***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: In a r and omized , double-blinded , controlled study , we evaluated the effect of diluting rocuronium 10 mg/mL to 1 or 0.5 mg/mL with 0.9 % NaCl on the pain associated with IV administration of rocuronium with small doses given before succinylcholine or nondepolarizing agent administration .  One hundred fifty patients undergoing surgical procedures that required general anesthesia were r and omized into three groups . Group 1 received rocuronium 10 mg/mL. Groups 2 and 3 received 1 and 0.5 mg/mL of rocuronium , respectively . Patient demographics , pain scores , osmolality , and the pH of the solutions were recorded . Group 1 had the most intense and frequent pain response . Eighty percent of patients in this group reported pain on injection . In Group 2 , the incidence and intensity of pain were significantly less when compared with those of Group 1 . In this group , 38 % of patients reported pain during injection . In Group 3 , none of the patients experienced pain on injection . The pH values and osmolalities of study solutions were not significantly different among groups . In conclusion , in awake patients , dilution of rocuronium 10 mg/mL at small doses given before succinylcholine or nondepolarizing agent administration of 0.06 mg/kg to 0.5 mg/mL with 0.9 % NaCl is a simple and cost-effective strategy for preventing pain during IV rocuronium injection Purpose The incidence of pain induced withdrawal movement following intravenous injection of rocuronium is high . This r and omized , double-blind , placebo-controlled study was design ed to evaluate the effect of pretreatment of remifentanil on the withdrawal movements due to intravenous injection of rocuronium during anesthetic induction . Material s and Methods Ninety adult female patients undergoing thyroidectomy were r and omly allocated to three groups . Each patient intravenously received one of three solutions of equal volume ( 4 mL ) : normal saline ( Group I , n = 30 ) , 0.5 µg/kg remifentanil ( Group II , n = 30 ) or 1 µg/kg remifentanil ( Group III , n = 30 ) . Thirty seconds after remifentanil administration , anesthesia was induced with 5 mg/kg IV thiopental . Twenty seconds after thiopental injection , 0.6 mg/kg IV rocuronium was administered ( injection rate of 0.5 mL/sec ) and patients ' withdrawal movements were assessed . Mean arterial pressure ( MAP ) and heart rate were assessed on arrival in the operation room , before the tracheal intubation and immediately , 1 and 2 min after the tracheal intubation . Results The incidence of withdrawal movements was significantly lower in both of the remifentanil groups ( 3 and 0 % in Group II and III , respectively ) than in the saline group ( 70 % ) . Remifentanil attenuated the increase of heart rate and MAP immediately and 1 min after the tracheal intubation . Conclusion The pretreatment with 0.5 and 1.0 µg/kg remifentanil of bolus doses prevented the withdrawal movements caused by rocuronium injection , and effectively blunted cardiovascular activation following tracheal intubation Background Rocuronium produces injection pain in 50 - 80 % of treated patients . Therefore , a variety of pretreatments have been attempted to reduce this issue . We evaluated the efficacy of 3 different doses of magnesium on the rocuronium injection pain and following hemodynamic changes by laryngoscopy and tracheal intubation ( LTI ) . Methods Two hundreds patients , ASA I and II , undergoing general anesthesia for elective surgery were r and omly divided to 4 groups : group 1 , 2 , 3 , 4 received saline 5 ml , magnesium 5 , 10 and 20 mg/kg prior to 0.6 mg/kg of rocuronium , respectively . Then , group 1 only was treated with esmolol ( 20 mg ) before LTI . Pain intensity with rocuronium injection was assessed using a four-point scale according to patient 's movement . Cardiovascular responses at baseline , after induction , 1 minutes after LTI were determined . Results Compared to saline , 10 and 20 mg/kg of magnesium significantly reduced the incidence of overall movement after rocuronium injection ( 34 % and 36 % in group 3 and 4 , respectively vs. 76 % in the group 1 ) ( P < 