Intraoperative continuous noninvasive hemoglobin monitoring in patients with placenta previa undergoing cesarean section: a prospective observational study

BACKGROUND: Obstetric patients with placenta previa are at risk for sever peripartum hemorrhage. Early detection of anemia and proper transfusion strategy are important for the management of obstetric hemorrhage. In this study, we assessed the utility and accuracy of noninvasive hemoglobin (SpHb) monitoring in patients with placenta previa during cesarean section.METHODS: Parturients diagnosed with placenta previa and scheduled for cesarean section under spinal anesthesia were enrolled. SpHb and laboratory Hb (Lab-Hb) were measured during surgery as primary outcomes.RESULTS: Seventy-four pairs of SpHb and Lab-Hb were collected from 39 patients. The correlation coefficient was 0.877 between SpHb and Lab-Hb (P < 0.001). The Bland-Altman plot showed a mean difference ± SD of 0.3 ± 0.8 g/dl between noninvasive Hb and Lab-Hb, and the limits of agreement were −1.2 to 1.8 g/dl. The magnitude of the difference between SpHb and Lab-Hb was < 0.5 g/dl in 64.9%; however, it was > 1.5 g/dl in 10.8%.CONCLUSIONS: SpHb monitoring had a good correlation with Lab-Hb. A small mean difference between SpHb and lab-Hb might not be clinically significant; however, the limits of agreements were not narrow. In particular, SpHb could be overestimated in the anemic population. Based on our results, further studies investigating the accuracy and precision of SpHb monitoring should be performed in parturients presenting Hb below 10 g/dl.

Comparison between continuous noninvasive hemoglobin monitoring and venous blood hemoglobin monitoring in children with kidney disease / 北京大学学报(医学版)

Objective:To assess the correlation and consistency between continuous noninvasive hemo globin detection and venous blood hemoglobin detection in children with kidney disease,and try to analyze the affecting factors.Try to provide a reference for the monitoring of hemoglobin in children with kid ney disease by continuous noninvasive hemoglobin detection technique.Methods:Eighty-five inpatient children with kidney disease,50 boys (58.8％) and 35 girls (41.2％),aged from 3 years old to 18 years old (9.35 ± 4.29) were included finally.Noninvasive hemoglobin monitoring by spectrophotometry (SpHb) was stably read by PRONTO-7,selecting the ring finger of the non handedness as the detection site.And then the venous blood hemoglobin of the same patient was collected in 5 minutes as the true hemoglobin (tHb) by Beckman coulter DXH-800.The data of SpHb and tHb were compared and analyzed using SPSS 17.0 and MedCalc.Results:Correlation analysis showed data of SpHb and tHb were with significant correlation,the correlation coefficient between SpHb and tHb was 0.85 (P ＜ 0.05).BlandAltman plot points suggested that the mean of differences between SpHb and tHb was-1.3 g/dL.The 95％ CI of agreement of SpHb-tHb was-4.2-1.5 g/dL,suggesting that the average measurement re sult of SpHb was lower than that of tHb.The mean of differences as percent between SpHb and tHb was -9.8％,95％ CI of agreement was (-35.9％,16.2％) exceeding the acceptable range of true value ± 6％.The consistent rate of non-invasive hemoglobin detection and venous blood hemoglobin detection was 31.8％,the 95％ CI of consistent rate was (21.7％,41.9％).The chi square test of the fourfold table showed that the diagnosis of anemia with SpHb was of high sensitivity,but the specificity was low,the false positive rate was high,and the difference was statistically significant (P =0.000).Conclusion:There was a significant correlation between SpHb and tHb in the children with kidney disease.Noninvasive hemoglobin measurement can be used for monitoring of changes of hemoglobin in children with kidney diseases.But the consistency between SpHb and tHb needs to be improved.Noninvasive hemoglobin measurement could not replace the venous hemoglobin measurement.It could not be used for the diagnosis of anemia,and the accuracy of hemoglobin concentration measurement in children with kidney disease should be further explored.

Factor XI deficiency and orthognathic surgery: a case report on anesthesia management

Factor XI deficiency (Hemophilia C) is a very rare autosomal recessive bleeding disorder. Patients with factor XI deficiency do not typically show any spontaneous bleeding or specific symptoms. Sometimes those who have this disorder are identified during special situations such as trauma or surgery. Orthognathic surgery is particularly associated with a high bleeding risk. Therefore, great care must be taken when treating patients with bleeding disorders such as factor XI deficiency. There are a few reports that address the management of patients with bleeding disorders during orthognathic surgery. The current report describes a patient with factor XI deficiency who underwent Le Fort I osteotomy together with bilateral sagittal split osteotomy. The patient's condition was assessed using both rotation thromboelastometry (ROTEM™) and noninvasive measurements of total hemoglobin (SpHb) using Masimo Radical 7 (Masimo Co. CA, USA).