***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We studied the influence of mivacurium on the recovery profile following outpatient laparoscopic tubal ligation in 60 healthy , nonpregnant women . After administration of midazolam 2 mg intravenously ( IV ) , anesthesia was induced with fentanyl , 2 micrograms/kg , and thiopental , 4 mg/kg , IV . When the patient became unresponsive ( loss of eyelid reflex ) , either succinylcholine 1 mg/kg , IV ( Group I ) , or mivacurium 0.2 mg/kg , IV ( Groups II and III ) , was administered to facilitate tracheal intubation . Anesthesia was maintained with isoflurane ( 0.5%-2 % inspired concentration ) in combination with 67 % N2O in oxygen . Muscle relaxation was maintained in all three groups with intermittent bolus doses of mivacurium , 2 - 4 mg , IV . In Group III , residual neuromuscular block was reversed with a combination of neostigmine , 2.5 mg , and glycopyrrolate , 0.5 mg , IV , at the end of the operation . In the postanesthesia care unit ( PACU ) , patients in Group III had a significantly increased incidence of postoperative nausea and vomiting compared to Group II . The use of succinylcholine ( versus mivacurium ) was also associated with more frequent postoperative nausea and vomiting . However , these emetic sequelae did not delay postoperative recovery times . In addition , a comparable number of patients in each treatment group required analgesic medication for postoperative pain . Although patients who received succinylcholine complained of significantly more neck pain during the 24-h period after discharge , nausea , vomiting , and shoulder pain were similar in all three groups during this period . We conclude that neostigmine and glycopyrrolate may contribute to the development of postoperative emesis when used for reversal of residual neuromuscular block . ( ABSTRACT TRUNCATED AT 250 WORDS Intrathecal ( IT ) neostigmine produces analgesia in animals and humans and enhances systemic opioid analgesia . To examine the safety of IT neostigmine for eventual use in obstetrics , we studied 24 healthy , term pregnant patients scheduled to receive elective cesarean section using a combined spinal-epidural anesthetic . Using an open-label , dose-ranging design , patients received either IT placebo or neostigmine 10 , 30 , or 100 microg in a 1-mL solution of 5 % glucose in normal saline followed in 15 min by 2 % epidural lidocaine for cesarean section . Neostigmine did not affect fetal heart rate tracings or Apgar scores . The women received patient-controlled analgesia intravenous morphine postoperatively . Compared with the glucose control , neostigmine produced a dose-independent reduction in postoperative morphine use . Cumulative average 24-h morphine use was 82 + /- 7 mg for women receiving IT placebo and 50 + /- 8 mg for women receiving IT neostigmine ( P < 0.003 ) . Hourly morphine use was significantly reduced in the neostigmine groups for 10 h postoperatively . These data indicate that IT neostigmine can produce 10 h of post-cesarean section analgesia without adverse fetal effects and support cautious further prospect i ve study Thirty-eight patients undergoing elective hip or knee surgery were r and omly allocated to two groups . Neuromuscular blockade in group A was antagonized with neostigmine 2.5 mg and atropine 1.2 mg , while group B received no drugs to facilitate antagonism of blockade . The incidence and severity of postoperative nausea and vomiting were assessed 24 h after operation . Nausea and vomiting were significantly reduced in group B. The incidence of nausea in group A was 68 % , compared with 32 % in group B ( P less than 0.01 ) . The incidence of vomiting was 47 % in group A , compared with 11 % in group B ( P less than 0.02 ) . A significant relationship was shown between postoperative emetic symptoms and the antagonism of neuromuscular blockade by neostigmine and atropine Eighty patients undergoing outpatient surgery under general anaesthesia were allocated r and omly to two groups : in group A residual neuromuscular block was antagonized with a mixture of neostigmine 1.5 mg and atropine 0.5 mg ; in group B spontaneous recovery was allowed . The patients were assessed after operation in hospital and 24 h after discharge . We found a significant difference ( P < 0.05 ) in requirements for antiemetic therapy  with a smaller need in the group which received neostigmine ( in group