REVIEW ARTICLE New technologies in pediatric anesthesia Helen Holtby 1,2 , Justin J. Skowno 3,4 , Daryl J. Kor 5 , Randall P. Flick 6 & Shoichi Uezono 7 1 Hospital of Sick Children Toronto, ON, Canada 2 University of Toronto Toronto, ON, Canada 3 Department of Anaesthesia, The Children’s Hospital at Westmead Sydney, NSW, Australia 4 Discipline of Paediatrics and Child Health, University of Sydney Sydney, NSW, Australia 5 Division of Critical Care Medicine, Department of Anesthesiology, Mayo Clinic Rochester, MN, USA 6 Department of Anesthesiology, Mayo Clinic Rochester, MN, USA 7 Department of Anesthesiology, Jikei Universtiy Tokyo, Japan Keywords pulse CO-oximetry; total hemoglobin; cardiac output monitoring; Anesthesia information management system; electric medical record Correspondence Shoichi Uezono, Department of Anesthesiology, Jikei University, 3-25-8 Nishishinbashi, Minato-ku, Tokyo 105-8461, Japan Email: shoichiuezono@gmail.com Accepted 20 July 2012 doi:10.1111/pan.12007 Summary This article reviews potential pediatric applications of 3 new technologies. (1) Pulse oximetry-based hemoglobin determination: Hemoglobin determination using spectrophotometric methods recently has been introduced in adults with varied success. This non-invasive and continuous technology may avoid veni- puncture and unnecessary transfusion in children undergoing surgery with major blood loss, premature infants undergoing unexpected and complicated emergency surgery, and children with chronic illness. (2) Continuous cardiac output monitoring: In adults, advanced hemodynamic monitoring such as continuous cardiac output monitoring has been associated with better surgical outcomes. Although it remains unknown whether similar results are applica- ble to children, current technology enables the monitoring of cardiac output non-invasively and continuously in pediatric patients. It may be important to integrate the data about cardiac output with other information to facilitate therapeutic interventions. (3) Anesthesia information management systems: Although perioperative electronic anesthesia information management sys- tems are gaining popularity in operating rooms, their potential functions may not be fully appreciated. With advances in information technology, anesthesia information management systems may facilitate bedside clinical decisions, administrative needs, and research in the perioperative setting. Introduction In the past few years, new technologies have been developed in the practice of anesthesia, some having potential applications in pediatric patients. In this review, we highlight three topics of particular interest to practic- ing pediatric anesthesiologists. Dr. Holtby reviews non- invasive hemoglobin determination using pulse oximetry. Dr. Skowno focuses on the current status of continuous cardiac output monitoring in pediatric patients. Drs. Kor and Flick demonstrate how the electronic medical record (EMR) can increase perioperative patient safety. Pulse oximetry–based hemoglobin determination ‘Dammitt, man I’m a doctor not a physicist,’ — Dr. Leonard ‘Bones’ McCoy aboard USS Enterprise 2245 CE, ‘Star Trek’ media collection Background Pulse oximetry–based hemoglobin determination uses light absorption techniques to determine the levels of total hemoglobin and other similar molecules such as carboxyhemoglobin. It bears some similarity with the ‘tricorder’ used for diagnosis on patients aboard the fic- tional USS Enterprise, providing laboratory and diag- nostic information from a convenient small device without painful physical contact. There are considerable advantages in avoiding invasive laboratory tests, espe- cially from a child’s perspective. Berkow et al. com- mented, ‘The development of spectrophotometric © 2012 Blackwell Publishing Ltd Pediatric Anesthesia 22 (2012) 952–961 952 Pediatric Anesthesia ISSN 1155-5645