Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Agreement between noninvasive hemoglobin monitoring (SpHb) and laboratory hemoglobin in patients undergoing free-flap reconstruction for oral squamous cell carcinoma

  • Giyoung Yun (Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute) ;
  • Ji-Young Yoon (Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute) ;
  • Cheul-Hong Kim (Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute) ;
  • Hee Young Kim (Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University) ;
  • Eun-Jung Kim (Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute)
  • Received : 2026.03.19
  • Accepted : 2026.04.27
  • Published : 2026.06.01
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Abstract

Background: Surgery for head and neck squamous cell carcinoma (HNSCC) often involves extensive resection with free-flap reconstruction, leading to significant blood loss. Accurate intraoperative hemoglobin (Hb) monitoring is crucial to guide transfusion. Non-invasive Hb monitoring (SpHb) offers continuous Hb measurement; however, its reliability in major oncological surgeries remains uncertain. Thus, this study evaluated the agreement between SpHb and point-of-care testing-measured Hb (POCT-Hb). Methods: In this retrospective study, patients undergoing oral squamous cell carcinoma (SCC) resection with free-flap reconstruction (Sep 2023-Oct 2025) were analyzed. Hb levels were measured at the time of anesthesia induction (T1) and surgical closure (T2) using POCT and simultaneous SpHb. The postoperative central-laboratory Hb level validated the POCT accuracy. Correlation (Pearson), intraclass correlation coefficient (ICC), and agreement (Bland-Altman) analyses were performed. Effects of intraoperative blood loss and dopamine infusion on SpHb accuracy were assessed using subgroup analyses, t-tests, and a univariate general linear model. Results: Fifty-five patients were included. SpHb showed a moderate correlation with POCT-Hb at T1 (r = 0.619, ICC = 0.563) and T2 (r = 0.639, ICC = 0.563), with wider Bland-Altman limits at T2. Furthermore, changes in SpHb underestimated ΔHb compared with POCT (r = 0.439). Intraoperative blood loss did not significantly affect SpHb accuracy, whereas dopamine use was associated with larger absolute differences and wider limits of agreement. The dopamine level remained an independent predictor of SpHb-POCT discrepancy. Conclusion: SpHb showed moderate agreement with POCT-Hb and was affected by dopamine use. Although its absolute accuracy is limited, SpHb may serve as a useful adjunct for trend monitoring and for guiding the timing of laboratory testing.

Keywords

Acknowledgement

This work was supported by a 2-Year Research Grant of Pusan National University.