0.0001 ) . Generalized movement was seen in 4 % of patients in groups 3 and 4 , respectively . Compared to baseline values , diastolic blood pressure ( DBP ) immediately after LTI significantly increased within groups 1 and 2 ( P < 0.001 ) , but not within groups 3 and 4 . Conclusions Magnesium ( 10 and 20 mg/kg ) prior to rocuronium was effective in attenuating rocuronium associated injection pain and cardiovascular changes by LTI The purpose of this study was to determine the effectiveness of antihistamine therapy for withdrawal movements caused by rocuronium injection . One hundred seventy one ASA I-II adults undergoing elective surgery were r and omly assigned to one of two groups . Patients in the control group ( Group C ) were premedicated with 2 mL normal saline , and those in the antihistamine group ( Group A ) were pre-medicated with 2 mL ( 45.5 mg ) pheniramine maleate . After the administration of thiopental sodium 5 mg/kg , rocuronium 0.6 mg/kg was injected . Withdrawal movements were assessed using a four- grade scale . The administration of antihistamine reveals lower grade of withdrawal movement after rocuronium injection BACKGROUND Pain from rocuronium injection is a common side-effect reported to occur in 50 - 80 % of the patients . This r and omized , double-blind , placebo-controlled study was design ed to evaluate the efficacy of pretreatment with i.v . remifentanil on prevention of withdrawal response during rocuronium injection in paediatric patients . METHODS After obtaining parental consents , 70 paediatric patients were r and omly allocated into two groups to receive either i.v . remifentanil 1 mug kg(-1 ) ( remifentanil group , n=35 ) or i.v . saline 5 ml ( saline group , n=35 ) . Anaesthesia was induced with thiopental sodium 2.5 % ( 5 mg kg(-1 ) ) and the test drug was injected over 30 s. One minute after the test drug injection , rocuronium 1 % ( 0.6 mg kg(-1 ) ) was injected over 5 s and the response was recorded . Mean arterial pressure ( MAP ) and heart rate were recorded on arrival in the operating theatre , before and 1 min after the tracheal intubation . RESULTS The overall incidence of withdrawal movements was significantly higher in the saline group ( 33 patients ; 94 % ) than that in the remifentanil group ( 8 patients ; 23 % ) ( P<0.001 ) . No patient in the remifentanil group showed generalized movement , whereas 51 % of patients in the saline group did . Remifentanil prevented significant increase in MAP after intubation . CONCLUSION This study demonstrated that pretreatment with remifentanil 1 microg kg(-1 ) provided a safe and simple method for reducing the incidence of rocuronium-associated withdrawal movement with haemodynamic stability in children OBJECTIVE To compare the efficacy of fentanyl and remifentanil as prodrugs in the prevention of rocuronium injection pain by using a control group . METHODS In a r and omized , double-blinded , controlled study , 102 adult patients aged between 18 - 60 undergoing elective surgery under general anesthesia and classified into American Society of Anesthesiologists ( ASA ) I and ASA II risk groups were included in the study . The study was carried out from July 2005 to April 2006 at Dokuz Eylul University , Izmir , Turkey . Unpremedicated patients were r and omly allocated to one of 3 groups . Patients received 2 mL ( 0.02 mg ) of remifentanil ( n = 34 ) , 2 mL of fentanyl 0.1 mg ( n = 34 ) , and 2 mL of saline ( n = 34 ) , by injection over 10 seconds . Thirty seconds after prodrug administration , 10 mg ( 10 mg/mL ) intravenous rocuronium bromide was administered over 5 seconds and pain assessment was performed by using a 5-point scale . RESULTS When the 3 groups of 34 patients were compared in terms of pain assessment scoring , a statistically significant difference was determined ( p=0.02 ) . When the groups were paired , it was seen that this difference result ed from the remifentanil and saline groups ( p=0.02 ) . CONCLUSION This study shows that a bolus dose of 0.02 mg of remifentanil is a more effective prodrug administration compared to the application of saline , however , remifentanil and fentanyl have no superiority over one another and the