Clinical value of qCON and qNOX monitoring for anesthesia in partial hepatectomy

Objective：To monitor the qCON, qNOX, and bispectral index (BIS) during anesthesia of partial hepatectomy, and investigate the correlation between qCON and BIS and the value of qNOX in monitoring noxious stimulation. Methods：Totally 40 patients undergoing semi-selective hepatectomy were randomly assigned into two groups, general anesthesia group (G group) and general anesthesia combined with epidural anesthesia group (GE group). Anesthesia in the two groups were performed by one anesthesiologist with more than 10 years of experience, who adjusted the level of hypnosis according to the continuous monitoring of BIS. The anesthesiologist was blinded for the values of qCON and qNOX. The measurements were obtained from a continuous recording of BIS, qNOX, qCON, and TOF. The value of BIS was kept at 40 to 60 with regulation of sevoflurane. After the surgery, when the indication was met, the extubation was performed, visual analogy scale (VAS) was evaluated and patients were sent to post anesthesia care unit (PACU). Patients were regularly assessed to determine whether awareness happened 24 h after surgery. Results：A total of 20 cases in G group and 20 cases in GE group completed the study. There were no significant statistical differences in age, gender composition, BMI, ASA classification, duration of surgery, and anesthesia between the two groups. There were no significant differences of BIS, qCON, qNOX in basic values, before intubation values, mean values during surgery, and after extubation values between the two groups. The mean VAS scores for the GE group were 0, and for the G group, the scores ranged from 0 to 3, the median value was 2. The correlation coefficient was 0.75 between BIS and qCON while analyzing with Spearman rank correlation. Conclusions：qCON might have a relatively good correlation with BIS and could be used to monitor the level of hypnosis during anesthesia. The use of qNOX might be helpful to monitor noxious stimulation during partial hepatectomy under general anesthesia combined with epidural block or general anesthesia alone.