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Relationship between ANI and qNOX and between MAC and qCON during outpatient laparoscopic cholecystectomy using remifentanil and desflurane without muscle relaxants: a prospective observational preliminary study

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Abstract

This study was designed to investigate qCON and qNOX variations during outpatient laparoscopic cholecystectomy using remifentanil and desflurane without muscle relaxants and compare these indices with ANI and MAC. Adult patients undergoing outpatient laparoscopic cholecystectomy were included in this prospective observational study. Maintenance of anesthesia was performed using remifentanil targeted to ANI 50–80 and desflurane targeted to MAC 0.8–1.2 without muscle relaxants. The ANI, qCON and qNOX and desflurane MAC values were collected at different time-points and analyzed using repeated measures ANOVA. The relationship between ANI and qNOX and between qCON and MAC were analyzed by linear regression. The ANI was comprised between 50 and 80 during maintenance of anesthesia. Higher values of qNOX and qCON were observed at induction and extubation than during all other time-points where they were comprised between 40 and 60. A poor but significant negative linear relationship (r2 = 0.07, p < 0.001) was observed between ANI and qNOX. There also was a negative linear relationship between qCON and MAC (r2 = 0.48, p < 0.001) and between qNOX and remifentanil infusion rate (r2 = 0.13, p < 0.001). The linear mixed-effect regression correlation (r2) was 0.65 for ANI-qNOX and 0.96 for qCON-MAC. The qCON and qNOX monitoring seems informative during general anesthesia using desflurane and remifentanil without muscle relaxants in patients undergoing ambulatory laparoscopic cholecystectomy. While qCON correlated with MAC, the correlation of overall qCON and ANI was poor but significant. Additionally, the qNOX weakly correlated with the remifentanil infusion rate. This observational study suggests that the proposed ranges of 40–60 for both indexes may correspond to adequate levels of hypnosis and analgesia during general anesthesia, although this should be confirmed by further research.

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Acknowledgements

The authors wish to thank Dr Luca Guizouarn, Dr Quentin Darnajoux, Dr Stefano Pigella, Dr Jennifer Rocher and Dr Sarah Touama for their participation in the study.

Funding

This study was performed with institutional sources. The CONOX© monitor and electrodes were supplied by Fresenius Kabi France during the time of the study.

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Authors and Affiliations

  1. Groupement Hospitalier Nord-Dauphiné, Centre Hospitalier Pierre Oudot, Service d’anesthésie, Bourgoin-Jallieu, France

    T. Pantalacci & E. Boselli

  2. Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de réanimation médicale, Pierre-Bénite, France

    B. Allaouchiche

  3. Université de Lyon, Université Claude Bernard Lyon I, VetAgro Sup unité APCSe UPSP 2016.A101, Marcy-l’Étoile, France

    B. Allaouchiche & E. Boselli

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  1. T. Pantalacci
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Contributions

TP made substantial contribution to the acquisition and interpretation of data for the work, drafted the work, approved the final version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. BA made substantial contribution to the acquisition of data for the work, revised the work critically for important intellectual content, approved the final version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. EB made substantial contribution to the design of the work and on the acquisition, analysis and interpretation of data for the work, revised the work critically for important intellectual content, approved the final version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to E. Boselli.

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Conflict of interest

Bernard Allaouchiche and Emmanuel Boselli have received honoraria from Fresenius Kabi.

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All participants provided written inform consent to participate to this study.

Ethical approval

The study was promoted by the Centre hospitalier Pierre Oudot and approved by the Ethics Committee (Centre de Protection des Personnes Île-de-France XI, Approval No. 20015–62544).

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Pantalacci, T., Allaouchiche, B. & Boselli, E. Relationship between ANI and qNOX and between MAC and qCON during outpatient laparoscopic cholecystectomy using remifentanil and desflurane without muscle relaxants: a prospective observational preliminary study. J Clin Monit Comput 37, 83–91 (2023). https://doi.org/10.1007/s10877-022-00861-x

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