Arulkumaran Rajendran, Cherian Anusha, Kuberan Aswini, Bidkar Prasanna Udupi
Department of Anaesthesiology and Critical Care, JIPMER, Puducherry, India.
Indian J Anaesth. 2024 Nov;68(11):996-1002. doi: 10.4103/ija.ija_174_24. Epub 2024 Oct 26.
Adequacy of Anaesthesia (AoA) and CONOX are combined monitors that assess levels of anaesthesia and analgesia and give a comprehensive score. No studies have measured and compared the total consumption of inhaled anaesthetic agents while using these monitors. We designed a study to compare AoA and CONOX in terms of sevoflurane usage, fentanyl usage and recovery from the effects of anaesthesia.
A randomised trial was conducted in 58 patients. Group A ( = 31) patients were monitored with AoA, and Group C ( = 27) patients were monitored with CONOX. Sevoflurane was titrated to maintain a state entropy value of 40-60 in AoA and a Quantium consciousness index (qCON) value of 40-60 in CONOX. Similarly, fentanyl was titrated with bolus doses of 0.5 μg/kg to maintain a surgical pleth index value of 40-60 in AoA and Quantium noxious index (qNOX) value of 40-60 in CONOX. Intraoperative awareness was assessed postoperatively using a modified Brice questionnaire. The -test or Chi-square test was used to compare the parameters between the groups.
Mean sevoflurane consumption was similar between AoA and CONOX groups [13.2 (standard deviation {SD}: 3.9) (95% confidence interval {CI}:11.8, 14.5) versus 14.4 (SD: 3.7) (95% CI: 13.0, 15.7) ml/h] ( = 0.236). Fentanyl usage was higher in the AoA group compared to the CONOX group [146.2 (SD: 34.28) (95% CI: 134.13, 158.26) versus 128.2 (SD: 26.7) (95% CI: 118.12, 138.27) μg] ( = 0.031). The emergence time and haemodynamic instability events were similar between AoA and CONOX.
Both AoA and CONOX measure anaesthetic depth similarly. However, interpreting qNOX values requires caution, as the patient's consciousness status influences them.
麻醉充分性（AoA）监测仪和CONOX监测仪是用于评估麻醉和镇痛水平并给出综合评分的联合监测设备。尚无研究在使用这些监测仪时测量并比较吸入麻醉药的总消耗量。我们设计了一项研究，以比较AoA和CONOX在七氟醚使用、芬太尼使用及麻醉效果恢复方面的情况。
对58例患者进行了一项随机试验。A组（n = 31）患者使用AoA进行监测，C组（n = 27）患者使用CONOX进行监测。在AoA监测中，滴定七氟醚以维持状态熵值在40 - 60，在CONOX监测中，滴定七氟醚以维持量子意识指数（qCON）值在40 - 60。同样，在AoA监测中，以0.5 μg/kg的推注剂量滴定芬太尼，以维持手术容积指数值在40 - 60，在CONOX监测中，滴定芬太尼以维持量子有害指数（qNOX）值在40 - 60。术后使用改良的布赖斯问卷评估术中知晓情况。采用t检验或卡方检验比较两组之间的参数。
AoA组和CONOX组的七氟醚平均消耗量相似[13.2（标准差{SD}：3.9）（95%置信区间{CI}：11.8，14.5）与14.4（SD：3.7）（95% CI：13.0，15.7）ml/h]（P = 0.236）。AoA组的芬太尼使用量高于CONOX组[146.2（SD：34.28）（95% CI：134.13，158.26）与128.2（SD：26.7）（95% CI：118.12，138.27）μg]（P = 0.031）。AoA组和CONOX组的苏醒时间及血流动力学不稳定事件相似。
AoA和CONOX对麻醉深度的测量相似。然而，由于患者的意识状态会影响qNOX值，因此在解读qNOX值时需要谨慎。
