***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: There have been cl aims that the postoperative course of patients may be improved by presentation during general anesthesia of therapeutic suggestions which predict a rapid and comfortable postoperative recovery . This study evaluated the effectiveness of such therapeutic suggestions under double-blind and r and omized conditions . A tape recording predicting a smooth recovery during a short postoperative stay without pain , nausea , or vomiting was played during anesthesia to about half the patients ( N = 109 ) , while the remaining , control patients were played a blank tape instead ( N = 100 ) . The patients were primarily undergoing operations on the fallopian tubes , total abdominal hysterectomy , vertical b and ing gastroplasty , cholecystectomy , and ovarian cystectomy or myomectomy . The anesthesia methods consisted of either isoflurane with 70 % nitrous oxide in oxygen to produce end-tidal concentrations of 1.0 , 1.3 , or 1.5 MAC ; or 70 % nitrous oxide in oxygen combined with high or low doses of opioids . Assessment s of the efficacy of the therapeutic suggestions in the recovery room and throughout the postoperative hospital stay included : the frequency of administration of analgesic and antiemetic drugs ; opioid doses ; the incidence of fever ; nausea , retching , and vomiting ; other gastrointestinal and urinary symptoms ; ratings of pain ; ratings of anxiety ; global ratings of the patients ' physical and psychological recoveries by the patients and their nurses ; and length of postoperative hospital stay . There were no meaningful , significant differences in postoperative recovery of patients receiving therapeutic suggestions and controls . These negative results were not likely to be due to insensitivity of the assessment s of recovery , as they showed meaningful interrelations among themselves and numerous differences in recovery following different types of surgery . Widespread utilization of therapeutic suggestions as a routine operating room procedure seems premature in the absence of adequate replication of previously published positive studies In a double‐blind r and omised study , we investigated the influence of positive intra‐operative suggestions , presented to anaesthetised patients undergoing total abdominal hysterectomy , on  postoperative pain , nausea and vomiting .  One hundred and forty patients were r and omly allocated to listen to one of four tapes containing either white noise or positive suggestions . The positive suggestions related to pain , postoperative nausea and vomiting , or both . We found that the positive intra‐operative suggestions had no beneficial effects in reducing postoperative pain or nausea scores , nor was the consumption of morphine or anti‐emetics reduced Background A high incidence of intraoperative awareness during cardiac surgery has been reported . Midlatency auditory evoked potentials ( MLAEP ) have been used recently as an indicator of awareness . In the current study , memory for information presented during anesthesia was investigated using MLAEP as one experimental indicator in 45 patients scheduled for elective cardiac surgery . Methods In all patients general anesthesia was maintained using high-dosage fentanyl ( 1.2 mg · h−1 ) . In addition , the patients of group 1 ( n = 10 ) received flunitrazepam ( 1.2 mg · h−1 ) , the patients of group 2 ( n = 10 ) isoflurane ( 0.6–1.2 vol% ) , and the patients of group 3 ( n = 10 ) propofol ( 4–8 mg · kg−1 . h−1 ) . Group 4 ( n = 15 ) served as a control , and those patients were assigned r and omly to one of the anesthetic regimes . After sternotomy and before cardiopulmonary bypass , an audiotape , which included an implicit memory task , was presented to the patients of groups 1–3 . Auditory evoked potentials were recorded while the patients were awake and during general anesthesia immediately before and after the audiotape presentation . Latencies of the brain stem peak V and the early cortical potentials Na and Pa were measured . Results Three to 5 days postoperatively no patient had a clear explicit memory of intraoperative events . However , there were statistically significant differences in the incidence of implicit recall among the groups . Five patients in the flunitrazepam-fentanyl group , 1 patient in the isoflurane-fentanyl group , 1 patient in the propofol-fentanyl group , and no patient in the control group showed an implicit memory of the intraoperative tape message . In the awake state , MLAEP showed high peak-to-peak amplitudes and a periodic waveform . In the patients with implicit memory postoperatively , MLAEP continued to show this pattern during general anesthesia . The early cortical potentials Na and Pa did not increase in latency or decrease in amplitude before or after the audiotape presentation . In contrast , in the patients without implicit memory , MLAEP waveform was severely