Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 28 , ISSUE 6 ( June, 2024 ) > List of Articles

Original Article

Quantium Consciousness Index and Quantium Noxious Index in Ketamine Subdose Administration Compared with Fentanyl and Midazolam in Postoperative ICU Patients: A Prospective, Observational Study

Alegra R Masharto, Andriamuri P Lubis, Chrismas G Bangun, Arlinda S Wahyuni

Keywords : Fentanyl, Intensive care units, Ketamine, Midazolam, Postoperative, qCON, qNOX, Subdose

Citation Information : Masharto AR, Lubis AP, Bangun CG, Wahyuni AS. Quantium Consciousness Index and Quantium Noxious Index in Ketamine Subdose Administration Compared with Fentanyl and Midazolam in Postoperative ICU Patients: A Prospective, Observational Study. Indian J Crit Care Med 2024; 28 (6):581-586.

DOI: 10.5005/jp-journals-10071-24734

License: CC BY-NC 4.0

Published Online: 31-05-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Aims and background: In postoperative patients in the intensive care units (ICUs), not only analgesics are needed but also sedation so that the patient can remain calm during treatment, especially patients with mechanical ventilation. By using the measurement parameters of the quantum consciousness index (qCON) and quantum noxious index (qNOX) in measuring the depth of sedation and adequacy of analgesics, the use of subdose ketamine instead of fentanyl and midazolam as sedative, analgesic agents can be performed as a new alternative to nociceptive monitoring methods with more objective results. This study aims to obtain results of comparing qCON and qNOX in postoperative patients by administering subdose ketamine compared with a combination of fentanyl and midazolam in RSUP Haji Adam Malik Medan. Materials and methods: A randomized clinical trial with a double-blind approach has been used in this study. A total of 44 experimental samples were gathered and randomly split into two groups after meeting the criteria for inclusion. Group A administered a ketamine subdose, whereas Group B administered a mixture of fentanyl and midazolam. The research data obtained were tested using Statistical Product and Science Service (SPSS). Results: There were differences in the median, minimum, and maximum values of qCON and qNOX in the groups given subdose ketamine and fentanyl and midazolam, but these were not statistically significant (p > 0.05) at T0, T1, and T2. Conclusion: Administering a subdose of ketamine can provide sedation and analgesia comparable to fentanyl and midazolam.