References

  1. Tang B, Huang R, Ma W. Advances in nanotechnology-based approaches for the treatment of head and neck squamous cell carcinoma. RSC Adv 2024; 14: 38668-88.
  2. Sattar T, Nazir I, Jabbar M, Malik J, Afzal S, Hanif S, et al. Current innovations in head and neck cancer: from diagnostics to therapeutics. Oncol Res 2025; 33: 1019-32. https://doi.org/10.32604/or.2025.060601
  3. Gauss C, Stone LD, Ghafouri M, Quan D, Johnson J, Fribley AM, et al. Overcoming resistance to standard-of-care therapies for head and neck squamous cell carcinomas. Cells 2024; 13: 1018.
  4. Lodders JN, Parmar S, Stienen NL, Martin TJ, Karagozoglu KH, Heymans MW, et al. Incidence and types of complications after ablative oral cancer surgery with primary microvascular free flap reconstruction. Med Oral Patol Oral Cir Bucal 2015; 20: e744-50. https://doi.org/10.4317/medoral.20657
  5. Applegate RL 2nd, Applegate PM, Cannesson M, Peiris P, Ladlie BL, Torp K. Multicenter comparison of three intraoperative hemoglobin trend monitoring methods. J Clin Monit Comput 2020; 34: 883-92. https://doi.org/10.1007/s10877-019-00428-3
  6. Shabaninejad H, Ghadimi N, Sayehmiri K, Hosseinifard H, Azarfarin R, Gorji HA. Comparison of invasive and noninvasive blood hemoglobin measurement in the operating room: a systematic review and meta-analysis. J Anesth 2019; 33: 441-53. https://doi.org/10.1007/s00540-019-02629-1
  7. Barker SJ, Shander A, Ramsay MA. Continuous noninvasive hemoglobin monitoring: a measured response to a critical review. Anesth Analg 2016; 122: 565-72. https://doi.org/10.1213/ANE.0000000000000605
  8. Helmer P, Steinisch A, Hottenrott S, Schlesinger T, Sammeth M, Meybohm P, et al. Evaluation of non-invasive hemoglobin monitoring in perioperative patients: a retrospective study of the Rad-67(TM) (Masimo). Diagnostics (Basel) 2025; 15: 128. https://doi.org/10.3390/diagnostics15020128
  9. Kim SH, Lilot M, Murphy LS, Sidhu KS, Yu Z, Rinehart J, et al. Accuracy of continuous noninvasive hemoglobin monitoring: a systematic review and meta-analysis. Anesth Analg 2014; 119: 332-46. https://doi.org/10.1213/ANE.0000000000000272
  10. Kim CH, Yoon JY, Yun G, Kim HY, Kim EJ. Accuracy of continuous and real-time total hemoglobin during bimaxillary orthognathic surgery. J Dent Anesth Pain Med 2025; 25: 23-32. https://doi.org/10.17245/jdapm.2025.25.1.23
  11. Alwabari M, Alhamad F, Alsahaf F, Al Amer F, Alniniya F, Alherz I, et al. Can non-invasive spectrophotometric hemoglobin replace laboratory hemoglobin concentrations for preoperative anemia screening? A diagnostic test accuracy study. J Clin Med 2023; 12: 5733.
  12. Ke YH, Hwang KY, Thin TN, Sim YE, Abdullah HR. The usefulness of non-invasive co-oximetry haemoglobin measurement for screening pre-operative anaemia. Anaesthesia 2021; 76: 54-60. https://doi.org/10.1111/anae.v76.1
  13. Nguyen BV, Vincent JL, Nowak E, Coat M, Paleiron N, Gouny P, et al. The accuracy of noninvasive hemoglobin measurement by multiwavelength pulse oximetry after cardiac surgery. Anesth Analg 2011; 113: 1052-7. https://doi.org/10.1213/ANE.0b013e31822c9679
  14. Saito J, Kitayama M, Amanai E, Toyooka K, Hirota K. Impact of acute changes in perfusion index and blood pressure on the accuracy of non-invasive continuous hemoglobin concentration measurements during induction of anesthesia. J Anesth 2017; 31: 193-7. https://doi.org/10.1007/s00540-017-2306-6
  15. Khalafallah AA, Chilvers CR, Thomas M, Chilvers CM, Sexton M, Vialle M, et al. Usefulness of non-invasive spectrophotometric haemoglobin estimation for detecting low haemoglobin levels when compared with a standard laboratory assay for preoperative assessment. Br J Anaesth 2015; 114: 669-76. https://doi.org/10.1093/bja/aeu403
  16. Park SG, Lee OH, Park YH, Shin HY, Kang H, Baek CW, et al. The changes of non-invasive hemoglobin and perfusion index of pulse co-oximetry during induction of general anesthesia. Korean J Anesthesiol 2015; 68: 352-7. https://doi.org/10.4097/kjae.2015.68.4.352
  17. Tsuei BJ, Hanseman DJ, Blakeman MJ, Blakeman TC, Yang SH, Branson RD, et al. Accuracy of noninvasive hemoglobin monitoring in patients at risk for hemorrhage. J Trauma Acute Care Surg 2014; 77: S134-9. https://doi.org/10.1097/TA.0000000000000326
  18. García-Soler P, Camacho Alonso JM, González-Gómez JM, Milano-Manso G. Noninvasive hemoglobin monitoring in critically ill pediatric patients at risk of bleeding. Med Intensiva 2017; 41: 209-15. https://doi.org/10.1016/j.medin.2016.06.011
  19. Hornedo-González KD, Jacob AK, Burt JM, Higgins AA, Engel EM, Hanson AC, et al. Non-invasive hemoglobin estimation for preoperative anemia screening. Transfusion 2023; 63: 315-22. https://doi.org/10.1111/trf.v63.2
  20. Lamhaut L, Apriotesei R, Combes X, Lejay M, Carli P, Vivien B. Comparison of the accuracy of noninvasive hemoglobin monitoring by spectrophotometry (SpHb) and HemoCueⓇ with automated laboratory hemoglobin measurement. Anesthesiology 2011; 115: 548-54. https://doi.org/10.1097/ALN.0b013e3182270c22
  21. Wang C, Wang X, Zhang H, Liu D, Zhang C. Effect of norepinephrine on peripheral perfusion index and its association with the prognosis of patients with sepsis. J Intensive Care Med 2024; 39: 21-7. https://doi.org/10.1177/08850666231187333
  22. Mowafi HA, Ismail SA, Shafi MA, Al-Ghamdi AA. The efficacy of perfusion index as an indicator for intravascular injection of epinephrine-containing epidural test dose in propofol-anesthetized adults. Anesth Analg 2009; 108: 549-53. https://doi.org/10.1213/ane.0b013e31818fc35b
  23. Desborough JP. The stress response to trauma and surgery. Br J Anaesth 2000; 85: 109-17. https://doi.org/10.1093/bja/85.1.109
  24. Hunter JM. Autonomic nervous system: physiology and pharmacology. In: Miller's anesthesia. 9th ed. Edited by Gropper MA. Philadelphia, Elsevier. 2020, pp 254-87.