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Comparison of the qCON and qNOX indices for the assessment of unconsciousness level and noxious stimulation response during surgery

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Abstract

The objective of this work is to compare the performances of two electroencephalogram based indices for detecting loss of consciousness and loss of response to nociceptive stimulation. Specifically, their behaviour after drug induction and during recovery of consciousness was pointed out. Data was recorded from 140 patients scheduled for general anaesthesia with a combination of propofol and remifentanil. The qCON 2000 monitor (Quantium Medical, Barcelona, Spain) was used to calculate the qCON and qNOX. Loss of response to verbal command and loss of eye-lash reflex were assessed during the transition from awake to anesthetized, defining the state of loss of consciousness. Movement as a response to laryngeal mask (LMA) insertion was interpreted as the response to the nociceptive stimuli. The patients were classified as movers or non-movers. The values of qCON and qNOX were statistically compared. Their fall times and rise times defined at the start and at the end of the surgery were calculated and compared. The results showed that the qCON was able to predict loss of consciousness such as loss of verbal command and eyelash reflex better than qNOX, while the qNOX has a better predictive value for response to noxious stimulation such as LMA insertion. From the analysis of the fall and rise times, it was found that the qNOX fall time (median: 217 s) was significantly longer (p value <0.05) than the qCON fall time (median: 150 s). At the end of the surgery, the qNOX started to increase in median at 45 s before the first annotation related to response to stimuli or recovery of consciousness, while the qCON at 88 s after the first annotation related to response to stimuli or recovery of consciousness (p value <0.05). The indices qCON and qNOX showed different performances in the detection of loss of consciousness and loss of response to stimuli during induction and recovery of consciousness. Furthermore, the qCON showed faster decrease during induction. This behaviour is associated with the hypothesis that the loss of response to stimuli (analgesic effect) might be reached after the loss of consciousness (hypnotic effect). On the contrary, the qNOX showed a faster increase at the end of the surgery, associated with the hypothesis that a higher probability of response to stimuli might be reached before the recovery of consciousness.

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Acknowledgments

The qNOX was based on an idea from the Department of Anesthesia Hospital CLINIC de Barcelona (Spain) funded by grant PS09/01209 of the Fondo de Investigaciones Sanitarias (FIS), Health Department, Government of Spain and has been developed in collaboration with Quantium Medical.

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Authors and Affiliations

  1. R&D Department, Quantium Medical, Barcelona, Spain

    Umberto Melia, Eva Gabarron, Patricia Pineda, Joan Fontanet & Erik Weber Jensen

  2. Systems Pharmacology Effect Control and Modeling (SPEC-M) Research Group, Anesthesiology Department, Hospital CLINIC de Barcelona, Barcelona, Spain

    Mercé Agustí, Nuria Souto, Erik Weber Jensen & Pedro Gambus

  3. Automatic Control and Informatic (ESAII) Department, Centre for Biomedical Research (CREB), UPC-Barcelonatech, Barcelona, Spain

    Montserrat Vallverdu & Erik Weber Jensen

  4. Neuroimmunology Research Program Institut de Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain

    Pedro Gambus

  5. Department of Anesthesia and Perioperative Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA

    Pedro Gambus

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  1. Umberto Melia
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  2. Eva Gabarron
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Correspondence to Umberto Melia.

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Conflicts of interest

Umberto Melia, Erik Weber Jensen, Joan Fontanet, Eva Gabarron and Patricia Pineda are employees of Quantium Medical. Quantium Medical is the commercial developer of both qCON and qNOX indices.

Ethical Statements

The study was performed after IRB approval (Committee on Ethics in Research, Hospital CLINIC de Barcelona no 2013/8356). All the patients has written informed consent.

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Melia, U., Gabarron, E., Agustí, M. 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 31, 1273–1281 (2017). https://doi.org/10.1007/s10877-016-9948-z

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  • DOI: https://doi.org/10.1007/s10877-016-9948-z

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