Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy.
Department of Anesthesiology and Intensive Care, School of Medicine and Health, Technical University of Munich, Munich, Germany.
J Clin Monit Comput. 2024 Dec;38(6):1281-1290. doi: 10.1007/s10877-024-01214-6. Epub 2024 Sep 12.
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 = 0.79qNOX + 5.8; p < 0.001; R = 0.84) had a strong linear association. We further confirmed the strong relationship between qCON/qNOX and BSR for qCON/qNOX < 25: qCON=-0.19BSR + 25.6 (p < 0.001; R = 0.72); qNOX=-0.20BSR + 26.2 (p < 0.001; R = 0.72). The relationship between qCON and EMG was strong at higher indices: qCON = 0.55EMG + 33.0 (p < 0.001; R = 0.68). There was no qCON > 80 without EMG > 0. The relationship between ceP and qCON was qCON=-3.8*ceP + 70.6 (p < 0.001; R = 0.11). The heat maps also suggest that the qCON and qNOX can at least partially separate the hypnotic and analgetic components of anesthesia.
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.
经过处理的脑电图（EEG）指数可帮助引导全身麻醉。CONOX（费森尤斯凯柏）计算两个指数，qCON（催眠水平）和 qNOX（痛觉）。CONOX 还计算肌电图（EMG）活动和脑电图爆发抑制（BSR）的指数。由于所有 EEG 参数似乎都相互影响，我们的目标是详细描述参数之间的关系。
我们使用了接受异丙酚麻醉的 14 名患者的 qCON、qNOX、EMG 和 BSR 信息。我们使用线性模型、热图和箱线图表示来描述指数之间的关系。我们还评估了 qCON/qNOX 与丙泊酚/瑞芬太尼效应部位浓度（ceP/ceR）之间的关联。
qNOX 和 qCON（qCON=0.79qNOX+5.8；p<0.001；R=0.84）之间存在很强的线性关联。我们进一步证实了 qCON/qNOX 与 BSR 之间的强关系，对于 qCON/qNOX<25：qCON=-0.19BSR+25.6（p<0.001；R=0.72）；qNOX=-0.20BSR+26.2（p<0.001；R=0.72）。在较高的指数下，qCON 与 EMG 的关系很强：qCON=0.55EMG+33.0（p<0.001；R=0.68）。在没有 EMG>0 的情况下，qCON>80 不存在。qCON 与 ceP 的关系为 qCON=-3.8*ceP+70.6（p<0.001；R=0.11）。热图还表明，qCON 和 qNOX 至少可以部分分离麻醉的催眠和镇痛成分。
我们可以描述 qCON、qNOX、EMG、BSR、ceP 和 ceR 之间的关系，这可能有助于麻醉师更好地解释提供的信息。一个主要发现是 qCON>80 对 EMG 活动的依赖性。这可能限制了在没有 EMG 的情况下检测到清醒的可能性。此外，qNOX 似乎普遍高于 qCON，但高阿片类药物剂量可能导致 qCON 比 qNOX 指数更高。
