The current status of continuous noninvasive measurement of total, carboxy, and methemoglobin concentration.

Intraoperative early detection of anemia, identifying toxic levels of carboxyhemoglobin after carbon monoxide exposure and titrating drug dosage to prevent toxic levels of methemoglobin are important goals. The pulse oximeter works by illuminating light into the tissue and sensing the amount of light absorbed. The same methodology is used by laboratory hemoglobinometers to measure hemoglobin concentration. Because both devices work in the same way, efforts were made to modify the pulse oximeter to also measure hemoglobin concentration. Currently there are 2 commercial pulse oximeters (Masimo Rainbow SET and OrSense NBM-200MP) that measure total hemoglobin concentration and one (Masimo) that also measures methemoglobin and carboxyhemoglobin. In this review, we describe the peer-reviewed literature addressing the accuracy of these monitors.