attenuated or abolished . Na and Pa showed marked increases in latencies and decreases in amplitudes or were completely suppressed . In 9 patients , including all patients ( 7 of 9 ) with implicit memory , Pa latency increased less than 12 ms , and 21 of 23 patients without implicit memory showed a Pa latency increase of greater than 12 ms during anesthesia and the audiotape presentation . Therefore , the Pa latency increase of greater or less than 12 ms may provide sensitivity of 100 % and specificity of 77 % in distinguishing patients with implicit memory from patients without implicit memory postoperatively . Conclusions When the early cortical potentials of MLAEP are preserved during general anesthesia , auditory information may be processed and remembered postoperatively by an implicit memory task Ninety-one patients undergoing biliary tract surgery were r and omly assigned to one of three treatment groups in which different sounds were administered , by means of earphones , in a double-blind design . The effects of the administration of positive suggestions , noise or operating theatre sounds on the postoperative course were studied . Results showed that exposure to positive suggestions during general anaesthesia , as compared with noise or operating theatre sounds , protected patients older than 55 yr against prolonged postoperative stay in hospital The clinical value of therapeutic suggestions during general anaesthesia was assessed in a double-blind r and omised placebo-controlled study . 39 unselected patients were allocated to  suggestion ( n = 19 ) or control ( n = 20 ) groups who were played either recorded therapeutic suggestions or a blank tape , respectively , during hysterectomy . The patients in the suggestion group spent significantly less time in hospital after surgery , suffered from a significantly shorter period of pyrexia , and were generally rated by nurses as having made a better than expected recovery . Patients in the suggestion group , unlike those in the control group , guessed accurately that they had been played an instruction tape To determine if improved postoperative recovery in surgical in patients receiving intraoperative therapeutic suggestions  are applicable in an outpatient population , 70 consenting , unpremedicated adults undergoing elective outpatient hernia repair under general anaesthesia were allocated r and omly to either a therapeutic tape ( TT ) or a comparison tape ( CT ) group . A st and ardized general anaesthetic technique was used with propofol , fentanyl or alfentanil , isoflurane and nitrous oxide in oxygen .  Pain , and nausea and vomiting were assessed after operation at 30 , 60 and 90 min and at 2 , 6 and 24 h. The presence of other side effects , such as headache and muscular discomfort , in addition to recall of tape contents , were also evaluated after operation . Absorption ability was measured before operation . The groups were similar in patient characteristics , preoperative , surgical and anaesthetic characteristics , and level of absorption . There were no differences in pain ratings or need for analgesics administered at any time after operation . Nausea/vomiting was experienced significantly fewer times by patients in group TT compared with group CT over the first 90 min ( group CT 15 % , group TT 4 % ; P < 0.02 ) , but not over the last three assessment times ( group CT 10 % , group TT 14 % ; P < 0.25 ) . The therapeutic tape group experienced fewer side effects over the entire postoperative assessment period ( P = 0.03 ) , in particular less headaches ( P = 0.03 ) and less muscular discomfort ( P < 0.02 ) . Use of intraoperative therapeutic suggestions could present mildly significant postoperative benefits in out patients Background : The authors studied whether playing a taped cognitive-behavior message during and immediately following bariatric surgery will improve performance of a postoperative regimen design ed to enhance recovery . Methods : The double-blinded placebo-controlled study consisted of 27 morbidly obese bariatric surgical patients r and omly assigned to listen to either a blank ( Controls ) or a positive therapeutic message audiotape ( Tape ) . A Postoperative Regimen Checklist ( PRC ) quantified different parts of the postoperative recovery regimen . Results : The data showed that patients in the Tape group , compared to the Controls : 1 ) achieved better scores at most PRC assessment points ( p<0.05 ) , 2 ) required less encouragement to perform tasks ( p<0.05 ) , and 3 ) were discharged from the hospital a mean of 1.6 days earlier . Conclusions : A taped cognitive-behavioral message , played to patients repetitively during and immediately following bariatric surgery , is effective in enhancing postoperative compliance and reducing in-patient length of stay In a double-blind , r and omized study , we have examined the influence of positive therapeutic suggestions , presented to anaesthetized patients undergoing total abdominal hysterectomy , on postoperative morbidity and duration of hospital stay .  