Relationships between the qNOX, qCON, burst suppression ratio, and muscle activity index of the CONOX monitor during total intravenous anesthesia: a pilot study.
Anaesthesia, General
Anaesthesiology
Electroencephalography
Patient monitoring
Propofol
Journal
Journal of clinical monitoring and computing
ISSN: 1573-2614
Titre abrégé: J Clin Monit Comput
Pays: Netherlands
ID NLM: 9806357
Informations de publication
Date de publication:
12 Sep 2024
12 Sep 2024
Historique:
received:
02
08
2024
accepted:
26
08
2024
medline:
13
9
2024
pubmed:
13
9
2024
entrez:
12
9
2024
Statut:
aheadofprint
Résumé
Processed electroencephalographic (EEG) indices can help to navigate general anesthesia. The CONOX (Fresenius Kabi) calculates two indices, the qCON (hypnotic level) and the qNOX (nociception). The CONOX also calculates indices for electromyographic (EMG) activity and EEG burst suppression (BSR). Because all EEG parameters seem to influence each other, our goal was a detailed description of parameter relationships. We used qCON, qNOX, EMG, and BSR information from 14 patients receiving propofol anesthesia. We described index relationships with linear models, heat maps, and box plot representations. We also evaluated associations between qCON/qNOX and propofol/remifentanil effect site concentrations (ceP/ceR). qNOX and qCON (qCON = 0.79*qNOX + 5.8; p < 0.001; R We could describe relationships between qCON, qNOX, EMG, BSR, ceP, and ceR, which may help the anaesthesiologist better interpret the information provided. One major finding is the dependence of qCON > 80 on EMG activity. This may limit the possibility of detecting wakefulness in the absence of EMG. Further, qNOX seems generally higher than qCON, but high opioid doses may lead to higher qCON than qNOX indices.
Sections du résumé
BACKGROUND
BACKGROUND
Processed electroencephalographic (EEG) indices can help to navigate general anesthesia. The CONOX (Fresenius Kabi) calculates two indices, the qCON (hypnotic level) and the qNOX (nociception). The CONOX also calculates indices for electromyographic (EMG) activity and EEG burst suppression (BSR). Because all EEG parameters seem to influence each other, our goal was a detailed description of parameter relationships.
METHODS
METHODS
We used qCON, qNOX, EMG, and BSR information from 14 patients receiving propofol anesthesia. We described index relationships with linear models, heat maps, and box plot representations. We also evaluated associations between qCON/qNOX and propofol/remifentanil effect site concentrations (ceP/ceR).
RESULTS
RESULTS
qNOX and qCON (qCON = 0.79*qNOX + 5.8; p < 0.001; R
CONCLUSION
CONCLUSIONS
We could describe relationships between qCON, qNOX, EMG, BSR, ceP, and ceR, which may help the anaesthesiologist better interpret the information provided. One major finding is the dependence of qCON > 80 on EMG activity. This may limit the possibility of detecting wakefulness in the absence of EMG. Further, qNOX seems generally higher than qCON, but high opioid doses may lead to higher qCON than qNOX indices.
Identifiants
pubmed: 39266928
doi: 10.1007/s10877-024-01214-6
pii: 10.1007/s10877-024-01214-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Jensen EW, Valencia JF, Lopez A, Anglada T, Agusti M, Ramos Y, et al. Monitoring hypnotic effect and nociception with two EEG-derived indices, qCON and qNOX, during general anaesthesia. Acta Anaesthesiol Scand. 2014;58(8):933–41. https://doi.org/10.1111/aas.12359 .
doi: 10.1111/aas.12359
pubmed: 24995461
Rampil IJ. A primer for EEG Signal Processing in Anesthesia. Anesthesiology. 1998;89:980–1002.
doi: 10.1097/00000542-199810000-00023
pubmed: 9778016
Schuller P, Newell S, Strickland P, Barry J. Response of bispectral index to neuromuscular block in awake volunteers. Br J Anaesth. 2015;115(suppl 1):i95–103.
doi: 10.1093/bja/aev072
pubmed: 26174308
Messner M, Beese U, Romstöck J, Dinkel M, Tschaikowsky K. The Bispectral Index declines during neuromuscular block in fully awake persons. Anesth Analg. 2003;97(2):488–91.
