What is Performance of two electroencephalogram based indices in Pediatric Population undergoing surgery Under GA?

Recent study evaluated the performance of the qCON and qNOX indices in monitoring the depth of anesthesia and nociception in pediatric patients undergoing surgery under general anesthesia.

The study was conducted on 46 pediatric patients aged 1-12 years undergoing elective surgery under general anesthesia, with or without regional analgesia. All patients underwent inhalation induction and maintenance using sevoflurane. The patients were monitored using the CONOX monitoring system, which provided qCON and qNOX scores at various time points including awake, induction, loss of eyelash reflex, intubation/LMA insertion, surgical incision, cessation of anesthesia, emergence, and eye-opening.

Study Results

The results showed a simultaneous fall and rise of qCON and qNOX upon induction and recovery, respectively. There was a rise in qNOX with surgical incision, but this rise was less in patients who received regional analgesia. The study found a significant fall in qNOX after the administration of regional analgesia. However, both qCON and qNOX were poorly correlated with the minimum alveolar concentration (MAC) of sevoflurane during general anesthesia in the pediatric population.

The authors concluded that both qCON and qNOX values change predictably with changes in the conscious level and with different noxious stimuli in pediatric patients. They suggested that further studies are required to confirm the findings, taking into account the postoperative assessment of delirium and recall of intraoperative events.

Key Points -

The 3 key points of the scientific article are:

1. The study evaluated the performance of the qCON and qNOX indices in monitoring the depth of anesthesia and nociception in pediatric patients undergoing surgery under general anesthesia.

2. The results showed a simultaneous fall and rise of qCON and qNOX upon induction and recovery, respectively, and a rise in qNOX with surgical incision, which was less in patients who received regional analgesia. There was a significant fall in qNOX after the administration of regional analgesia.

3. The authors concluded that both qCON and qNOX values change predictably with changes in the conscious level and with different noxious stimuli in pediatric patients, but they were poorly correlated with the minimum alveolar concentration (MAC) of sevoflurane during general anesthesia. Further studies are required to confirm the findings, taking into account the postoperative assessment of delirium and recall of intraoperative events.

Reference –

Praveen M, Kumar A, Parikh B, Sikdar I. Evaluation of qCON and qNOX indices in pediatric surgery under general anesthesia. J Anaesthesiol Clin Pharmacol 2024;40:264‑70.