Blood Transfusion, Hemoglobins, Hemorrhage
Conditions
Brief summary
The primary aim of this study is to evaluate whether pulse oximetry based noninvasive hemoglobin (SpHb) monitoring can reduce the incidence of hemoglobin (Hb) level out of the target range in adult patients undergoing major surgery with the potential risk of bleeding.
Interventions
PROCEDURESpHb monitoring
Noninvasive, continuous pulse oximetry-based hemoglobin (SpHb) monitoring
PROCEDUREConventional management
Conventional management without SpHb monitoring
Sponsors
Seoul National University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
19 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients with ASA physical status class I, II, III, who scheduled to undergo elective non-cardiac major surgery with more than moderate risk of bleeding under general anesthesia or spinal anesthesia. * Eligible Surgery include: Spine surgery, bone tumor surgery, Total Hip Replacement, ovarian cancer surgery, cervical cancer surgery, radical cystectomy, open retroperitoneal mass excision, Radical Retropubic Prostatectomy, explorative laparotomy for abdominal mass excision, abdominal aortic aneurysm repair * Patients who are requiring an arterial catheter as a part of their standard care.
Exclusion criteria
* Patients with preexisting deformity or skin condition that would impede sensor placement * Patients with allergies to the adhesive sensor material * Patients with uncorrected preoperative anemia (preoperative hemoglobin \< 7 g/dL) * Patients who were not suitable for participation in the opinion of the study investigator.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The incidence of deviation from the target hemoglobin range | Until transfer to PACU (Post-Anesthesia Care Unit), from the beginning of the induction of anesthesia | (The number of laboratory samples with the result hemoglobin concentrations were out of the target range)/(Total number of laboratory samples that performed during intra-operative periods) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Point-of-care (POC) sampling during surgery | Until transfer to PACU (Post-Anesthesia Care Unit), from the beginning of the induction of anesthesia | Number of Point-of-care (POC) sampling for measurement of hemoglobin concentration. In SpHb group, POC sampling will be done according to SpHb level. In control group, POC sampling will be done at discretion of anesthesiologist. |
| Accuracy of the SpHb value | Until transfer to PACU (Post-Anesthesia Care Unit), from the beginning of the induction of anesthesia | Standard Laboratory hemoglobin measurement will be used as reference. Laboratory measurements will be done every 30 minute during surgery |
| Number of patients who receive intra-operative transfusion | Until transfer to PACU (Post-Anesthesia Care Unit), from the beginning of the induction of anesthesia | Number of patients who were transfused with pRBCs intraoperatively |
| Total volume of intravenous fluids given | Until transfer to PACU (Post-Anesthesia Care Unit), from the beginning of the induction of anesthesia | Total volume of intravenous fluids given intra-operatively |
| The percentage extent of deviation from the target hemoglobin range | Until transfer to PACU (Post-Anesthesia Care Unit), from the beginning of the induction of anesthesia | The percentage extent of deviation of laboratory hemoglobin out of the prespecified target range |
| Time for transfusion delay | Until transfer to PACU (Post-Anesthesia Care Unit), from the beginning of the induction of anesthesia | Time from the determination of transfusion to actual transfusion, in minutes |
| Incidence of intraoperative hypotension | Until transfer to PACU (Post-Anesthesia Care Unit), from the beginning of the induction of anesthesia | hypotension is defined as SBP \< 80% of baseline SBP |
| laboratory total hemoglobin value, at postoperative day 1 | at postoperative day 1 | total hemoglobin value measured by standard laboratory method |
| Total volume of pRBCs transfused | Until transfer to PACU (Post-Anesthesia Care Unit), from the beginning of the induction of anesthesia | Total volume of pRBCs transfused intra-operatively |
Countries
South Korea
Outcome results
None listed