The Evolution and Global Impact of Pulse Oximetry: From Innovation to Standard of Care - A Comprehensive Review for Anesthesiologists and Critical Care Physicians

Author(s): Michiaki Yamakage

This review examines the evolution, clinical applications, and global impact of pulse oximetry, with emphasis on its transformative role in anesthesiology and critical care medicine. Technological advancements, clinical evidence, limitations, and future directions—including educational uses, quality improvement initiatives, and implementation science - are discussed in detail.

A comprehensive literature review of PubMed, MEDLINE, and Cochrane databases (1970–2024) was conducted using terms such as “pulse oximetry,” “oxygen saturation monitoring,” “perioperative monitoring,” and “anesthesia safety.” Industrial patents, regulatory documents, and international guidelines from organizations including the WHO, ASA, and ESA were reviewed. Clinical case studies from major medical centers and quality improvement data were analyzed to highlight real-world benefits.

Since its introduction in the early 1980s, pulse oximetry has progressed from basic analog instruments to sophisticated digital systems with AI-driven analytics and wireless connectivity. It enables early detection of hypoxemic events, typically 1–2 minutes before clinical signs appear. Although largescale randomized trials have not demonstrated significant reductions in perioperative mortality, it is universally recognized as indispensable for safe anesthetic practice. During the COVID-19 pandemic, it played a crucial role in identifying silent hypoxemia, with home monitoring programs preventing thousands of hospitalizations. Adoption exceeds 95% in high-income countries, with rapid growth in low-resource settings through targeted training and quality initiatives.

Future directions include multi-wavelength technology, AI-enhanced signal processing, and solutions to address skin pigmentation–related accuracy gaps. Integration into telemedicine, medical education, and quality frameworks will secure its role as a cornerstone of next-generation healthcare.