Indications:​

• General Anaesthesia or Sedation: Conox® is designed for monitoring patients undergoing general anaesthesia or sedation.​
• Healthcare Professionals: It is intended for use by trained anaesthesia professionals in various hospital or medical facility settings.

Contraindications:​

• MRI Machines: Do NOT use Conox® in the presence of an MRI machine.​
• Defibrillation: Conox® is NOT intended for use during defibrillation.​
• Sensor Placement: The sensor should not be placed on injured skin.

Unlike other monitoring devices that use fine needles to pierce the skin, Conox® sensors are completely non-invasive, utilising conductive gel technology. Special precautions should be taken when applying a Conox® sensor to ensure accurate readings and patient comfort. Please refer to the video here for detailed instructions on proper sensor application.

• The Conox® sensor can be used for up to 24 hours on a patient.​
• In intensive care settings, the sensor must be changed after 24 hours. Additionally, the sensor's position on the forehead should be modified to avoid skin irritation.

• There is no age limitation for using the Conox® Paediatric sensor; it can be used for patients of all ages. However, please note that in very young infants, whose brains are less developed, most monitoring devices, including Conox®, may not be as accurate. Therefore, extra caution and clinical judgement should be applied when interpreting the data in this patient population.
  

• An impedance check test is automatically performed every 15 minutes when the sensor is connected to the patient cable. This test can also be initiated manually by pressing the appropriate button on the user interface.
• Impedance measures the skin's resistance to the transmission of the electrical signal from the EEG. Achieving low impedance is crucial as it ensures higher signal quality for accurate monitoring.
  

• Like all EEG monitoring devices, Conox® can be affected by artifacts, including electrocautery (ECT). Electromagnetic interference (EMI) from sources like ECT can impact EEG monitors. The effects on Conox® vary based on the intensity of the EMI, the distance between the EMI source and the Conox® sensors, and other factors.
  

• qNOX is a non-invasive index of nociception derived from the power spectral density of the electroencephalogram (EEG). It provides a measure of the patient's response to noxious stimuli during surgery and sedation.
• qNOX is calculated using an adaptive neuro-fuzzy inference system (ANFIS) trained on a large dataset of EEG recordings from surgical patients. The index primarily measures the power of the EEG signal in the theta (4-8 Hz) and gamma (>32 Hz) frequency bands, which are associated with pain processing.
  

Yes, Conox® can be safely used with gas anaesthesia. Numerous studies have utilised Conox to monitor the depth of anaesthesia with gas anaesthetics, including sevoflurane and desflurane. A recent study compared the efficacy of Sevoflurane and Desflurane as Volatile Induction Maintenance Anaesthesia (VIMA) using Conox in patients undergoing laparoscopic cholecystectomy. The findings indicated no significant difference between the two agents in terms of time to extubation, intraoperative haemodynamics, or postoperative pain scores. [1]​

1. G. Kaur, M. M. Panditrao and M. Madhav , "To Compare Efficacy of Sevoflurane and Desflurane Employed as Volatile Induction Maintenance Anaesthesia (VIMA) using Conox® in Patients Undergoing Laparoscopic Cholecystectomy," IOSR Journal of Dental and Medical Sciences, vol. 22, no. 3, pp. 01-09, 2023.​

• Several studies have evaluated the use of the qCON index during anaesthesia involving ketamine:
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  1. Cañellas et al. (2019): This study examined the effect of ketamine on the qCON and BIS indices during propofol anaesthesia. It was found that the qCON index maintained values within the anaesthesia range (40-60) in patients under ketamine and propofol anaesthesia administered via an intravenous TCI system during maintenance. [2]
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  2. Christenson et al. (2021): This study compared the qCON and Sedline PSI indices to predict the hypnotic effect during desflurane general anaesthesia with ketamine. The findings indicated that both qCON and PSI indices effectively discriminated between the awake and anaesthetised states under desflurane anaesthesia. Notably, the qCON index demonstrated better performance during ketamine administration with desflurane anaesthesia compared to the PSI index. [3]
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• These studies suggest that qCON is a reliable index for monitoring anaesthesia levels, even when ketamine is used, maintaining accuracy and effectively distinguishing between different states of consciousness.

2. J. Cañellas, U. Melia, S. Pacreu, J. Fernández-Candil, C. González and E. W. Jensen, “The effect of ketamine on the qCON and the BIS during propofol anaesthesia,” in ISAP 28th Annual Meeting, Orlando, 2019. ​
3. C. Christenson, P. M. Vazquez, M. Breidenstein, B. Farhan, J. Mathew, U. Melia, E. W. Jensen and D. Mathews, “Comparison of the Conox (qCON) and Sedline (PSI) depth of anaesthesia indices to predict the hypnotic effect during desflurane general anaesthesia with ketamine,” Journal of Clinical Monitoring and Computing, vol. 35, no. 6, pp. 1421-1428, 2021. ​

• Yes, recent studies have validated the qCON index for non-opioid anaesthesia, specifically focusing on the use of dexmedetomidine:
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  1. Rayamajhi et al. (2021): This study demonstrated the safe and effective application of low-dose spinal anaesthesia combined with quadratus lumborum block in abdominal surgeries, providing extended postoperative analgesia under the guidance of the qCON index.
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  2. Garcia-Hernando (2022): This study validated the qCON index in predicting the hypnotic effect of sevoflurane with or without dexmedetomidine as an anxiolytic.
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• These findings highlight the potential utility of the qCON index in non-opioid anaesthesia settings, although further research is needed to explore the impact of larger doses of dexmedetomidine on the index.

4. A. J. Rayamajhi, B. K. Dhungel, S. Paudel and P. Paudel, “USG Guided Quadaratus Lumburoum Block and Low Dose Spinal Anesthesia in Abdominal Surgeries,” Journal of Nepal Health Research Council, vol. 19, no. 2, pp. 402-407, 2021.
5. G. Garcia-Hernando, C. G. Pijuan, M. Vallverdú-Ferrer, E. W. Jensen, A. F. Friend, M. W. Breidenstein, D. J. Nuñez and C. M. Christenson, “Assessment of the effect of sevoflurane and dexmedetomidine on the BIS and qCON indices,” in ISAP 31st Annual Meeting, New Orleans, 2022.