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Comparison of the Conox (qCON) and Sedline (PSI) depth of anaesthesia indices to predict the hypnotic effect during desflurane general anaesthesia with ketamine

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Abstract

Comparison of two depth of anesthesia indices, qCON (Conox) and PSI (Sedline), during desflurane sedation and their sensitivity to random ketamine boluses in patients undergoing routine surgery. The performance of desflurane and ketamine on both indices was analyzed for 11 patients, and the ketamine sensitivity was compared with another group of 11 patients under sevoflurane and propofol.

The MOAA/S was used to determine sedation level and pain. Different boluses of ketamine ranging from 10 to 30 mg where randomly administered in both groups and the effect on the indexes were measured after 4 min.

The indices were recorded during the whole surgery, and their correlations with the desflurane concentration and the discrimination between awake and anesthetized states were evaluated with the prediction probability statistic (Pk). The Pk values, mean (se), discriminating between awake and anesthetized states were 0.974(0.016) for the qCON and 0.962(0.0123) for the PSI, while the 1-Pk statistic for the qCON and the PSI with respect to the desflurane concentration were 0.927(0.016) and 0.918(0.018), respectively, with no statistically significant differences.

The agreement between both depth of hypnosis parameters was assessed under the Bland-Altman plot and the Spearman correlation, rs = 0.57(p < 0.001).

During the sevoflurane-propofol anesthesia, which served as a control group, both indices experienced a similar behavior with a no significant change of their median values after ketamine. However, during desflurane anesthesia the qCON index did not change significantly after ketamine administration, qCON (before = 33 (4), after = 30 (17); Wilcoxon, p = 0.89), while the PSI experienced a significant increase, PSI (before = 31(6), after = 39(16) Wilcoxon, p = 0.013).

This study shows that qCON and PSI have similar performance under desflurane with good discrimination between the awake and anesthetized states. While both indices exhibited similar behavior under ketamine boluses under a sevoflurane-propofol anesthesia, the qCON index had a better performance under ketamine during desflurane anesthesia.

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Authors and Affiliations

  1. University of Vermont Medical Center, Burlington, VT, USA

    Catherine Christenson, Max Breidenstein, Borzoo Farhang, Jackson Mathews & Donald Mathews

  2. Quantium Medical, Mataro, Barcelona, Spain

    Pablo Martinez-Vazquez, Umberto Melia & Erik Weber Jensen

  3. Deutsches Primaten Zentrum (DPZ)GmbH, Gottingen, Germany

    Pablo Martinez-Vazquez

  4. Fresenius Kabi GmbH, Bad Homburg, Germany

    Erik Weber Jensen

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  1. Catherine Christenson
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  2. Pablo Martinez-Vazquez
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Correspondence to Pablo Martinez-Vazquez.

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Conflict of interest

Catherine Christenson, Max Breidenstein, Borzoo Farhang, Jackson Mathews and Donald Mathews declare no conflict of interest. Pablo Martinez-Vazquez, Umberto Melia and Erik Weber Jensen are employees of Quantium Medical. Quantium Medical is the commercial developer for the qCON index.

Ethical approval

The study was performed after IRB approval (Committees on Humans Subjects. Serving the University of Vermont and the UVM Medical Center), code CHRMS 15-618. All the patients have written informed consent.

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Christenson, C., Martinez-Vazquez, P., Breidenstein, M. et al. Comparison of the Conox (qCON) and Sedline (PSI) depth of anaesthesia indices to predict the hypnotic effect during desflurane general anaesthesia with ketamine. J Clin Monit Comput 35, 1421–1428 (2021). https://doi.org/10.1007/s10877-020-00619-3

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  • DOI: https://doi.org/10.1007/s10877-020-00619-3

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