• Sun-Kyung Park, Chahnmee Hur, Young-Won Kim, Seokha Yoo, Young-Jin Lim, and Jin-Tae Kim.
• Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
• J Clin Anesth. 2024 May 1; 93: 111326111326.

Study ObjectiveThe effect of noninvasive CO-oximetry hemoglobin (SpHb) monitoring on the clinical outcomes of patients undergoing surgery remains unclear. This trial aimed to evaluate whether SpHb monitoring helps maintain hemoglobin levels within a predefined target range during major noncardiac surgeries with a potential risk of intraoperative hemorrhage.DesignA single-center, prospective, randomized controlled trial.SettingUniversity hospital.PatientsOne hundred and thirty patients undergoing elective noncardiac surgery with a potential risk of hemorrhage.InterventionsPatients were randomly allocated to undergo either SpHb-guided management (SpHb group) or usual care (control group).MeasurementsThe primary outcome was the rate of deviation of the total hemoglobin concentration (determined from laboratory testing) from a pre-specified target range (8-14 g/dL). This was defined as the number of laboratory tests revealing such deviations divided by the total number of laboratory tests performed during the surgery.Main ResultsThe primary outcome occurred significantly less frequently in the SpHb group as compared to that in the control group (15/555 [2.7%]) vs. 68/598 [11.4%]; relative risk, 0.24; 95% confidence interval, 0.13-0.41; P < 0.001). Fewer point-of-care blood tests were performed in the SpHb group than in the control group (median [interquartile range], 2 [1-4] vs. 4 [2-5]; P < 0.001). There were no significant intergroup differences in the number of patients who received red blood cell transfusions during surgery (SpHb vs. control, 33.8% vs. 46.2%; P = 0.201). The incidence of unnecessary red blood cell preparation (>2 units) was lower in the SpHb group than in the control group (3.1% vs. 16.9%; P = 0.024).ConclusionsCompared with routine care, SpHb-guided management resulted in significantly lower rates of hemoglobin deviation outside the target range intraoperatively in patients undergoing major noncardiac surgeries with a potential risk of hemorrhage.Clinical Trial RegistrationClinicalTrials.gov (identifier: NCT03816514).Copyright © 2023 Elsevier Inc. All rights reserved.

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