Seventy-five patients were allocated r and omly  to be exposed to one of three tapes containing positive therapeutic suggestions , a modified history of the Queen 's Medical Centre , or no message . We found that neither therapeutic suggestions nor the presence of a voice during anaesthesia improved postoperative outcome or reduced duration of hospital stay after total abdominal hysterectomy Purpose : This study was design ed to determine whether music or music in combination with therapeutic suggestions in the intra‐operative period under general anaesthesia could improve the recovery of hysterectomy patients In a double-blind study , 33 patients ( herniorraphy , cholecystectomy and orthopaedic ) were r and omly assigned to either suggestion or control groups . Under known clinical levels of nitrous oxide and enflurane or halothane anaesthesia , suggestion patients were exposed to statements of the importance of  touching their ear  during a postoperative interview . Compared with controls , suggestion patients did touch their ear ( tetrachoric correlation 0.61 , P less than 0.001 ) and they did so more frequently ( Mann-Whitney U test , P less than 0.02 ) . All suggestion patients were completely amnesic for the intraoperative spoken suggestion , despite inquiries which included hypnotic regression to the operation Background : The authors previously demonstrated memory function during apparently adequate general anesthesia in trauma patients . Hypnotic state fluctuations , stress , and variable amnesic qualities of commonly used anesthetics could account for this effect . Methods : The authors replicated the trauma investigation in 90 elective surgical patients to enable anesthetic titration to a bispectral index value of 50–55 during auditory presentation of word stimuli .  Patients were r and omly assigned to maintenance with propofol ( n = 48 ) or isoflurane ( n = 42 ) .  Before surgery , state anxiety and trait anxiety were assessed using self-report measures . Postoperative memory assessment relied on the process dissociation procedure using a word stem completion task . Results : There were no differences between groups for relevant demographic , preoperative , or supplemental drug variables . Ninety-eight percent of words were presented within a bispectral index range of 40–60 , with values averaging 48.8 ( SD = 5.7 ) during word presentation . Neither the process dissociation procedure nor st and ard measures of conscious recall and recognition memory showed evidence of explicit or implicit memory . Preoperative stress levels did not correlate with postoperative memory test scores in either study group . Conclusions : In contrast to the results of their previous study , the authors found no evidence of memory function with close control of hypnotic state . This suggests that hypnotic state fluctuations are important to memory activation under anesthesia . Other variables may contribute to preserved memory function as well . Propofol and isoflurane block memory equally well during adequate anesthesia A double-blind , r and omized study was conducted to examine the effect of different types of therapeutic suggestions , administered during general anaesthesia , on post-operative course . Eighty-two patients undergoing cholecystectomy were intra-operatively exposed to either affirmative and non-affirmative suggestions , affirmative or non-affirmative suggestions separately , or some irrelevant text . Patients who had received both affirmative and non-affirmative suggestions  spent less time in hospital than patients in the other three groups . No significant differences were demonstrated for subjective well-being measured on the third and sixth days In a double-blind , r and omized study , patients undergoing cholecystectomy were administered one of four different sounds during general anaesthesia : positive suggestions , nonsense suggestions , seaside sounds or sounds from the operating theatre . The effect of these sounds on the postoperative course was examined to assess intraoperative auditory registration . No differences were found between the four groups in postoperative variables Thirty‐two ASA I or II women undergoing abdominal hysterectomy were r and omly allocated to four groups to determine what type , if any , of recorded intraoperative message they would receive . Groups I and II heard a neutral recording with no verbal content . Group III heard an experimental recording with a positive suggestion for a rapid recovery . Group IV had a self‐prepared message . The tapes were played during general anesthesia when anesthetic depth was judged 
    Output:
    
Conclusions Even though effects were small , our results provide indications that intraoperative suggestions can have the potential to reduce the need for medication and enhance recovery .