A four of 40 patients received an antiemetic compared with 12 in group B ) . There was no significant difference in frequency of nausea or vomiting between the two groups . The incidence of postoperative nausea was 14 in group A and 18 in group B and the number of patients with postoperative vomiting was 10 in group A and 15 in group The study was design ed to compare the frequency and severity of postoperative vomiting in paediatric out- patients receiving controlled ventilation ( IPPV ) or breathing spontaneously ( SV ) during anaesthesia for strabismus repair . One hundred and twenty unpremedicated children ( ages 2 - 12 years ) were studied in a r and omized fashion . After intravenous induction of anaesthesia and tracheal intubation , patients breathed halothane 1 - 1.5 per cent inspired and N2O 66 per cent in O2 spontaneously ( n = 60 ) , or received IPPV , halothane 0.5 - 1 per cent , N2O 66 per cent , and pancuronium 0.05 mg.kg-1 , which was reversed with neostigmine and atropine ( n = 60 ) . The incidence of vomiting with SV was 50 per cent ( 95 per cent confidence limits : 34.5 - 65.5 per cent ) compared with 40 per cent ( 24.5 - 55.5 per cent ) with IPPV ( p > 0.25 ) . Patients in the SV group experiencing emesis had longer operations than those not vomiting ( mean ± SEM = 1.5 ± 0,1 vs 1.2 ± 0.1 hours , p < 0.005 ) . This was not the case with IPPV . There was no correlation between age , sex , duration of surgery , or number of extraocular muscles repaired , and frequency or severity of vomiting or time to discharge . No significant advantage was afforded by IPPV over SV in the present study .RésuméCette étude était conçue afin de comparer la fréquence et sévérité du vomissement post-opératoire chez les patients pédiatriques externes admis pour correction de strabisme sous anesthésie générale en respiration spontanée ( SV ) ou ventilation contrôlée ( IPPV ) . Cent vingt patients non prémédiqués âgés de 2 à 12 ans ont été étudiés ďune façon r and omisée . Après ľinduction intraveineuse de ľanesthésie et ľintubation trachéale les patients ont reçu de ľhalothane 1 - 1.5 pour cent et protoxyde ďazote 66 pour cent avec O2 soit en respiration spontanée ( n = 60 ) , soit en ventilation contrôlée de ľhalothane 0.5 - 1 pour cent , protoxyde ďazote 66 pour cent et pancuronium 0.05 mg-kg-1 , qui a été antagonisé avec la néostigmine et ľatropine ( n = 60 ) . Ľincidence de vomissement en ventilation spontanée était de 50 pour cent ( 95 pour cent limite de confiance : 34.5 - 65.5 pour cent ) comparé à 40 pour cent ( 24.5 - 55.5 pour cent ) avec IPPV ( p > 0.25 ) . Les patients du groupe SV ayant accusé des vomissements ont subi des opérations de plus longue durée que ceux qui n’en ont pas eus ( movenne ± SEM = 1.5 ± 0.1 versus 1.2 ± 0.1 heures , p < 0.005 ) . Ceci n’était pas le cas avec le groupe IPPV . Il n’y avait aucune corrélation avec ľâge , sexe , durée de la chirurgie ou le nombre de muscles extra-oculaires réparés avec la fréquence ou la sévérité des vomissements ou le temps du congé . Aucun avantage significatif n‘a acquis par la ventilation contrôlée comparativement à la ventilation spontanée dans la présente élude As professionals , we want to use the best treatments ; as patients , we want to be given them . Knowing whether an intervention works ( or does not work ) is fundamental to clinical decision making . However , clinical decision making involves more than simply taking published results of research directly to the bedside . Physicians need to consider how similar their patients are to those in the published studies , to take the values and preferences of their patients into account , and to consider their own experience with a given test or treatment . Evidence from clinical research is becoming increasingly important in medical- practice decisions as more and better evidence is published . But when is the evidence strong enough to justify changing a practice ? Individual studies that involve only small numbers of patients may have results that are distorted by the r and om play of chance and thus lead to less than optimal decisions . As is clear from other papers in this series , systematic review s identify , critically appraise , and review all the relevant studies on a clinical question and are more likely to give a valid answer . They use explicit methods and quality st and ards to reduce bias . Their results are the closest we can come to reaching the truth given our current state of knowledge . The questions about an intervention that a systematic review should answer are the following : 1 . Does it work ? 