Noninvasive and Continuous Hemoglobin Monitoring for Surgical Blood Management

Inclusion Criteria:

   - Adult patients undergoing one of the listed major surgeries associated with
   possibility of significant blood loss

   - Consenting patients who are primarily managed by the consenting Anesthesiologists
   participating in the study (Not applicable at participating centers which have
   obtained a waiver of informed consent for the patients from their respective IRB)

   - At least one finger available and accessible for performing non-invasive hemoglobin
   monitoring (preoperative perfusion index greater than 0.5)

Exclusion Criteria:

   - Any patients who do not fit the criteria for use of sensor, specifically, any patient
   with nail polish and/or a nail deformity, or obstructed physical access (e.g. due to
   bandage) to all fingers that would be used for sensor placement, in a manner that
   interferes with satisfactory sensor placement

   - Any patients being monitored with motor evoked potential devices

   - Any patients with a known hemoglobinopathy

   - Any patients undergoing Cardio-Pulmonary Bypass (CPB)

   - Any patients who cannot be transfused or has refused consent for a blood transfusion

   - Patients who are moribund/salvage cases as determined by the participating
   Anesthesiologist in charge of management of the patient in the operating room

   - Patients being treated by any artificial oxygen carriers within 30 days of hospital
   stay

   - Patients who are actively enrolled in or within 30 days of completion of any other
   study (except for purely observational studies with no intervention)

   - Patients being managed outside of an operating room in the participating centers, or
   in operating room with conditions not conducive to perform and complete the study
   procedures (including use of the hemoglobin monitoring device)

   - Patients younger than 18 years old

   - Patients who are pregnant

   - Any patients expected to receive transfusion preoperatively