detecting anemia better than clinicians: a randomized controlled trial

Tang

et al. 2019

BMC Anesthesiol

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Background Hemoglobin measurement is important for transfusion decision-making. Pulse CO-Oximetry provides real-time continuous hemoglobin (SpHb) monitoring. The triage role of SpHb trends based on hemoglobin measurements was investigated. Methods In this diagnostic randomized controlled trial, 69 patients undergoing spine or cytoreductive surgery were randomly enrolled into SpHb-monitoring and standard-care groups. Diagnostic blood samples were drawn for CO-oximetry Hb (CoOxHb) when the SpHb decreased by 1 g/dl or at the clinician’s discretion in the standard-care group. The positive predictive value (PPV) was defined as the ability to detect a decrease in CoOxHb > 1 g/dl or a CoOxHb < 10 g/dl; the PPVs were compared using Fisher’s exact test. The SpHb and trend accuracies were calculated. The transfusion units and postoperative hemoglobin levels were compared. Results The PPV of a decrease in CoOxHb > 1 g/dl was 93.3% in the SpHb group vs 54.5% without SpHb monitoring ( p = 0.002). The PPV of CoOxHb < 10 g/dl was 86.7% vs. 50.0% for these groups ( p = 0.015). The CoOxHb was never < 7 g/dl with SpHb monitoring. Sixty SpHb–CoOxHb data pairs and 28 delta pairs (ΔSpHb-ΔCoOxHb) were collected. The bias, precision and limits of agreement were − 0.29, 1.03 and − 2.30 to 1.72 g/dl, respectively. When ΔSpHb and ΔCoOxHb were > 1 g/dl, the concordance rate for changes in hemoglobin reached 100%. The delta pairs revealed a positive correlation [ΔSpHb = 0.49 * ΔCoOxHb - 0.13; r = 0.69, 95% confidence interval (0.53, 0.82)]. No significant differences were found in the transfusion volume or postoperative anemia state. Conclusions The SpHb trend tracked changes in hemoglobin satisfactorily during surgery and more accurately estimated the appropriate timing for invasive hemoglobin measurements than the clinicians. Trial registration ChiCTR1800016290 (Prospective registered). Initial registration date was 24/05/2018.

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“…Although radial blood flow decreased immediately and recovered 5 min after cannulation, blood flow reduction at the fingertip may have occurred because the diameters of the radial artery or its dorsal branch significantly decreased after cannulation [ 26 , 27 ]. Fourth, SpHb with PI of <1.0 should be excluded from the final analysis because the decrease in PI after phenylephrine administration reduced the changes in the bias values after anesthesia induction [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Continuous and Noninvasive Hemoglobin Monitoring in the Presence of CO2 Insufflation: An Observational Pilot Study

et al. 2021

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Background Laparoscopic surgery has several benefits, but it requires prolonged carbon dioxide (CO 2 ) insufflation. Several factors affect the accuracy of continuous and noninvasive hemoglobin (SpHb) monitoring, but the effects of CO 2 insufflation are undetermined. This study investigated the effect of CO 2 insufflation on SpHb monitoring in laparoscopic surgery. Material/Methods Twenty patients undergoing laparoscopic gastrectomy were enrolled. Anesthesia was maintained using sevoflurane and remifentanil within an end-tidal CO 2 of 30–45 mmHg. The CO 2 insufflation was maintained at 12 mmHg using CO 2 . SpHb was monitored with a Radical-7 Pulse CO-Oximeter, and laboratory hemoglobin (tHb) was analyzed using a satellite blood analyzer. Results Forty paired measurements were analyzed. The mean perfusion index, SpHb, and tHb were 3.10±1.77%, 10.92±1.48 g/dL, and 11.51±0.88 g/dL, respectively. SpHb underestimated tHb with a bias (precision) of −0.59 (1.28 g/dL), and the 95% limit of agreement was wide (−3.11 to 1.92 g/dL). SpHb was moderately correlated with tHb ( r =0.50, 95% CI: 0.23 to 0.70). The concordance rate was 67%. ΔSpHb was not correlated with ΔtHb ( r =0.29, 95% CI: −0.18 to −0.65). A similar bias, wider limits of agreement, a higher |SpHb-tHb|, but more significant correlation between SpHb and tHb were observed for the “PaCO 2 <40 mmHg” range compared with the “40 mmHg ≤PaCO 2 ” range. Conclusions SpHb may have an acceptable accuracy but has a weak trending ability in the presence of CO 2 insufflation, and it can be affected by PaCO 2 . Further research on the effects of CO 2 insufflation on SpHb is needed.

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Impact of acute changes in perfusion index and blood pressure on the accuracy of non-invasive continuous hemoglobin concentration measurements during induction of anesthesia

Abstract: The findings suggest that blunting the increase in PI by maintaining arterial pressure during induction of anesthesia improves the agreement between SpHb and tHb values.

Cited by 5 publications

References 10 publications

Effects of different mean arterial pressure targets on plasma volume, ANP and glycocalyx—A randomized trial

Effects of different mean arterial pressure targets on plasma volume, ANP and glycocalyx—A randomized trial

Continuous noninvasive hemoglobin monitoring estimates timing for detecting anemia better than clinicians: a randomized controlled trial

Accuracy of Continuous and Noninvasive Hemoglobin Monitoring in the Presence of CO2 Insufflation: An Observational Pilot Study

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