2 . If it works , how well does it work in general and compared with placebo , no treatment , or other interventions that are currently in use ? 3 . Is it safe ? 4 . Will it be safe and effective for my patients ? Whereas the critical appraisal and qualitative synthesis provided by review articles can be interpreted directly , the numerical products of quantitative review s can be more difficult to underst and and apply in daily clinical practice . This paper provides guidance on how to interpret the numerical and statistical results of systematic review s , translate these results into more underst and able terms , and apply them directly to individual patients . Many of these principles can also be used to interpret the numerical results of individual clinical studies . They are particularly relevant to systematic review s , however , because such review s contain more information than do primary studies and often exert greater influence than do individual studies . Making Sense of the Numerical Results of Clinical Studies Although the results of clinical studies can be expressed in intuitively meaningful ways , such results do not always easily translate into clinical decision making . For example , results are frequently expressed in terms of risk , which is an expression of the frequency of a given outcome . ( Risks are probabilities , which can vary between 0.0 and 1.0 . A probability of 0.0 means that the event will never happen , and a probability of 1.0 means that it always happens . ) Consider a hypothetical study of the recurrence of migraine headaches in a control group receiving placebo and a treatment group receiving a new antimigraine preparation , drug M ( a secondary prevention trial ) . Suppose that at the end of the trial , migraines recurred in 30 % of the control group ( the risk for recurrence was 0.30 ) but in only 5 % of the drug M group ( risk of 0.05 ) ( Table 1 ) . Table 1 . Numerical Expression of Hypothetical Clinical Trial Results The outcomes of the study are clear enough for the two groups when they are examined separately . But clinicians and patients are more interested in the comparative results , that is , the outcome in one group relative to the outcome in the other group . This overall ( comparative ) result can be expressed in various ways . For example , the relative risk , which is the risk in the treatment group relative to that in the control group , is simply the ratio of the risks in the two groups . In other words , relative risk is the risk in the treatment group divided by that in the control group , 0.05 0.30 , or 0.17 . The comparison can also be expressed as the reduction in relative risk , which is the ratio between the decrease in risk ( in the treatment group ) and the risk in the control group , 0.25 0.30 , or 0.83 ( Table 1 ) . ( The relative risk reduction can also be calculated as 1 relative risk ) . Although the clinical meaning of relative risk ( and relative risk reduction ) is reasonably clear , relative risk has the distinct disadvantage that a given value ( for example , 0.17 ) is the same whether the risk with treatment decreases from 0.80 to 0.14 , from 0.30 to 0.05 , from 0.001 to 0.00017 , and so forth . The clinical implication s of these changes clearly differ from one another enormously and depend on the specific disease and intervention . An important alternate expression of comparative results , therefore , is the absolute risk reduction . Absolute risk reduction is determined by subtracting the risk in one group from the risk in the other ( for example , the risk in the treatment group is subtracted from the risk in the placebo group ) . In the case of our migraine study , the absolute risk reduction would be 0.30 0.05 , which equals 0.25 , or 25 percentage points . In contrast , for a study in which the risk decreased from 0.001 to 0.00017 , the absolute risk reduction would be only 0.00083 , or 0.083 percentage points , which is a trivial change in comparison ( Table 
    Output:
    
Omitting neostigmine may have a clinical ly relevant antiemetic effect when high doses are used .
Omitting antagonism , however , introduces a non-negligent risk of residual paralysis even with short-acting neuromuscular blocking agents