Application Of Continuous Noninvasive Hemoglobin Monitoring In Pediatric Anesthesia

ObjectiveTo evaluate the value of continuous noninvasive hemoglobin monitor in pediatric anesthesia by investigate the relationship and consistency between the SpHb measured by Masimo SET Radical-7 Pulse CO-Oximeter and the laboratory blood gas analysis results(Hbsatlab). Methods1 Thirty child patients undergoing operation with low risk of hemorrhage were enrolled in this study. The basic information was recorded including age, gender, weight, etc. SpHb was monitored continually and recorded 5 minutes after induction of anesthesia, 5 minutes after skin incision, every 2 hours during the surgery, and at the end of surgery. The arterial blood samples were collected and invasive hemoglobin(Hbsatlab) levels were measured at above mentioned time points. Hbsatlab levels were compared with the corresponding SpHb.2 Twenty child patients undergoing operation with high risk of hemorrhage were enrolled in this study. The basic information was recorded including age, gender, weight, etc. SpHb was monitored continually and recorded 5 minutes after induction of anesthesia, 5 minutes after skin incision, every 2 hours during the surgery, right time before and after blood transfusion, and at the end of surgery. The arterial blood samples were collected and invasive hemoglobin(Hbsatlab) levels were measured at above mentioned time points. Hbsatlab levels were compared with the corresponding SpHb.3 Twenty child patients undergoing resection of hemangioma were enrolled in this study. The basic information was recorded including age, gender, weight, etc. The patients were randomly divided into crystalloid group and colloid group which received a fluid administration of sodium lactate ringer’s injection or 4% succinylated gelatin injection for over 30 min during the dynamic phase. SpHb was monitored continually and recorded 5 minutes after induction of anesthesia, 5 minutes after skin incision, every 2 hours during the steady-state phase, every 10 minutes during the dynamic phase, and at the end of surgery. The arterial blood samples were collected and invasive hemoglobin(Hbsatlab) levels were measured at above mentioned time points. Hbsatlab levels were compared with the corresponding SpHb. The total fluid administration, blood transfusion volume, hemorrhage volume, urinary volume, duration of the operation and PI value were recorded at above mentioned time points. Results1 Pearson correlation analysis displayed that SpHb had a linear correlation with Hbsatlab. The regression equation was y=3.38+0.69 x, r=0.60, P<0.001. Bland-Altman analysis showed SpHb to Hbsatlab values were in good consistence. The mean difference between SpHb and Hbsatlab was 0.43g/dL with 95% CI being-0.9 to 1.8 g/dL.2 Pearson correlation analysis displayed that SpHb had a linear correlation with Hbsatlab. The regression equation was y=0.02+0.96 x, r=0.93, P<0.001. Bland-Altman analysis showed SpHb to Hbsatlab values were in good consistence. The mean difference between SpHb and Hbsatlab was 0.40g/dL with 95% CI being-0.9 to 1.7 g/dL. The hemoglobin error grid analysis displayed that 97.1%(101/104)spots were in Zone A, 2.9%(3/104) were in Zone B and none in Zone C.3 Pearson correlation analysis displayed that SpHb had a linear correlation with Hbsatlab. The regression equation was y=-0.6+1.04 x, r=0.97, P<0.001. The regression equation was y=-1.81+1.15 x, r=0.97, P<0.001 in the steady-state phase and was y=-1.03+1.1x,r=0.91,P<0.001 in the dynamic phase. Bland-Altman analysis showed SpHb to Hbsatlab values were in good consistence. The mean difference between SpHb and Hbsatlab was 0.15g/dL with 95% CI being-0.8 to 1.1 g/dL. The mean difference between SpHb and Hbsatlab was 0.10g/dL with 95% CI being-0.8 to 1.0 g/dL in the steady-state phase and was 0.14g/dL with 95% CI being-1.0 to 1.3 g/dL in the dynamic phase. Pearson correlation analysis displayed that |SpHb-Hbsatlab| had a linear correlation with Hbsatlab(r=-0.223,P<0.01) and PI(r=-0.582,P<0.001). Conclusion1 Continuous noninvasive hemoglobin measurement is an accurate method to monitor hemoglobin level in children undergoing operation with low risk of hemorrhage.2 Continuous noninvasive hemoglobin measurement is an accurate method to monitor hemoglobin level in children undergoing operation with high risk of hemorrhage. It is still be a question whether the SpHb can provide objective evidence for clinicians of blood transfusion.3 The accuracy of SpHb are influenced by the types of infusion fluid, Hbsatlab and PI. Although the SpHb accuracy decreases after colloid administration, it can still reflect real hemoglobin levels. The accuracy of SpHb increases first and then decreases with increasing Hbsatlab. It increases with increasing PI.