PDF Share
  1. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises. Pain 2020;161(9):1976–1982. DOI: 10.1097/j.pain.0000000000001939.
  2. Michaelides A, Zis P. Depression, anxiety and acute pain: Links and management challenges. Postgrad Med 2019;131(7):438–444. DOI: 10.1080/00325481.2019.1663705.
  3. Cohen M, Quintner J, Rysewyk SV. Reconsidering the International Association for the study of pain definition of pain. Pain Rep 2018;3(2):e634. DOI: 10.1097/PR9.0000000000000634.
  4. Small C, Laycock H. Acute postoperative pain management. Br J Surg 2020;107(2):e70–e80. DOI: 10.1002/bjs.11477.
  5. Jehosua BY, Suarjaya IPP, Hartawan IU, Senapathi TGA. The use of CONOX as a guide to the general anesthesia on laparotomy patients compared with standard clinical care – A pilot study. Neurol Spinale Med Chir 2021;4(2):51–54. DOI: 10.36444/nsmc.v4i2.158.
  6. Harsha MS, Bhatia PK, Sharma A, Sethi P. Comparison of quantium consciousness index and richmond agitation sedation scale in mechanically ventilated critically Ill patients: An observational study. Indian J Crit Care Med 2022;26(4):493–497. DOI: 10.5005/jp-journals-10071-24183.
  7. Deol HS, Surani SR, Udeani G. Inter-rater reliability of the Ramsay Sedation Scale for critically-ill intubated patients. Cureus 2019;11(10):e6021. DOI: 10.7759/cureus.6021.
  8. Chawla R, Myatra SN, Ramakrishnan N, Todi S, Kansal S, Dash SK. Current practices of mobilization, analgesia, relaxants and sedation in Indian ICUs: A survey conducted by the Indian Society of Critical Care Medicine. Indian J Crit Care Med 2014;18(9):575–584. DOI: 10.4103/0972-5229.140146.
  9. Raff M, Belbachir A, El-Tallawy S, Ho KY, Nagtalon E, Salti A, et al. Intravenous oxycodone versus other intravenous strong opioids for acute postoperative pain control: A systematic review of randomized controlled trials. Pain Ther 2019;8(1):19–39. DOI: 10.1007/s40122-019-0122-4.
  10. Masharto AR, Lubis B, Irina S. Correlation between mortality risk factor and death rate of ICU patient in H. Adam Malik Hospital in 2021. Int J Innov Sci Res Technol 2022;7(6):5–11. DOI: 10.5281/zenodo.6641506.
  11. Tanggono A, Sinardja CD, Suarjaya IPP. Oxycodone as a replacement to opioid to facilitate tracheal intubation. Bali J Anaesthesiol 2020;4(4):208–209. DOI: 10.4103/BJOA.BJOA_117_20.
  12. Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation 2017;135(12):e686–e725. DOI: 10.1161/CIR.0000000000000470.
  13. Kaur A, Mehta N, Gupta S. Intraoperative nociception monitoring by qNOX score using three different doses of fentanyl. JK Sci 2021;23(4):185–190. Available from:
  14. Jensen EW, Valencia JF, Lopez A, Anglada T, Agustí M, Ramos Y, et al. Monitoring hypnotic effect and nociception with two EEG-derived indices, qCON and qNOX, during general anaesthesia. Acta Anaesthesiol Scand 2014;58(8):933–941. DOI: 10.1111/aas.12359.
  15. Ali H, Ismail AA, Wahdan AS. Low-dose ketamine infusion versus morphine infusion during abdominoplasty to change the postoperative pain profile. Anesth Pain Med 2020;10(6):e108469. DOI: 10.5812/aapm.108469.
  16. Wang J, Xu Z, Feng Z, Ma R, Zhang X. Impact of ketamine on pain management in cesarean section: A systematic review and meta-analysis. Pain Physician 2020;23(2):135–148. PMID: 32214291.
  17. Gelmanas A, Vitartaite M, Tamosiunas R, Macas A. Low-dose ketamine for acute postoperative pain treatment. In: Saiz-Sapena N, Granell-Gil M., editors. Ketamine Revisited – New Insights into NMDA Inhibitors. USA: IntechOpen, 2022. DOI: 10.5772/intechopen.100415.
  18. Samuel H, Aweke S, Tuni J. Effect of low-dose intravenous ketamine on postoperative pain following cesarean section under spinal anesthesia: A prospective cohort study, Ethiopia. Ann Med Surg (Lond) 2022;77:103570. DOI: 10.1016/j.amsu.2022.103570.
  19. Radvansky BM, Shah K, Parikh A, Sifonios AN, Le V, Eloy JD. Role of ketamine in acute postoperative pain management: A narrative review. Biomed Res Int 2015;2015:749837. DOI: 10.1155/2015/749837.
  20. Ren Q, Hua L, Zhou X, Cheng Y, Lu M, Zhang C, et al. Effects of a single sub-anesthetic dose of ketamine on postoperative emotional responses and inflammatory factors in colorectal cancer patients. Front Pharmacol 2022;5(13):818–822. DOI: 10.3389/fphar.2022.818822.
  21. Zhao L, Zhang H, Cheng H. Effect of a single sub-dose of ketamine on postoperative fatigue syndrome in colorectal cancer patients undergoing radical laparoscopic surgery: A double-blind, pilot study. J Affect Disord 2022;1(312):146–151. DOI: 10.1016/j.jad.2022. 06.029.
  22. Gorlin AW, Rosenfeld DM, Ramakrishna H. Intravenous sub-anesthetic ketamine for perioperative analgesia. J Anaesthesiol Clin Pharmacol 2016;32(2):160–167. DOI: 10.4103/0970-9185.182085.
  23. Aribawa IGNM, Senapathi TGA, Wiryana M, Sinardja IK, Budiarta IG, Widnyana IMG, et al. The effectiveness of patient controlled analgesia (PCA) morphine-ketamine compared to patient controlled analgesia (PCA) morphine to reduce total dose of morphine and Visual Analog Scale (VAS) in postoperative laparotomy surgery. Bali J Anest 2017;1(2):31–34. DOI: 10.15562/bjoa.v1i2.11.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.