Jensen E W, Valencia J F, López A, Anglada T, Agustí M, Ramos Y, Serra R, Jospin M, Pineda P, Gambus P
Department ESAII, Centre for Biomedical Engineering Research, UPC BarcelonaTech, Barcelona, Spain.
Acta Anaesthesiol Scand. 2014 Sep;58(8):933-41. doi: 10.1111/aas.12359. Epub 2014 Jul 4.
The objective of the present study was to validate the qCON index of hypnotic effect and the qNOX index of nociception. Both indices are derived from the frontal electroencephalogram (EEG) and implemented in the qCON 2000 monitor (Quantium Medical, Barcelona, Spain).
The study was approved by the local ethics committee, including data from 60 patients scheduled for ambulatory surgery undergoing general anaesthesia with propofol and remifentanil, using TCI. The Bis (Covidien, Boulder, CO, USA) was recorded simultaneously with the qCON. Loss of eyelash reflex [loss of consciousness (LOC)] was recorded, and prediction probability for Bis and qCON was calculated. Movement as a response to noxious stimulation [laryngeal mask airway (LMA) insertion, laryngoscopy and tracheal intubation] was registered. The correlation coefficient between qCON and Bis was calculated. The patients were divided into movers/non-movers as a response to noxious stimulation. A paired t-test was used to assess significant difference for qCON and qNOX for movers/non-movers.
The prediction probability (Pk) and the standard error (SE) for qCON and Bis for detecting LOC was 0.92 (0.02) and 0.94 (0.02) respectively (t-test, no significant difference). The R between qCON and Bis was 0.85. During the general anaesthesia (Ce propofol > 2 μg/ml, Ce remifentanil > 2 ng/ml), the mean value and standard deviation (SD) for qCON was 45 (8), while for qNOX it was 40 (6). The qNOX pre-stimuli values were significantly different (P < 0.05) for movers/non-movers as a response to LMA insertion [62.5 (24.0) vs. 45.5 (24.1)], tracheal intubation [58.7 (21.8) vs. 41.4 (20.9)], laryngoscopy [54.1 (21.4) vs. 41.0 (20.8)]. There were no significant differences in remifentanil or propofol effect-site concentrations for movers vs. non-movers.
The qCON was able to reliably detect LOC during general anaesthesia with propofol and remifentanil. The qNOX showed significant overlap between movers and non-movers, but it was able to predict whether or not the patient would move as a response to noxious stimulation, although the anaesthetic concentrations were similar.
本研究的目的是验证催眠效果的qCON指数和伤害感受的qNOX指数。这两个指数均源自额叶脑电图（EEG），并应用于qCON 2000监护仪（西班牙巴塞罗那的Quantium Medical公司）。
本研究经当地伦理委员会批准，纳入了60例计划接受门诊手术的患者，这些患者在全凭静脉麻醉下使用丙泊酚和瑞芬太尼，并采用靶控输注（TCI）。同时记录qCON和美国科维迪恩公司（Covidien，美国科罗拉多州博尔德市）生产的脑电双频指数（Bis）。记录睫毛反射消失[意识消失（LOC）]情况，并计算Bis和qCON的预测概率。记录对有害刺激[插入喉罩气道（LMA）、喉镜检查和气管插管]的反应动作。计算qCON和Bis之间的相关系数。根据对有害刺激的反应将患者分为有动作组/无动作组。采用配对t检验评估有动作组/无动作组qCON和qNOX的显著差异。
qCON和Bis检测LOC的预测概率（Pk）和标准误差（SE）分别为0.92（0.02）和0.94（0.02）（t检验，无显著差异）。qCON和Bis之间的R值为0.85。在全身麻醉期间（丙泊酚效应室浓度>2μg/ml，瑞芬太尼效应室浓度>2ng/ml），qCON的平均值和标准差（SD）为45（8），而qNOX为40（6）。对于对LMA插入[62.5（24.0）对45.5（24.1）]、气管插管[58.7（21.8）对41.4（20.9）]、喉镜检查[54.1（21.4）对41.0（20.8）]有反应的有动作组/无动作组，qNOX刺激前值有显著差异（P<0.05）。有动作组与无动作组在瑞芬太尼或丙泊酚效应室浓度方面无显著差异。
qCON能够可靠地检测丙泊酚和瑞芬太尼全身麻醉期间的LOC。qNOX在有动作组和无动作组之间显示出显著重叠，但尽管麻醉浓度相似，它能够预测患者是否会对有害刺激产生动作反应。