doi: 10.1213/01.ANE.0000072741.78244.C0
pubmed: 12873942
Schnider TW, Minto CF, Gambus PL, Andresen C, Goodale DB, Shafer SL, et al. The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers. Anesthesiology. 1998;88(5):1170–82.
doi: 10.1097/00000542-199805000-00006
pubmed: 9605675
Schnider TW, Minto CF, Shafer SL, Gambus PL, Andresen C, Goodale DB, et al. The influence of age on Propofol Pharmacodynamics. Anesthesiology. 1999;90(6):1502–16.
doi: 10.1097/00000542-199906000-00003
pubmed: 10360845
Minto CF, Schnider TW, Egan TD, Youngs E, Lemmens HJ, Gambus PL, et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I. Model development. Anesthesiology. 1997;86(1):10–23. https://doi.org/10.1097/00000542-199701000-00004 .
doi: 10.1097/00000542-199701000-00004
pubmed: 9009935
Minto CF, Schnider TW, Shafer SL. Pharmacokinetics and pharmacodynamics of remifentanil. II. Model application. Anesthesiology. 1997;86(1):24–33. https://doi.org/10.1097/00000542-199701000-00005 .
doi: 10.1097/00000542-199701000-00005
pubmed: 9009936
Short TG, Ho TY, Minto CF, Schnider TW, Shafer SL. Efficient trial design for eliciting a pharmacokinetic-pharmacodynamic model-based response surface describing the interaction between two intravenous anesthetic drugs. Anesthesiology. 2002;96(2):400–8. https://doi.org/10.1097/00000542-200202000-00027 .
doi: 10.1097/00000542-200202000-00027
pubmed: 11818774
Hentschke H, Stüttgen MC. Computation of measures of effect size for neuroscience data sets. Eur J Neurosci. 2011;34(12):1887–94. https://doi.org/10.1111/j.1460-9568.2011.07902.x .
doi: 10.1111/j.1460-9568.2011.07902.x
pubmed: 22082031
Melia U, Gabarron E, Agusti M, Souto N, Pineda P, Fontanet J, et al. Comparison of the qCON and qNOX indices for the assessment of unconsciousness level and noxious stimulation response during surgery. J Clin Monit Comput. 2017;31(6):1273–81. https://doi.org/10.1007/s10877-016-9948-z .
doi: 10.1007/s10877-016-9948-z
pubmed: 27766525
Shoushtarian M, McGlade DP, Delacretaz LJ, Liley DT. Evaluation of the brain anaesthesia response monitor during anaesthesia for cardiac surgery: a double-blind, randomised controlled trial using two doses of fentanyl. J Clin Monit Comput. 2016;30(6):833–44. https://doi.org/10.1007/s10877-015-9780-x .
doi: 10.1007/s10877-015-9780-x
pubmed: 26407878
Akeju O, Westover MB, Pavone KJ, Sampson AL, Hartnack KE, Brown EN, et al. Effects of sevoflurane and propofol on frontal electroencephalogram power and coherence. Anesthesiology. 2014;121(5):990–8.
doi: 10.1097/ALN.0000000000000436
pubmed: 25233374
Ropcke H, Rehberg B, Koenen-Bergmann M, Bouillon T, Bruhn J, Hoeft A. Surgical stimulation shifts EEG concentration-response relationship of desflurane. Anesthesiology. 2001;94(3):390–9. discussion 5A.
doi: 10.1097/00000542-200103000-00006
pubmed: 11374596
Rundshagen I, Schroeder T, Prichep L, John E, Kox W. Changes in cortical electrical activity during induction of anaesthesia with thiopental/fentanyl and tracheal intubation: a quantitative electroencephalographic analysis. Br J Anaesth. 2004;92(1):33–8.
doi: 10.1093/bja/aeh020
pubmed: 14665550
Hight DF, Gaskell AL, Kreuzer M, Voss LJ, García PS, Sleigh JW. Transient electroencephalographic alpha power loss during maintenance of general anaesthesia. Br J Anaesth. 2019;122(5):635–42. https://doi.org/10.1016/j.bja.2018.11.029 .
doi: 10.1016/j.bja.2018.11.029
pubmed: 30915994
Hagihira S, Takashina M, Mori T, Ueyama H, Mashimo T. Electroencephalographic bicoherence is sensitive to noxious stimuli during isoflurane or sevoflurane anesthesia. J Am Soc Anesthesiologists. 2004;100(4):818–25.