administration of fentanyl is equally effective as saline prodrug administration We evaluated the pretreatment of small-dose of ketamine or normal saline in the reduction of withdrawal movements induced by rocuronium injection . One-hundred pediatric patients ( aged 1–6 yr ) were r and omly assigned into 2 groups . A 22-gauge IV cannula was inserted into the dorsum of the h and , and ketamine 0.2 mg/kg or normal saline was given , followed by a 5 mg/kg thiopental injection 10 s later . IV rocuronium ( 0.8 mg/kg ) was injected over 5 s. The patient ’s response to rocuronium injection was grade d by using a four-point scale in a double-blinded manner . We observed that the incidence of withdrawal movements was 83 % in the saline group and 27 % in patients pretreated with ketamine ( P < 0.05 ) . Some patients in both groups developed skin erythema at the site of injection . We conclude that pretreatment with small-dose ketamine significantly attenuates withdrawal movements associated with IV injection of rocuronium in pediatric patients anesthetized with thiopental Background The main disadvantage of rocuronium is the pain associated with vascular injection . We evaluated the efficacy of palonosetron for reducing pain after rocuronium injection . Methods Eighty patients scheduled for elective surgery were r and omly divided into two groups : Group C ( normal saline 1.5 ml , n = 40 ) and Group P ( palonosetron 0.075 mg , n = 40 ) . Anesthesia was induced with thiopental 5 mg/kg and the test drug was injected over 10 seconds . Thirty seconds after the injection of the test drug , rocuronium 0.6 mg/kg was injected over 30 seconds and the response was recorded . Injection pain was grade d using a 4-point scale . The grade was 0 points for no movement , 1 point for wrist movement , 2 points for elbow or shoulder movement , and 3 points for whole body movement . Mean arterial pressure and heart rate were recorded on arrival in the operating room and before and 30 seconds after rocuronim injection . Results There was no significant difference in the grade 1 response between the two groups ; however , the grade 2 and 3 responses in Group P were 5 ( 12.5 % ) and 4 ( 10 % ) , respectively , which were significantly lower than in Group C , with 13 ( 32.5 % ) responses for each grade . There were no significant differences in hemodynamic changes within each group . However , the difference in mean arterial pressure before and after the injection of rocuronium was significantly larger in Group C compared to Group P. Conclusions Pretreatment with palonosetron 0.075 mg reduced the incidence and severity of withdrawal movement after rocuronium administration Abstract Background Pain caused by intravenous injection of the muscle relaxant rocuronium bromide is common in children and adolescents . The cause of this unwanted effect is still unclear , and different pretreatment drugs have been administered in attempts to alleviate this side effect , with varying degrees of success . Purpose This study used a 60-s venous occlusion technique to evaluate the effectiveness of pretreatment with lidocaine , fentanyl , or remifentanil in preventing pain-induced withdrawal caused by intravenous injection of rocuronium bromide during the induction of general anesthesia . Method One hundred and one child and adolescent patients , ASA Ι – ΙΙ , requiring various surgical procedures under general anesthesia with muscle relaxation and mechanical ventilation , were enrolled . Patients were allocated r and omly using computer-generated r and omization into one of four pretreatment groups : a remifentanil group ( 1 µg/kg , n = 25 ) , fentanyl group ( 1 µg/kg , n = 26 ) , lidocaine 1 % group ( 0.5 mg/kg , n = 25 ) , and normal saline group ( n = 25 ) . Drug doses were prepared in normal saline to a total volume of 5 ml . Venous occlusion was applied 10 cm above the venous access site . Pretreatment drugs were injected and retained for 60 s at the site of injection by an anesthetist blinded to group allocation . After release of the tourniquet , rocuronium ( 0.5 mg/kg ) was then injected over 5 s , and 
    Output:
    
Complications were reported more often with use of opioids