title: 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: OBJECTIVE
  Several factors affect the accuracy of non-invasive continuous hemoglobin concentration (SpHb) measurements. We had previously shown an increase in the perfusion index (PI) following induction of anesthesia which was associated with an increase in the difference between SpHb and total hemoglobin (tHb) (SpHb-tHb). We hypothesized that blunting the increase in PI by maintaining blood pressure during induction of anesthesia would improve the agreement between SpHb and tHb measurements.
  
  
  METHODS
  Twenty-nine adult patients were enrolled. Patients were randomly assigned by use of sequentially numbered, opaque sealed envelopes to a control (group C) or a phenylephrine group (group P). Anesthesia was induced and maintained with propofol, remifentanil, and ketamine. In group P, phenylephrine was infused at 0.5 µg/kg/min during induction of anesthesia. SpHb and PI were monitored with a Radical-7 Pulse CO-Oximeter. tHb and hematocrit were measured with the ABL800 blood gas analyzer.
  
  
  RESULTS
  Following induction of anesthesia, PI increased significantly in both groups (p < 0.001 and p < 0.05 in groups C and P, respectively). However, the increase in PI was significantly smaller in group P than in group C (2.6 ± 1.3 vs 0.8 ± 1.4%, p < 0.001). Similarly, the change in SpHb-tHb was significantly smaller in group P than in group C (0.40 ± 0.78 vs 0.97 ± 0.70 g/dl, p < 0.05). Changes in SpHb-tHb are correlated with changes in PI (r = 0.46, p < 0.05).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan. fix-you@hotmail.co.jp.
authors.forename: Junichi
authors.identifier: http://orcid.org/0000-0002-6040-4926
authors.initials: J
authors.lastname: Saito
authors.affiliation: Division of Operating Center, Hirosaki University Medical Hospital, Hirosaki, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Kitayama
authors.affiliation: Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan.
authors.forename: Erika
authors.initials: E
authors.lastname: Amanai
authors.affiliation: Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Toyooka
authors.affiliation: Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Hirota
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000379:methods*; D001784:Blood Gas Analysis; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D008991:Monitoring, Physiologic; D010092:Oximetry
chemical_list: D006454:Hemoglobins
keywords: Anesthesia; Non-invasive continuous hemoglobin concentration; Perfusion index