Kochs E, Bischoff P, Pichlmeier U, Schulte am Esch J. Surgical stimulation induces changes in brain electrical activity during isoflurane/nitrous oxide anesthesia. A topographic electroencephalographic analysis. Anesthesiology. 1994;80(5):1026–34.
doi: 10.1097/00000542-199405000-00012
pubmed: 8017642
Ledowski T, Schmitz-Rode I. Predicting acute postoperative pain by the Qnox score at the end of surgery: a prospective observational study. Br J Anaesth. 2020;124(2):222–6. https://doi.org/10.1016/j.bja.2019.09.041 .
doi: 10.1016/j.bja.2019.09.041
pubmed: 31759614
Casans-Francés R, Feldheiser A, Gómez-Ríos MA, Muñoz-Alameda LE. Predicting acute postoperative pain by the qNOX score at the end of surgery. Comment on Br J Anaesth. 2020; 124: 222–226. Br J Anaesth. 2020.
Fontanet J, Gabarrón E, Jospin M, Vallverdú M, Gambus P, Jensen E. Comparison of the qNOX and ANI indices of Nociception during Propofol and Remifentanil Anaesthesia. Trento, Italy: ESGCO. Fai della Paganella; 2014.
Bruhn J, Bouillon T, Shafer S. Bispectral Index (BIS) and Burst suppression: revealing a part of the BIS Algorithm. J Clin Monit Comput. 2000;16:593–6.
doi: 10.1023/A:1012216600170
pubmed: 12580235
Zanner R, Schneider G, Meyer A, Kochs E, Kreuzer M. Time delay of the qCON monitor and its performance during state transitions. J Clin Monit Comput. 2020. https://doi.org/10.1007/s10877-020-00480-4 .
doi: 10.1007/s10877-020-00480-4
pubmed: 32040794
pmcid: 7943427
Jung D, Yang S, Lee MS, Lee Y. Remifentanil alleviates Propofol-Induced Burst suppression without affecting Bispectral Index in female patients: a Randomized Controlled Trial. J Clin Med. 2019;8(8). https://doi.org/10.3390/jcm8081186 .
Ludbrook GL, Visco E, Lam AM. Propofol: relation between brain concentrations, electroencephalogram, middle cerebral artery blood flow velocity, and cerebral oxygen extraction during induction of anesthesia. Anesthesiology. 2002;97(6):1363–70. https://doi.org/10.1097/00000542-200212000-00006 .
doi: 10.1097/00000542-200212000-00006
pubmed: 12459660
Muhlhofer W, Zak R, Kamal T, Rizvi B, Sands L, Yuan M, et al. Burst-suppression ratio underestimates absolute duration of electroencephalogram suppression compared with visual analysis of intraoperative electroencephalogram. BJA: Br J Anaesth. 2017;118(5):755–61.
doi: 10.1093/bja/aex054
pubmed: 28486575
pmcid: 6224027
Hart SM, Buchannan CR, Sleigh JW. A failure of M-Entropy to correctly detect burst suppression leading to sevoflurane overdosage. Anaesth Intensive Care. 2009;37(6):1002–4.
doi: 10.1177/0310057X0903700619
pubmed: 20014609
Daniel M, Weiskopf RB, Noorani M, Eger EI 2. Fentanyl augments the blockade of the sympathetic response to incision (MAC-BAR) produced by desflurane and isoflurane: desflurane and isoflurane MAC-BAR without and with fentanyl. Anesthesiology. 1998;88(1):43–9. https://doi.org/10.1097/00000542-199801000-00009 .
doi: 10.1097/00000542-199801000-00009
pubmed: 9447854
Jensen E, Litvan H, Struys M, Vazquez PM. Pitfalls and challenges when assessing the depth of hypnosis during general anaesthesia by clinical signs and electronic indices. Acta Anaesthesiol Scand. 2004;48(10):1260–7.
doi: 10.1111/j.1399-6576.2004.00521.x
pubmed: 15504186
Linassi F, Zanatta P, Tellaroli P, Ori C, Carron M. Isolated forearm technique: a meta-analysis of connected consciousness during different general anaesthesia regimens. Br J Anaesth. 2018;121(1):198–209. https://doi.org/10.1016/j.bja.2018.02.019 .
doi: 10.1016/j.bja.2018.02.019
pubmed: 29935574