The suppression of spinal F-waves by propofol does not predict immobility to painful stimuli in humans† J.H. Baars, S Tas, K.F. Herold, D.A. Hadzidiakos,

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The suppression of spinal F-waves by propofol does not predict immobility to painful stimuli in humans† J.H. Baars, S Tas, K.F. Herold, D.A. Hadzidiakos, B Rehberg British Journal of Anaesthesia Volume 96, Issue 1, Pages 118-126 (January 2006) DOI: 10.1093/bja/aei283 Copyright © 2006 British Journal of Anaesthesia Terms and Conditions

Fig 1 Original tracings of M-wave and F-wave. Original tracings of M-wave and F-wave (a) before anaesthesia and (b) under 2 mg litre−1 propofol plasma concentration in a male patient (characteristics: age, 49; body height, 200 cm; weight, 110 kg). (Note: as F-wave latency is related to the body height it is far above the average in this patient.) British Journal of Anaesthesia 2006 96, 118-126DOI: (10.1093/bja/aei283) Copyright © 2006 British Journal of Anaesthesia Terms and Conditions

Fig 2 Individual hysteresis loops (effect vs propofol plasma concentration) and collapsed loops (effect vs effect compartment concentrations) of the different drug effect measures. Original data were collected from all patients. The collapsed curves were generated from the individual equilibration time constants. To estimate the goodness of fit the grey line in the collapsed loops shows the mean concentration–response curve of all patients (see Fig. 6). Loops for F-wave amplitude are shown in (a) for plasma concentration and (b) for effect site concentration, for F-wave persistence in (c) for plasma concentration and (d) for effect site concentration and for the BIS in (e) for plasma concentration and (f) for effect site concentration. For the F-wave amplitude the data were averaged within a time-window of 20 s. British Journal of Anaesthesia 2006 96, 118-126DOI: (10.1093/bja/aei283) Copyright © 2006 British Journal of Anaesthesia Terms and Conditions

Fig 3 EC50-values and equilibration half-time derived from the individual sigmoidal pharmacokinetic–pharmacodynamic modelling of the examined drug effects. Horizontal bar=mean value. BIS, bispectral index (n=21). British Journal of Anaesthesia 2006 96, 118-126DOI: (10.1093/bja/aei283) Copyright © 2006 British Journal of Anaesthesia Terms and Conditions

Fig 4 Response of F-wave amplitude to noxious electrical stimulation. (a) Consecutive F-wave tracings around noxious stimulation in one patient. The noxious stimulation was performed during a calculated propofol plasma concentrations of 4.5 mg litre−1, which equals a calculated brain concentration or 3.5 mg litre−1 (ke0 0.25 min−1). The patient did move after stimulation. Note: background noise remained stable during the tetanic stimulation at the wrist which did not cause any recordable artefacts. Response of F-wave amplitude (b) and BIS (c) to noxious electrical stimulation (at t=0 s; stimulus intensity: 50 Hz, 60 mA, 5 s, 0.2 ms square wave) for all patients who did not move after stimulation (non-movers) and those patients who did move (movers). Data are means and standard error of the mean. British Journal of Anaesthesia 2006 96, 118-126DOI: (10.1093/bja/aei283) Copyright © 2006 British Journal of Anaesthesia Terms and Conditions

Fig 5 Comparison of the sigmoidal concentration–response curves. Comparison of the sigmoidal concentration–response curves for suppression of F-wave amplitude (continuous line), F-wave persistence (dashed–dotted line) and BIS (dotted line). These curves were generated from the mean values of the computer fits of all individual concentration–response curves at each concentration. Dashed and dashed–dotted lines show the logistic regression curve for the suppression of the motor response to noxious electrical stimulation and the logistic regression curve for loss and return of consciousness, respectively. Horizontal error bars=standard errors of the EC50-values. Note: for the BIS, F-wave amplitude and loss of consciousness/return of consciousness the x-axis displays the effect site concentrations whereas the logistic regression curve for the response to tetanus is based on calculated plasma concentrations. British Journal of Anaesthesia 2006 96, 118-126DOI: (10.1093/bja/aei283) Copyright © 2006 British Journal of Anaesthesia Terms and Conditions

Fig 6 Time-course of F-wave amplitude and BIS relative to loss and return of consciousness. Filled circles, BIS; open circles, F-wave amplitude normalized to individual control values. Grey lines show the linear regression curves. Data are means and standard errors of the mean. British Journal of Anaesthesia 2006 96, 118-126DOI: (10.1093/bja/aei283) Copyright © 2006 British Journal of Anaesthesia Terms and Conditions